Related Experiment Video
Updated: Aug 22, 2025
Continuous Venous-Arterial Doppler Ultrasound During a Preload Challenge
Published on: January 20, 2023
Dynamic parameters for fluid responsiveness in mechanically ventilated children: A systematic review
Patcha Yenjabog1, Wacharoot Kanchongkittiphon2, Somchai Chutipongtanate3,4,5
1Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Insights
Respiratory variation in aortic peak velocity reliably predicts fluid responsiveness in mechanically ventilated children. This dynamic hemodynamic parameter aids in avoiding fluid overload and improving patient outcomes.
Area of Science:
- Pediatric Critical Care Medicine
- Hemodynamics
- Mechanical Ventilation
Background:
- Fluid administration is a critical initial treatment for unstable pediatric patients.
- Accurate evaluation of fluid responsiveness is essential in mechanically ventilated children to prevent detrimental fluid overload.
- Mortality rates increase with excessive fluid administration in pediatric intensive care.
Purpose of the Study:
- To systematically review and compare the diagnostic performance of dynamic hemodynamic parameters for predicting fluid responsiveness.
- To identify the most reliable parameters for guiding fluid management in mechanically ventilated children.
Main Methods:
- A systematic review of four electronic databases (PubMed, EMBASE, Scopus, Central) was conducted for studies published between January 2010 and December 2020.
- Included studies assessed the diagnostic performance of dynamic parameters following a fluid challenge in mechanically ventilated children.
- Twenty-seven studies involving 1,005 participants and 1,138 fluid challenges were analyzed.
Main Results:
- Respiratory variation in aortic peak velocity demonstrated reliable performance in predicting fluid responsiveness (Area Under the Curve: 0.71–1.00; cutoff: 7%–20%).
- Dynamic parameters like pulse pressure variation and stroke volume variation were used in congenital heart surgery patients.
- Plethysmography variability index was applied in neurological, general surgery, and pediatric intensive care unit patients.
Conclusions:
- Respiratory variation in aortic peak velocity shows promising diagnostic performance for fluid responsiveness in mechanically ventilated children.
- High sensitivity of this parameter is beneficial for non-cardiac surgery and ICU patients, improving survival through early fluid resuscitation.
- High specificity is advantageous in congenital heart surgery, where fluid overload poses significant risks.
Objective:
Fluid administration is the initial step of treatment of unstable pediatric patients. Evaluation of fluid responsiveness is crucial in mechanically ventilated children to avoid fluid overload, which increases mortality. We aim to review and compare the diagnostic performance of dynamically hemodynamic parameters for predicting fluid responsiveness in mechanically ventilated children.
Design:
A systematic review was performed using four electronic databases, including PubMed, EMBASE, Scopus, and Central, for published articles from 1 January 2010 to 31 December 2020. Studies were included if they described diagnostic performance of dynamic parameters after fluid challenge was performed in mechanically ventilated children.
Settings:
Pediatric intensive and cardiac intensive care unit, and operative room.
Patients:
Children aged 1 month to 18 years old who were under mechanical ventilation and required an intravenous fluid challenge.
Measurements And Main Results:
Twenty-seven studies were included in the systematic review, which included 1,005 participants and 1,138 fluid challenges. Respiratory variation in aortic peak velocity was reliable among dynamic parameters for predicting fluid responsiveness in mechanically ventilated children. All studies of respiratory variation in aortic peak velocity showed that the area under the receiver operating characteristic curve ranged from 0.71 to 1.00, and the cutoff value for determining fluid responsiveness ranged from 7% to 20%. Dynamic parameters based on arterial blood pressure (pulse pressure variation and stroke volume variation) were also used in children undergoing congenital heart surgery. The plethysmography variability index was used in children undergoing neurological and general surgery, including the pediatric intensive care patients.
Conclusions:
The respiratory variation in aortic peak velocity exhibited a promising diagnostic performance across all populations in predicting fluid responsiveness in mechanically ventilated children. High sensitivity is advantageous in non-cardiac surgical patients and the pediatric intensive care unit because early fluid resuscitation improves survival in these patients. Furthermore, high specificity is beneficial in congenital heart surgery because fluid overload is particularly detrimental in this group of patients.
Systematic Review Registration:
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206400.
Related Concept Videos
01:29Mechanical Ventilation I: Indication and Settings
01:14Ventilatory Modes
There are three ventilatory modes: full support, partial support, and spontaneous. These are described below.
Full Support Modes
Full support modes include controlled mechanical ventilation, continuous mandatory...
01:19Factors Affecting Pulmonary Ventilation
Alveolar Surface Tension
The alveolar fluid lines the luminal surface of the alveoli and exerts a force called surface tension. This force is caused by the polar water molecules in the liquid being more strongly attracted to each...
01:23Mechanical Ventilation II: Invasive Ventilation
Negative-Pressure Ventilators
Negative-pressure ventilators create a vacuum around the chest or body to draw air into the lungs, simulating breathing. This method does not require an...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:23Mechanical Ventilation III: Noninvasive Ventilation
Noninvasive Positive-Pressure Ventilation...