Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis

Annals of Intensive Care

Jorge Iván Alvarado Sánchez¹  William Fernando Amaya Zuñiga²  Gustavo Adolfo Ospina-Tascón³  Juan Daniel Caicedo Ruiz⁴  Luis Eduardo Cruz Martínez⁴  Juan José Diaztagle Fernández⁵ 

[1] Department of Anaesthesiology, Centro Policlínico del Olaya, Bogotá, Colombia;Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia;Department of Anaesthesiology, Fundación Santa Fe de Bogotá, Bogotá, Colombia;Department of Intensive Care, Fundación Valle del Lili - Universidad ICESI, Cali, Colombia;Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia;Department of Physiology Sciences, Faculty of Medicine, Universidad Nacional de Colombia, Bogotá, Colombia;Fundación Universitaria de Ciencias de La Salud, Bogotá, Colombia;Department of Internal Medicine, Hospital de San José, Bogotá, Colombia;

关键词: Pulse pressure variation;    Stroke volume variation;    End-expiratory occlusion test;    Passive leg raising;    Tidal volume challenge;    Inferior vena cava respiratory variability;    Mini-fluid challenge;    Fluid responsiveness;    Critical care;    Critical illness;   

DOI  :  10.1186/s13613-021-00817-5

来源: Springer

【 摘 要 】

IntroductionDynamic predictors of fluid responsiveness have shown good performance in mechanically ventilated patients at tidal volumes (Vt) > 8 mL kg−1. Nevertheless, most critically ill conditions demand lower Vt. We sought to evaluate the operative performance of several predictors of fluid responsiveness at Vt ≤ 8 mL kg−1 by using meta-regression and subgroup analyses.MethodsA sensitive search was conducted in the Embase and MEDLINE databases. We searched for studies prospectively assessing the operative performance of pulse pressure variation (PPV), stroke volume variation (SVV), end-expiratory occlusion test (EEOT), passive leg raising (PLR), inferior vena cava respiratory variability (Δ-IVC), mini-fluid challenge (m-FC), and tidal volume challenge (VtC), to predict fluid responsiveness in adult patients mechanically ventilated at Vt ≤ 8 ml kg−1, without respiratory effort and arrhythmias, published between 1999 and 2020. Operative performance was assessed using hierarchical and bivariate analyses, while subgroup analysis was used to evaluate variations in their operative performance and sources of heterogeneity. A sensitivity analysis based on the methodological quality of the studies included (QUADAS-2) was also performed.ResultsA total of 33 studies involving 1,352 patients were included for analysis. Areas under the curve (AUC) values for predictors of fluid responsiveness were: for PPV = 0.82, Δ-IVC = 0.86, SVV = 0.90, m-FC = 0.84, PLR = 0.84, EEOT = 0.92, and VtC = 0.92. According to subgroup analyses, variations in methods to measure cardiac output and in turn, to classify patients as responders or non-responders significantly influence the performance of PPV and SVV (p < 0.05). Operative performance of PPV was also significantly affected by the compliance of the respiratory system (p = 0.05), while type of patient (p < 0.01) and thresholds used to determine responsiveness significantly affected the predictability of SVV (p = 0.05). Similarly, volume of fluids infused to determine variation in cardiac output, significantly affected the performance of SVV (p = 0.01) and PLR (p < 0.01). Sensitivity analysis showed no variations in operative performance of PPV (p = 0.39), SVV (p = 0.23) and EEOT (p = 0.15).ConclusionMost predictors of fluid responsiveness reliably predict the response of cardiac output to volume expansion in adult patients mechanically ventilated at tidal volumes ≤ 8 ml kg−1. Nevertheless, technical and clinical variables might clearly influence on their operative performance

【 授权许可】

CC BY