Stephin Zachariah Saji, Olivia Murga, Swati Khurana, Bui Hung Phan, Bana Khalil, Amina Mustafa Nagra, Steysi Falcon Aragon, Deekksha Kolagatla, Victor Sebastian Arruarana, Domenica A Herrera, Samer Kottiech, Ernesto Calderón Martínez
{"title":"利用左心室流出道速度时间积分评估成人脓毒症或感染性休克患者的液体反应性——一项系统综述","authors":"Stephin Zachariah Saji, Olivia Murga, Swati Khurana, Bui Hung Phan, Bana Khalil, Amina Mustafa Nagra, Steysi Falcon Aragon, Deekksha Kolagatla, Victor Sebastian Arruarana, Domenica A Herrera, Samer Kottiech, Ernesto Calderón Martínez","doi":"10.1007/s40477-025-01072-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Sepsis and septic shock are life-threatening conditions driven by dysregulated host responses to infection, resulting in multi-organ dysfunction. While early fluid resuscitation is essential, both fluid overload and under-resuscitation can worsen outcomes. Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) has emerged as a non-invasive echocardiographic tool to assess fluid responsiveness. This systematic review evaluates the diagnostic performance, cutoff values, and limitations of LVOT VTI as a tool for assessing fluid responsiveness in adult patients with sepsis or septic shock.</p><p><strong>Methods: </strong>A systematic search of PubMed, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL was conducted through April 13, 2025, following PRISMA 2020 guidelines (PROSPERO ID: CRD420251036927). Eligible studies used transthoracic or transesophageal echocardiography to measure LVOT VTI and assessed changes following passive leg raise (PLR) or volume expansion tests (VET). Fluid responsiveness was defined as a ≥ 10-15% increase in VTI.</p><p><strong>Results: </strong>Three observational studies including 199 adult patients (20 with sepsis, 179 with septic shock) met inclusion criteria. Two studies used VET (500 mL saline), and one used PLR. Optimal LVOT VTI cutoffs ranged from > 7% to 16%, with sensitivity 78-96%, specificity 91-100%, and AUCs 0.84-0.99. Based on the Newcastle-Ottawa Scale, two studies were rated good quality, and one was fair.</p><p><strong>Conclusion: </strong>LVOT VTI is a reliable, non-invasive parameter for assessing fluid responsiveness in sepsis and septic shock. Despite limited data, this review supports its integration into bedside fluid management protocols to guide individualized resuscitation strategies.</p><p><strong>Prospero registration id: </strong>CRD420251036927.</p>","PeriodicalId":51528,"journal":{"name":"Journal of Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Utilization of left ventricular outflow tract velocity time integral in the assessment of fluid responsiveness in adult patients with sepsis or septic shock - a systematic review.\",\"authors\":\"Stephin Zachariah Saji, Olivia Murga, Swati Khurana, Bui Hung Phan, Bana Khalil, Amina Mustafa Nagra, Steysi Falcon Aragon, Deekksha Kolagatla, Victor Sebastian Arruarana, Domenica A Herrera, Samer Kottiech, Ernesto Calderón Martínez\",\"doi\":\"10.1007/s40477-025-01072-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Sepsis and septic shock are life-threatening conditions driven by dysregulated host responses to infection, resulting in multi-organ dysfunction. While early fluid resuscitation is essential, both fluid overload and under-resuscitation can worsen outcomes. Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) has emerged as a non-invasive echocardiographic tool to assess fluid responsiveness. This systematic review evaluates the diagnostic performance, cutoff values, and limitations of LVOT VTI as a tool for assessing fluid responsiveness in adult patients with sepsis or septic shock.</p><p><strong>Methods: </strong>A systematic search of PubMed, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL was conducted through April 13, 2025, following PRISMA 2020 guidelines (PROSPERO ID: CRD420251036927). Eligible studies used transthoracic or transesophageal echocardiography to measure LVOT VTI and assessed changes following passive leg raise (PLR) or volume expansion tests (VET). Fluid responsiveness was defined as a ≥ 10-15% increase in VTI.</p><p><strong>Results: </strong>Three observational studies including 199 adult patients (20 with sepsis, 179 with septic shock) met inclusion criteria. Two studies used VET (500 mL saline), and one used PLR. Optimal LVOT VTI cutoffs ranged from > 7% to 16%, with sensitivity 78-96%, specificity 91-100%, and AUCs 0.84-0.99. Based on the Newcastle-Ottawa Scale, two studies were rated good quality, and one was fair.</p><p><strong>Conclusion: </strong>LVOT VTI is a reliable, non-invasive parameter for assessing fluid responsiveness in sepsis and septic shock. Despite limited data, this review supports its integration into bedside fluid management protocols to guide individualized resuscitation strategies.</p><p><strong>Prospero registration id: </strong>CRD420251036927.</p>\",\"PeriodicalId\":51528,\"journal\":{\"name\":\"Journal of Ultrasound\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.4000,\"publicationDate\":\"2025-08-23\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Ultrasound\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1007/s40477-025-01072-1\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q3\",\"JCRName\":\"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Ultrasound","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1007/s40477-025-01072-1","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING","Score":null,"Total":0}
Utilization of left ventricular outflow tract velocity time integral in the assessment of fluid responsiveness in adult patients with sepsis or septic shock - a systematic review.
Background: Sepsis and septic shock are life-threatening conditions driven by dysregulated host responses to infection, resulting in multi-organ dysfunction. While early fluid resuscitation is essential, both fluid overload and under-resuscitation can worsen outcomes. Left Ventricular Outflow Tract Velocity Time Integral (LVOT VTI) has emerged as a non-invasive echocardiographic tool to assess fluid responsiveness. This systematic review evaluates the diagnostic performance, cutoff values, and limitations of LVOT VTI as a tool for assessing fluid responsiveness in adult patients with sepsis or septic shock.
Methods: A systematic search of PubMed, Cochrane, Scopus, Web of Science, EMBASE, and CINAHL was conducted through April 13, 2025, following PRISMA 2020 guidelines (PROSPERO ID: CRD420251036927). Eligible studies used transthoracic or transesophageal echocardiography to measure LVOT VTI and assessed changes following passive leg raise (PLR) or volume expansion tests (VET). Fluid responsiveness was defined as a ≥ 10-15% increase in VTI.
Results: Three observational studies including 199 adult patients (20 with sepsis, 179 with septic shock) met inclusion criteria. Two studies used VET (500 mL saline), and one used PLR. Optimal LVOT VTI cutoffs ranged from > 7% to 16%, with sensitivity 78-96%, specificity 91-100%, and AUCs 0.84-0.99. Based on the Newcastle-Ottawa Scale, two studies were rated good quality, and one was fair.
Conclusion: LVOT VTI is a reliable, non-invasive parameter for assessing fluid responsiveness in sepsis and septic shock. Despite limited data, this review supports its integration into bedside fluid management protocols to guide individualized resuscitation strategies.
期刊介绍：
The Journal of Ultrasound is the official journal of the Italian Society for Ultrasound in Medicine and Biology (SIUMB). The journal publishes original contributions (research and review articles, case reports, technical reports and letters to the editor) on significant advances in clinical diagnostic, interventional and therapeutic applications, clinical techniques, the physics, engineering and technology of ultrasound in medicine and biology, and in cross-sectional diagnostic imaging. The official language of Journal of Ultrasound is English.
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