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Aortic Peak Flow Velocity As a Predictor of Fluid Responsiveness in Mechanically Ventilated Children: A Systematic
Saviga Sethasathien1, Theerapon Jariyasakoolroj2, Suchaya Silvilairat1
1Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
Insights
Respiratory variations in aortic peak flow velocity (delta Vpeak) accurately predict fluid responsiveness in mechanically ventilated children. This meta-analysis found delta Vpeak has good accuracy, with no identified moderators influencing its predictability.
Area of Science:
- Pediatric Critical Care Medicine
- Cardiopulmonary Physiology
- Hemodynamic Monitoring
Background:
- Fluid responsiveness assessment is crucial in mechanically ventilated children.
- Predicting fluid responsiveness guides fluid therapy and improves outcomes.
- Respiratory variations in aortic peak flow velocity (delta Vpeak) are a potential non-invasive predictor.
Approach:
- A systematic meta-analysis was conducted on 15 studies involving 452 pediatric patients.
- Searches were performed across major databases (PubMed, Embase, Scopus, CINAHL) up to June 20, 2022.
- Diagnostic test data were synthesized to calculate pooled sensitivity, specificity, diagnostic odds ratio (DOR), and area under the curve (AUC).
Key Points:
- Delta Vpeak demonstrated a pooled sensitivity of 0.80 and specificity of 0.82.
- The pooled diagnostic odds ratio (DOR) was 23.41, with an AUC of 0.87.
- No significant moderators (e.g., ventilator settings, fluid type, vasoactive drugs) were found to influence delta Vpeak accuracy.
Conclusions:
- Delta Vpeak, with a cutoff of approximately 12.3%, is a reliable predictor of fluid responsiveness in mechanically ventilated children.
- The consistent accuracy across various clinical scenarios highlights its utility.
- Further research can focus on refining its application and integration into clinical practice.
Objectives:
This meta-analysis aimed to determine the accuracy of the respiratory variations in aortic peak flow velocity (delta Vpeak) in predicting fluid responsiveness and the moderators of that accuracy.
Data Sources:
We performed searches for studies that used delta Vpeak as a predictor of fluid responsiveness in mechanically ventilated children in PubMed, Embase, Scopus, and CINAHL from inception to June 20, 2022.
Study Selection And Data Extraction:
Fifteen studies ( n = 452) were included in this meta-analysis. The diagnostic test data of the included studies were synthesized as pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and the area under the curve (AUC) of the summary receiver operating characteristic of delta Vpeak.
Data Synthesis:
The delta Vpeak cutoff values applied in these studies had a median of 12.3% (interquartile range, 11.50-13.25%). The pooled sensitivity and specificity of delta Vpeak were 0.80 (95% CI, 0.71-0.87) and 0.82 (95% CI, 0.75-0.87), respectively. The DOR of delta Vpeak was 23.41 (95% CI, 11.61-47.20). The AUC of delta Vpeak was 0.87. Subgroup analyses revealed that the accuracy of delta Vpeak was not moderated by ventilator settings, measures of delta Vpeak, gold standard index, the cutoff gold standard value of responders, type and volume of fluid, duration of fluid challenge, use of vasoactive drugs, general anesthesia, and cardiopulmonary bypass.
Conclusions:
By using the cutoff of approximately 12.3%, the delta Vpeak appears to have good accuracy in predicting fluid responsiveness in mechanically ventilated children. The moderators of delta Vpeak predictability are not found.
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