Respiratory variation in peripheral arterial blood flow peak velocity to predict fluid responsiveness in mechanically ventilated patients: a systematic review and meta-analysis

Abstract

BackgroundFluid overloading is detrimental to organ function and results in a poor prognosis. It is necessary to evaluate fluid responsiveness before fluid loading. We performed a systematic meta-analysis to evaluate the diagnostic value of the respiratory variation in peripheral arterial blood flow peak velocity (△Vpeak PA) in predicting fluid responsiveness in mechanically ventilated patients.MethodsPubMed, Embase and The Cochrane Library databases were searched for studies that used △Vpeak PA to predict fluid responsiveness in mechanically ventilated patients. We calculated the pooled values of sensitivity, specificity and the area of the summary receiver operating characteristic curve by Meta-Disc 14.0 software.ResultsNine studies with a total of 402 patients were included. Two low quality studies were deleted in further analysis. Moreover, because of different locations of peripheral artery, the rest included studies were divided into brachial site group and carotid site group for meta-analysis individually. The pooled sensitivity, specificity and area under curve were 0.85 (95% confidence interval (CI) 0.77–0.92), 0.86 (95% CI 0.77–0.92) and 0.9268 in carotid site group. The pooled sensitivity, specificity and area under curve were 0.72 (95% CI 0.60–0.81), 0.85 (95% CI 0.74–0.93) and 0.8587 in brachial site group.Conclusions△Vpeak of carotid and brachial artery had a diagnostic value in predicting fluid responsiveness respectively. Moreover, △Vpeak of carotid artery had more value than brachial artery in predicting fluid responsiveness. However, there was some clinical heterogeneity; therefore, further studies are needed to confirm diagnostic accuracy.

Predictors of fluid responsiveness in critically ill patients mechanically ventilated at low tidal volumes: systematic review and meta-analysis

“…Several meta-analyses have evaluated the operative performance of these predictors in different clinical settings [9][10][11][12][13][14][15][16][17][18][19][20]. Differently from this current metanalysis, patients included received Vt from 4.9 to 12 ml kg −1 [9,10,17] and evaluated other types of populations [14,18].…”

“…Several meta-analyses evaluating the operative performance of fluid responsiveness predictors in different clinical settings have led to variable results [9][10][11][12][13][14][15][16][17][18][19][20]. These meta-analyses, however, did not evaluate specific subgroups, and there are no meta-regressions assessing the reliability of methods to evaluate fluid responsiveness.…”

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

“…Recently, noninvasive dynamic indices that calculate variation of peak velocity of the artery during several respiratory cycles measured by ultrasound have become an alternative quick volume assessment method [20, 21]. However, vessels in pediatric patients are thinner and more variable than adults.…”

Respiratory Variation in Carotid Artery Peak Systolic Velocity Is Unable to Predict Fluid Responsiveness in Spontaneously Breathing Critically Ill Patients When Assessed by Novice Physician Sonologists

“…To our knowledge, all studies to date comparing carotid DVpeak against an objective measure of fluid responsiveness have used expert sonologists. 15,[18][19][20] Our study demonstrates that novice physician sonologists were unable to accurately predict fluid responsiveness using POCUS measurement of carotid DVpeak (AUROC ¼ 0.61). The carotid DVpeak cutoff of 8% derived by maximizing the sensitivity and specificity of our observed data was unable to distinguish between fluid responders and non-responders.…”

“…[15][16][17][18] A 2018 meta-analysis that included mechanically ventilated patients with a variety of diagnoses and in several clinical settings reported that carotid DVpeak is able to predict fluid responsiveness with a pooled area under the receiver operating curve (AUROC) of 0.92. 19 A study of spontaneously breathing patients that compared POCUS measured aortic velocity time integral to carotid POCUS showed that carotid DVpeak performed well predicting fluid responsiveness (AUROC ¼ 0.81). Test characteristics of carotid DVpeak among nonintubated patients were diminished compared to mechanically ventilated patients, suggesting that heart-lung interactions may make carotid DVpeak less reliable when used with spontaneously breathing patients.…”