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
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13054_2024_Article_5078.pdf
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Author(s)
Chaves, Renato C. F.
Barbas, Carmen S. V.
Queiroz, Veronica N. F.
Serpa Neto, Ary
Deliberato, Rodrigo O.
Pereira, Adriano J.
Timenetsky, Karina T.
Silva Júnior, João M.
Takaoka, Flávio
de Backer, Daniel
Date Issued
August 31, 2024
Journal
Critical Care
Publisher
BioMed Central
Citation
Chaves, R.C.F., Barbas, C.S.V., Queiroz, V.N.F. et al. 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. Crit Care 28, 289 (2024).
Version
Final published version
Abstract
Importance
Maneuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes.
Objective
To describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients.
Registration
The protocol was registered at PROSPERO: CRD42019146781.
Information sources and search
PubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023.
Study selection and data collection
Prospective and intervention studies were selected.
Statistical analysis
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.
Results
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).
Conclusions
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.
MIT Department
MIT Critical Data (Laboratory)
Harvard--MIT Program in Health Sciences and Technology. Laboratory for Computational Physiology
Harvard University--MIT Division of Health Sciences and Technology
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DOI of Published Version
https://doi.org/10.1186/s13054-024-05078-9
