Assessment of fluid responsiveness using pulse pressure variation, stroke volume variation, plethysmographic variability index, central venous pressure, and inferior vena cava variation in patients undergoing mechanical ventilation: a systematic review and meta-analysis

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE

Critical Care Pub Date : 2024-08-31 DOI:10.1186/s13054-024-05078-9

Renato Carneiro de Freitas Chaves, Carmen Silvia Valente Barbas, Veronica Neves Fialho Queiroz, Ary Serpa Neto, Rodrigo Octavio Deliberato, Adriano José Pereira, Karina Tavares Timenetsky, João Manoel Silva Júnior, Flávio Takaoka, Daniel de Backer, Leo Anthony Celi, Thiago Domingos Corrêa

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引用次数: 0

Abstract

Maneuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes. To describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients. The protocol was registered at PROSPERO: CRD42019146781. PubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023. Prospective and intervention studies were selected. Data for each maneuver were reported individually and data from the five most employed maneuvers were aggregated. A traditional and a Bayesian meta-analysis approach were performed. A total of 69 studies, encompassing 3185 fluid challenges and 2711 patients were analyzed. The prevalence of fluid responsiveness was 49.9%. Pulse pressure variation (PPV) was studied in 40 studies, mean threshold with 95% confidence intervals (95% CI) = 11.5 (10.5–12.4)%, and area under the receiver operating characteristics curve (AUC) with 95% CI was 0.87 (0.84–0.90). Stroke volume variation (SVV) was studied in 24 studies, mean threshold with 95% CI = 12.1 (10.9–13.3)%, and AUC with 95% CI was 0.87 (0.84–0.91). The plethysmographic variability index (PVI) was studied in 17 studies, mean threshold = 13.8 (12.3–15.3)%, and AUC was 0.88 (0.82–0.94). Central venous pressure (CVP) was studied in 12 studies, mean threshold with 95% CI = 9.0 (7.7–10.1) mmHg, and AUC with 95% CI was 0.77 (0.69–0.87). Inferior vena cava variation (∆IVC) was studied in 8 studies, mean threshold = 15.4 (13.3–17.6)%, and AUC with 95% CI was 0.83 (0.78–0.89). Fluid responsiveness can be reliably assessed in adult patients under mechanical ventilation. Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC. However, there is no data supporting any of the above mentioned as being the best maneuver. Additionally, other well-established tests, such as the passive leg raising test, end-expiratory occlusion test, and tidal volume challenge, are also reliable.

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利用机械通气患者的脉压变化、每搏量变化、胸廓成像变化指数、中心静脉压和下腔静脉变化评估输液反应性：系统综述和荟萃分析

在血管内容量扩张前评估输液反应性的操作可限制无用的输液，从而改善预后。目的：描述评估机械通气患者液体反应性的方法。该方案已在 PROSPERO 注册：CRD42019146781。对 PubMed、EMBASE、CINAHL、SCOPUS 和 Web of Science 进行了检索，检索时间从开始至 2023 年 8 月 8 日。选择了前瞻性和干预性研究。每种方法的数据单独报告，使用最多的五种方法的数据汇总。采用传统和贝叶斯荟萃分析方法。共分析了 69 项研究，包括 3185 次输液挑战和 2711 名患者。液体反应性的发生率为 49.9%。40项研究对脉压变化（PPV）进行了研究，平均阈值与95%置信区间（95% CI）=11.5（10.5-12.4）%，接收者操作特征曲线下面积（AUC）与95% CI为0.87（0.84-0.90）。有 24 项研究对卒中容量变异（SVV）进行了研究，平均阈值（95% CI）= 12.1 (10.9-13.3)%，AUC（95% CI）为 0.87 (0.84-0.91)。17项研究对胸透变异指数（PVI）进行了研究，平均阈值 = 13.8 (12.3-15.3)%，AUC为0.88 (0.82-0.94)。12项研究对中心静脉压（CVP）进行了研究，平均阈值（95% CI）= 9.0 (7.7-10.1) mmHg，AUC（95% CI）为 0.77 (0.69-0.87)。8项研究对下腔静脉变异（∆IVC）进行了研究，平均阈值 = 15.4 (13.3-17.6)%，AUC（95% CI）为 0.83 (0.78-0.89)。在机械通气的成人患者中，液体反应性可以得到可靠的评估。在预测液体反应性的五种比较方法中，PPV、SVV 和 PVI 优于 CVP 和 ∆IVC。但是，没有数据支持上述任何一种方法为最佳方法。此外，其他成熟的试验，如被动抬腿试验、呼气末闭塞试验和潮气量挑战也是可靠的。

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.