Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis
Abstract Introduction Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice. Meth...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-023-04629-w |
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| author | Jorge Iván Alvarado Sánchez Juan Daniel Caicedo Ruiz Juan José Diaztagle Fernández Luís Eduardo Cruz Martínez Fredy Leonardo Carreño Hernández Carlos Andrés Santacruz Herrera Gustavo Adolfo Ospina-Tascón |
| author_facet | Jorge Iván Alvarado Sánchez Juan Daniel Caicedo Ruiz Juan José Diaztagle Fernández Luís Eduardo Cruz Martínez Fredy Leonardo Carreño Hernández Carlos Andrés Santacruz Herrera Gustavo Adolfo Ospina-Tascón |
| author_sort | Jorge Iván Alvarado Sánchez |
| collection | DOAJ |
| description | Abstract Introduction Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice. Methods A sensitive strategy was conducted in the Medline and Embase databases to search for prospective studies assessing the operative performance of pulse pressure variation, stroke volume variation, passive leg raising (PLR), end-expiratory occlusion test (EEOT), mini-fluid challenge, and tidal volume challenge to predict fluid responsiveness in critically ill and acutely ill surgical patients published between January 1999 and February 2023. Adjusted diagnostic odds ratios (DORs) were calculated by subgroup analyses (inverse variance method) and meta-regression (test of moderators). Variables potentially modifying the operative performance of such predictor tests were classified as technical and clinical. Results A total of 149 studies were included in the analysis. The volume used during fluid loading, the method used to assess variations in macrovascular flow (cardiac output, stroke volume, aortic blood flow, volume‒time integral, etc.) in response to PLR/EEOT, and the apneic time selected during the EEOT were identified as technical variables modifying the operative performance of such fluid responsiveness predictor tests (p < 0.05 for all adjusted vs. unadjusted DORs). In addition, the operative performance of fluid responsiveness predictors was also influenced by clinical variables such as the positive end-expiratory pressure (in the case of EEOT) and the dose of norepinephrine used during the fluid responsiveness assessment for PLR and EEOT (for all adjusted vs. unadjusted DORs). Conclusion Prediction of fluid responsiveness in critically and acutely ill patients is strongly influenced by a number of technical and clinical aspects. Such factors should be considered for individual intervention decisions. |
| first_indexed | 2024-03-11T22:12:47Z |
| format | Article |
| id | doaj.art-2e5614ffba4744f8b534378e934b8b63 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-03-11T22:12:47Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-2e5614ffba4744f8b534378e934b8b632023-09-24T11:20:53ZengBMCCritical Care1364-85352023-09-0127111210.1186/s13054-023-04629-wVariables influencing the prediction of fluid responsiveness: a systematic review and meta-analysisJorge Iván Alvarado Sánchez0Juan Daniel Caicedo Ruiz1Juan José Diaztagle Fernández2Luís Eduardo Cruz Martínez3Fredy Leonardo Carreño Hernández4Carlos Andrés Santacruz Herrera5Gustavo Adolfo Ospina-Tascón6Fundación Santa Fe de Bogotá, Department of Intensive CareDepartment of Physiology Sciences, Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Physiology Sciences, Faculty of Medicine, Universidad Nacional de ColombiaDepartment of Physiology Sciences, Faculty of Medicine, Universidad Nacional de ColombiaUniversidad de Los AndesFundación Santa Fe de Bogotá, Department of Intensive CareDepartment of Intensive Care, Fundación Valle del LiliAbstract Introduction Prediction of fluid responsiveness in acutely ill patients might be influenced by a number of clinical and technical factors. We aim to identify variables potentially modifying the operative performance of fluid responsiveness predictors commonly used in clinical practice. Methods A sensitive strategy was conducted in the Medline and Embase databases to search for prospective studies assessing the operative performance of pulse pressure variation, stroke volume variation, passive leg raising (PLR), end-expiratory occlusion test (EEOT), mini-fluid challenge, and tidal volume challenge to predict fluid responsiveness in critically ill and acutely ill surgical patients published between January 1999 and February 2023. Adjusted diagnostic odds ratios (DORs) were calculated by subgroup analyses (inverse variance method) and meta-regression (test of moderators). Variables potentially modifying the operative performance of such predictor tests were classified as technical and clinical. Results A total of 149 studies were included in the analysis. The volume used during fluid loading, the method used to assess variations in macrovascular flow (cardiac output, stroke volume, aortic blood flow, volume‒time integral, etc.) in response to PLR/EEOT, and the apneic time selected during the EEOT were identified as technical variables modifying the operative performance of such fluid responsiveness predictor tests (p < 0.05 for all adjusted vs. unadjusted DORs). In addition, the operative performance of fluid responsiveness predictors was also influenced by clinical variables such as the positive end-expiratory pressure (in the case of EEOT) and the dose of norepinephrine used during the fluid responsiveness assessment for PLR and EEOT (for all adjusted vs. unadjusted DORs). Conclusion Prediction of fluid responsiveness in critically and acutely ill patients is strongly influenced by a number of technical and clinical aspects. Such factors should be considered for individual intervention decisions.https://doi.org/10.1186/s13054-023-04629-wCritical careFluid responsivenessPulse pressure variationStroke volume variationPassive leg raisingEnd-expiratory occlusion test |
| spellingShingle | Jorge Iván Alvarado Sánchez Juan Daniel Caicedo Ruiz Juan José Diaztagle Fernández Luís Eduardo Cruz Martínez Fredy Leonardo Carreño Hernández Carlos Andrés Santacruz Herrera Gustavo Adolfo Ospina-Tascón Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis Critical Care Critical care Fluid responsiveness Pulse pressure variation Stroke volume variation Passive leg raising End-expiratory occlusion test |
| title | Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis |
| title_full | Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis |
| title_fullStr | Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis |
| title_full_unstemmed | Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis |
| title_short | Variables influencing the prediction of fluid responsiveness: a systematic review and meta-analysis |
| title_sort | variables influencing the prediction of fluid responsiveness a systematic review and meta analysis |
| topic | Critical care Fluid responsiveness Pulse pressure variation Stroke volume variation Passive leg raising End-expiratory occlusion test |
| url | https://doi.org/10.1186/s13054-023-04629-w |
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