Low Predictability of Three Different Noninvasive Methods to Determine Fluid Responsiveness in Critically Ill Children

Abstract

Dynamic preload variables such as stroke volume variation or respiratory variations in vena cava inferior diameter may not be useful for predicting fluid responsiveness in certain pediatric patient populations. Esophageal Doppler peak velocity was predictive of fluid responsiveness where a target value of more than 135,5 cm/s may be a signal to terminate further fluid challenges. This target value may be different in different age groups, as esophageal Doppler peak velocity varies with age.

Does respiratory variation of inferior vena cava diameter predict fluid responsiveness in spontaneously ventilating children with sepsis

“…However, during spontaneous ventilation, lower RA pressure and uncontrolled, variable intrathoracic pressure changes with respiration may reduce the accuracy of IVC ultrasound to predict fluid responsiveness . The test characteristics of respiratory variation in IVC diameter in mechanically ventilated children are mixed, with reported AUROC values ranging from 0.37 to 0.85 . These studies all maintained tidal volumes of 8–10 mL/kg during IVC sonography, reducing one possible source of heterogeneity.…”

“…29 The test characteristics of respiratory variation in IVC diameter in mechanically ventilated children are mixed, with reported AUROC values ranging from 0.37 to 0.85. [31][32][33] These studies all maintained tidal volumes of 8-10 mL/kg during IVC sonography, reducing one possible source of heterogeneity. However, all differed in their inclusion criteria, fluid bolus volume and content, their definition of fluid responsiveness and in their cut-off values for a positive index test.…”

Nonosmotic secretion of arginine vasopressin and salt loss in hyponatremia in Kawasaki disease

“…Decreased urine sodium levels are suggestive of a reduced effective circulating volume . Although IVCCI did not indicate a decreased intravascular volume in nine patients who were evaluated, several studies have shown that IVCCI is a poor predictor of central venous pressure or fluid responsiveness . Terai et al reported that IVIG‐resistant patients had higher vascular endothelial growth factor levels and gained more weight after IVIG than IVIG‐responsive patients .…”

“…18 Although IVCCI did not indicate a decreased intravascular volume in nine patients who were evaluated, several studies have shown that IVCCI is a poor predictor of central venous pressure or fluid responsiveness. 19,20 Terai et al reported that IVIG-resistant patients had higher vascular endothelial growth factor levels and gained more weight after IVIG than IVIG-responsive patients. 21 Vascular leakage might therefore cause intravascular volume depletion and decreased urine sodium levels, leading to a subsequent increase in total body water in KD.…”

Surviving sepsis campaign in children

“…Il faut noter que la plupart des paramètres dynamiques de précharge-dépendance n'ont été validés comme paramètres prédictifs de la réponse au remplissage vasculaire que chez des adultes ventilés (avec un volume courant >7 ml/kg) [38]. Chez l'enfant, seules les variations respiratoires du pic de vélocité du débit aortique semblent prédictives de cette réponse [39,40]. L'augmentation de l'index cardiaque après lever de jambe semble intéressante pour prédire la précharge dépendance mais mérite d'être confirmée [41].…”