Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis

Xiang, Shijun; Xu, Hailin; Liu, Zimeng; Wu, Jianfeng; Cao, Dai-Yin; Chen, Juan; Chen, Minying; Liu, Yongjun; Guan, Xiangdong

doi:10.1213/ane.0000000000003459

Cited by 37 publications

(37 citation statements)

References 37 publications

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“…Positive pressure ventilation has an influence on ΔIVC. In adults with tidal volume ≥ 8 ml/kg and positive end-expiratory pressure (PEEP) < 5 cmH 2 O, ΔIVC is a good indicator of fluid responsiveness, but not in patients with a low tidal volume or a PEEP of > 5 cmH 2 O [44]. On the other hand, ΔIVC decreases with the initiation of positive pressure ventilation in children (Fig.…”

Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

Fluid responsiveness in the pediatric population

Lee

Kim

Jang

et al. 2019

Korean J Anesthesiol

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It is challenging to predict fluid responsiveness, that is, whether the cardiac index or stroke volume index would be increased by fluid administration, in the pediatric population. Previous studies on fluid responsiveness have assessed several variables derived from pressure wave measurements, plethysmography (pulse oximeter plethysmograph amplitude variation), ultrasonography, bioreactance data, and various combined methods. However, only the respiratory variation of aortic blood flow peak velocity has consistently shown a predictive ability in pediatric patients. For the prediction of fluid responsiveness in children, flow- or volume-dependent, noninvasive variables are more promising than pressure-dependent, invasive variables. This article reviews various potential variables for the prediction of fluid responsiveness in the pediatric population. Differences in anatomic and physiologic characteristics between the pediatric and adult populations are covered. In addition, some important considerations are discussed for future studies on fluid responsiveness in the pediatric population.

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Section: Potential Predictors Of Fluid Responsivenesmentioning

confidence: 99%

Fluid responsiveness in the pediatric population

Lee

Kim

Jang

et al. 2019

Korean J Anesthesiol

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“…However, more studies were published in the recent years, and comparing with demonstrating △VPeak is capable for predicting fluid responsiveness of ventilated children, acquiring optimal △VPeak threshold value of prediction possesses more clinical value. In a similar meta-analysis of respiratory variation in inferior vena cava diameter (△IVC), Si et al [42] directly calculated the mean cutoff value of △IVC with only six studies in subgroups as the optimal threshold value of △IVC. In our scatter pot of △VPeak cutoff value, we observed that the cutoff value of △VPeak distributed symmetrically around the value of 12 to 13% [43].…”

Section: Discussionmentioning

confidence: 99%

“…Firstly, sample size and study numbers in our meta-analysis were limited, although they were twice the number than previous studies. We included 11 diagnostic tests distributed between 2008 and 2018, with only 302 sample sizes, which were much smaller than the similar scale meta-analysis [42]. We attributed this phenomenon to the fact that ventilated children requiring △VPeak measurement were most critical or severe trauma, such as cardiac surgery, neurosurgery, or complicated diseases hospitalized in ICU.…”

Section: Discussionmentioning

confidence: 99%

Value of respiratory variation of aortic peak velocity in predicting children receiving mechanical ventilation: a systematic review and meta-analysis

et al. 2019

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BackgroundAccurate volume assessment is crucial in children under fluid therapy. Over the last decade, respiratory variation of aortic peak velocity (△VPeak) has been applied in intensive care unit and surgeries to help clinicians guide fluid management. The aim of this systematic review and meta-analysis was to test diagnostic performance of △VPeak in predicting fluid responsiveness of ventilated children and to explore the potential factors that influence the accuracy of △VPeak.MethodsWe searched PubMed, Embase, and Cochrane from inception to April 2019 that evaluated association between △VPeak and fluid responsiveness after fluid challenge in children receiving mechanical ventilation. Data synthesis was performed within the bivariate mixed-effects regression model modified for synthesis of diagnostic test data.ResultsEleven studies with a total of 302 pediatric patients were included in our meta-analysis. The pooled sensitivity and specificity of △VPeak was 0.89 (95%CI = 0.77 to 0.95) and 0.85 (95%CI = 0.77 to 0.91), respectively. The diagnostic odds ratio (DOR) of △VPeak was 48 (95%CI = 15 to 155). SROC yielded an area under the curve of 0.91 (95%CI = 0.88–0.93). The △VPeak cutoff value was nearly conically symmetrical distribution and varied from 7 to 20%. After excluding several extreme studies, most data were centered between 12 and 13%. The medium and mean cutoff values of △VPeak were 12.2% and 12.7%, respectively. In subgroup analysis, compared to total data analysis, △VPeak performed weaker in the younger children group (mean ages < 25 months), with lower area under the summary receiver operating characteristic curve (AUSROC) of 0.80 (0.76 to 0.83), but stronger in the older children group (mean ages > 25 months), with AUSROC of 0.96 (0.94 to 0.97).ConclusionsOverall, △VPeak has a good ability in predicting fluid responsiveness of children receiving mechanical ventilation, but this ability decreases in younger children (mean age < 25 months). The optimal threshold of △VPeak to predict fluid responsiveness in ventilated children is reliable between 12 and 13%.Trial registrationThe study protocol was registered prospectively on PROSPERO no. CRD42019129361.

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“…The results of this study showed that IVC-DI lacked a sufficiently high value in diagnosing volume responsiveness, which is similar to the results of the meta-analyses previously published by Long et al (31) and Orso et al (32). However, the meta-analysis of Si et al (33) suggested that IVC-DI was a reliable index in diagnosing volume responsiveness under conditions where the TV ≥ 8 mL/kg and the PEEP ≤ 5 cm H 2 O. In addition, when compared with a TV < 8 mL/kg or a PEEP > 5 cm H 2 O, IVC-DI displayed greater sensitivity (0.80 vs 0.66; P=0.02), specificity (0.94 vs 0.68; P<0.001), diagnostic odds ratio (68 vs 4; P<0.001), and AUROC (0.88 vs 0.70; P<0.001).…”

Section: Discussionmentioning

confidence: 99%

Evaluation of volume responsiveness by pulse pressure variability and inferior vena cava dispensability index at different tidal volumes by mechanical ventilation

Thapa

et al. 2019

Braz J Med Biol Res

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This study investigated the effects of tidal volume (TV) on the diagnostic value of pulse pressure variation (PPV) and the inferior vena cava dispensability index (IVC-DI) for volume responsiveness during mechanical ventilation. In patients undergoing elective surgery with mechanical ventilation, different TVs of 6, 9, and 12 mL/kg were given for two min. The left ventricular outflow tract velocity-time integral (VTI) was measured by transthoracic echocardiography. The IVC-DI was measured at sub-xyphoid transabdominal long axis. The PPV was measured via the radial artery and served as baseline. Index measurements were repeated after fluid challenge. VTI increased by more than 15% after fluid challenge, which was considered as volume responsive. Seventy-nine patients were enrolled, 38 of whom were considered positive volume responsive. Baseline data between the response group and the non-response group were similar. Receiver operating characteristic curve confirmed PPV accuracy in diagnosing an increase in volume responsiveness with increased TV. When TV was 12 mL/kg, the PPV area under the curve (AUC) was 0.93 and the threshold value was 15.5%. IVC-DI had the highest diagnostic accuracy at a TV of 9 mL/kg and an AUC of 0.79, with a threshold value of 15.3%. When TV increased to 12 mL/kg, the IVC-DI value decreased. When the TV was 9 and 12 mL/kg, PPV showed improved performance in diagnosing volume responsiveness than did IVC-DI. PPV diagnostic accuracy in mechanically ventilated patients was higher than IVC-DI. PPV accuracy in predicting volume responsiveness was increased by increasing TV.

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Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis

Cited by 37 publications

References 37 publications

Fluid responsiveness in the pediatric population

Fluid responsiveness in the pediatric population

Value of respiratory variation of aortic peak velocity in predicting children receiving mechanical ventilation: a systematic review and meta-analysis

Evaluation of volume responsiveness by pulse pressure variability and inferior vena cava dispensability index at different tidal volumes by mechanical ventilation

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