3/3/2023 0 Comments Narrow pulse pressureWe excluded studies employing a ventilatory strategy that maintained spontaneous breathing or generated a tidal volume 50% would mean significant heterogeneity. We included those studies in which the predictive value had been assessed by calculating both sensitivity and specificity in identifying those patients who subsequently responded to fluid challenge. No ethical approval and patient consent are required. ![]() Reviews, case reports, and studies published in abstract form were excluded. Only studies published as full-text articles in an indexed journal were included. The objective of this systematic review and meta-analysis was to evaluate the accuracy of PPV in predicting fluid responsiveness in ICU patients.Īll relevant clinical trials investigating the ability of PPV to predict fluid responsiveness in adult patients in the ICU were considered for inclusion. ![]() ![]() In addition, more studies have been published since. Nevertheless, seven out of the 29 studies included in the systematic review were performed in operating rooms rather than ICUs. Among these functional hemodynamic parameters, pulse pressure variation (PPV) – which can easily and accurately obtained by online assessment of the arterial waveform with a standard multiparametric monitor – has been shown to be highly predictive of fluid responsiveness in a systematic review, with sensitivity, specificity, and diagnostic odds ratio of 0.89, 0.88, and 59.86, respectively. Over the last decade, a number of studies have been reported, which have used heart–lung interactions during mechanical ventilation to assess fluid responsiveness. Static measures, including central venous pressure, pulmonary capillary wedge pressure, right ventricular end-diastolic volume, left ventricular end-diastolic area, inferior vena-caval diameter, and global end-diastolic volume index, are of poor value in guiding fluid resuscitation. Medical history, clinical manifestations (such as skin turgor, blood pressure, pulse rate, and urine output), and routine laboratory tests are important but of limited sensitivity and specificity. However, only about one-half of the critically ill patients exhibit a positive response to fluid challenge, and accurate prediction of fluid responsiveness remains one of the most difficult tasks at the bedside in the ICU. No matter what the study result is, the first step in hemodynamic therapy in all of the above studies is always preload optimization. Moreover, conflicting results have been reported with regards to studies investigating goal-directed hemodynamic therapy in critically ill patients, such as Rivers and colleagues’ study and the OPTIMISE study. PPV predicts fluid responsiveness accurately in mechanically ventilated patients with relative large tidal volume and without spontaneous breathing and cardiac arrhythmia.ĭespite the fact that fluid resuscitation is considered the first line of therapy in hemodynamically unstable patients, a large body of evidence indicates that unnecessary positive fluid balance is associated with increased morbidity and mortality. A significant threshold effect was identified. A summary receiver operating characteristic curve yielded an area under the curve of 0.94 (95% CI 0.91 to 0.95). The pooled sensitivity was 0.88 (95% confidence interval (CI) 0.81 to 0.92) and pooled specificity was 0.89 (95% CI 0.84 to 0.92). Twenty-two studies with 807 mechanically ventilated patients with tidal volume more than 8 ml/kg and without spontaneous breathing and cardiac arrhythmia were included, and 465 were responders (58%). Data were synthesized using an exact binomial rendition of the bivariate mixed-effects regression model modified for synthesis of diagnostic test data. We searched MEDLINE and EMBASE and included clinical trials that evaluated the association between PPV and fluid responsiveness after fluid challenge in mechanically ventilated patients in intensive care units. ![]() However, as far as we know, no systematic review and meta-analysis has been carried out to evaluate the value of PPV in predicting fluid responsiveness specifically upon patients admitted into intensive care units. The last decade witnessed the use of pulse pressure variation (PPV) to predict fluid responsiveness. Fluid resuscitation is crucial in managing hemodynamically unstable patients.
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