Predicting fluid responsiveness in 100 critically ill children: the effect of baseline contractility

Saxena, Renu; Durward, Andrew; Steeley, Sarah; Murdoch, Ian A.; Tibby, Shane M.

doi:10.1007/s00134-015-4075-8

Cited by 27 publications

(24 citation statements)

References 49 publications

(13 reference statements)

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“…Reasons for exclusion are detailed in S2 File. Consequently, six studies were ultimately included in our analysis [13, 14, 20–23]. …”

Section: Resultsmentioning

confidence: 99%

“…Zhang et al [12] reported that SVV was of diagnostic value for fluid responsiveness in adult patients ventilated with tidal volume greater than 8 ml/kg in operating room or intensive care unit. However, in the pediatric population, the predictive value of SVV remains relatively underexplored and the available results are controversial [13–15]. We hypothesised that SVV could be of predictive value in predicting fluid responsiveness in children.…”

Section: Introductionmentioning

confidence: 99%

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Does stroke volume variation predict fluid responsiveness in children: A systematic review and meta-analysis

Liu

Qiao

et al. 2017

PLoS ONE

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ObjectiveStroke volume variation (SVV) is a reliable predictor of fluid responsiveness in adult patients. However, the predictive value of SVV is uncertain in pediatric patients. We performed the first systematic meta-analysis to evaluate the diagnostic value of SVV in predicting fluid responsiveness in children.MethodsPUBMED, EMBASE, and Cochrane Central Register of Controlled Trials were searched up to December 2016. Original studies assessing the diagnostic accuracy of SVV in predicting fluid responsiveness in children were considered to be eligible. A random-effects model was used to calculate pooled values of sensitivity, specificity and diagnostic odds ratio with 95% CI. The summary receiver operating characteristic curve was estimated and area under the curve was calculated. Quality of the studies was assessed with the QUADAS-2 tool.ResultsSix studies with a total of 279 fluid boluses in 224 children were included. The analysis demonstrated a pooled sensitivity of 0.68 (95% CI,0.59–0.76), pooled specificity of 0.65 (95% CI, 0.57–0.73), pooled diagnostic odds ratio of 8.24 (95% CI, 2.58–26.30), and the summary area under the summary receiver operating characteristic curve of 0.81. However, significant inter-study heterogeneity was found (p<0.05, I2 = 61.3%), likely due to small sample size and diverse study characteristics.ConclusionsCurrent evidence suggests that SVV was of diagnostic value in predicting fluid responsiveness in children under mechanical ventilation. Given the high heterogeneity of published data, further studies are needed to confirm the diagnostic accuracy of SVV in predicting fluid responsiveness in pediatric patients.

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“…Reasons for exclusion are detailed in S2 File. Consequently, six studies were ultimately included in our analysis [13, 14, 20–23]. …”

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does stroke volume variation predict fluid responsiveness in children: A systematic review and meta-analysis

Liu

Qiao

et al. 2017

PLoS ONE

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“…[34] In a study for critically ill children, the dP/dt max derived from PRAM has been used as a parameter representing ventricular contractility and shown to track the change according to inotropic use. [35] …”

Section: Discussionmentioning

confidence: 99%

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

et al. 2016

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The maximum rate of pressure rise (dP/dtmax) in radial artery has been proposed as a noninvasive surrogate of aortic dp/dtmax, reflecting left ventricular (LV) contractility in children. The aim of this study was to investigate relationship between aortic and radial dp/dtmax at weaning from cardiopulmonary bypass (CPB) and usefulness of these indices for estimating postoperative outcomes in pediatric congenital heart surgery.Aortic and radial arterial pressure waveforms were analyzed simultaneously during weaning from CPB in 29 congenital heart surgery. The maximum first derivatives of aortic and radial arterial waveforms were calculated and averaged from 3 consecutive respiratory cycles. We obtained the maximum vasoactive inotropic score during the first 36 postoperative hours, LV ejection fraction, and fractional shortening on transthoracic echocardiography performed within postoperative day 7.A significant difference between aortic and radial dP/dtmax was observed (mean difference 356 mm Hg/s, 44% of averages), and radial dP/dtmax was weakly correlated with aortic dP/dtmax (r =0.373, P = 0.047). Aortic dP/dtmax was significantly associated with the maximum vasoactive inotropic score (P < 0.001), postoperative LV ejection fraction (P = 0.018), and fractional shortening (P = 0.015); however, radial dP/dtmax was not. On Receiver operating characteristic analysis, aortic dP/dtmax had a greater area under the curve than radial dP/dtmax in predicting higher vasoactive inotropic score (0.827 vs 0.673).Immediately after CPB in pediatric congenital heart surgery, radial dP/dtmax may not replace aortic dP/dtmax because of a discrepancy between central and peripheral arterial waveforms. In this critical period, aortic dP/dtmax can be useful to estimate postoperative ventricular function rather than peripherally derived dP/dtmax.

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“…Bojan and coauthors also hypothesized that cardiopulmonary bypass would have a significantly greater role than low cardiac output on AKI development. It must be acknowledged that no direct measure of cardiac output was included in their study and its assessment is currently poorly applied in the context of pediatric cardiac surgery [11] and pediatric intensive care [12, 13]: it would be interesting to perform a similar analysis including direct cardiac output estimation.…”

Section: Main Textmentioning

confidence: 99%

Latent AKI is… still AKI: the quantification of the burden of renal dysfunction

2016

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The association between pediatric cardiac surgery, acute kidney injury (AKI), and clinical outcomes has been studied several times in the recent literature. In this issue of Critical Care an interesting and original study analyzed the path from causal AKI entities to clinical AKI consequences through the application of structural equation modeling. The authors described the complex connections linking duration of cardiopulmonary bypass, cross clamp-time, and descriptors of low cardiac output syndrome to AKI modeled as a complex variable composed of post-operative serum creatinine increase of 50 % over baseline, urine output <0.5 ml/kg/h, and urine creatinine-normalized neutrophil gelatinase lipocalin within 12 h of surgery. Similarly, the causal relationships between AKI and hard outcomes in the analyzed population were verified and quantified. The authors, for the first time, produce a repeatable coefficient (0.741) that may become a useful quality benchmark and could be applied to test future interventions aiming to reduce the burden of AKI on children’s clinical course.

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Predicting fluid responsiveness in 100 critically ill children: the effect of baseline contractility

Abstract: Current paediatric predictors of volume response perform poorly; prediction may be improved if baseline contractility is taken into account.

Cited by 27 publications

References 49 publications

Does stroke volume variation predict fluid responsiveness in children: A systematic review and meta-analysis

Does stroke volume variation predict fluid responsiveness in children: A systematic review and meta-analysis

Usefulness of the maximum rate of pressure rise in the central and peripheral arteries after weaning from cardiopulmonary bypass in pediatric congenital heart surgery

Latent AKI is… still AKI: the quantification of the burden of renal dysfunction

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