The effects of static and dynamic measurements using transpulmonary thermodilution devices on fluid therapy in septic shock: A systematic review

Abstract

Transpulmonary thermodilution devices have been widely shown to be accurate in septic shock patients in assessing fluid responsiveness. We conducted a systematic review to assess the relationship between fluid therapy protocols guided by transpulmonary thermodilution devices on fluid balance and the amount of intravenous fluid used in septic shock. We searched MEDLINE, Embase and The Cochrane Library. Studies were eligible for inclusion if they were prospective, parallel trials that were conducted in an intensive care setting in patients with septic shock. The comparator group was either central venous pressure, early goal-directed therapy or pulmonary artery occlusion pressure. Studies assessing only the accuracy of fluid responsiveness prediction by transpulmonary thermodilution devices were excluded. Two reviewers independently performed the search, extracted data and assessed the bias of each study. In total 27 full-text articles were identified for eligibility; of these, nine studies were identified for inclusion in the systematic review. Three of these trials used dynamic parameters derived from transpulmonary thermodilution devices and six used primarily static parameters to guide fluid therapy. There was evidence for a significant reduction in positive fluid balance in four out of the nine studies. From the available studies, the results suggest the benefit of transpulmonary thermodilution monitoring in the septic shock population with regard to reducing positive fluid balance is seen when the devices are utilised for at least 72 hours. Both dynamic and static parameters derived from transpulmonary thermodilution devices appear to lead to a reduction in positive fluid balance in septic shock patients compared to measurements of central venous pressure and early goal-directed therapy.

Transpulmonary thermodilution

“…parameters were superior in reducing in positive fluid balance, as compared to measurements of central venous pressure and early goal-directed therapy [30]. However, despite all these solid physiological purposes, in a recent randomized controlled trial (RCT), a TPTD-based algorithm considering ITBVI (ITBV index), EVLW, and CO was not superior to a central venous pressure-based algorithm to manage the fluid management of 330 ICU patients with septic shock and/or ARDS [31].…”

“…For instance, a recent a systematic review of nine studies enrolling ICU patients with septic shock, pointed out the potential benefit of TPTD monitoring, showing a reduction of the positive fluid balance when the devices were utilized for at least 72 h, and that TPTD-derived dynamic and static parameters were superior in reducing in positive fluid balance, as compared to measurements of central venous pressure and early goal-directed therapy [30]. However, despite all these solid physiological purposes, in a recent randomized controlled trial (RCT), a TPTD-based algorithm considering ITBVI (ITBV index), EVLW, and CO was not superior to a central venous pressure-based algorithm to manage the fluid management of 330 ICU patients with septic shock and/or ARDS [31].…”