Predictive value of dynamic arterial elastance for vasopressor withdrawal: a systematic review and meta-analysis

Dynamic arterial elastance (Ea_dyn) has been investigated for its ability to predict hypotension during the weaning of vasopressors. Our study focused on assessing Ea_dyn's performance in the context of critically ill adult patients admitted to the intensive care unit, regardless of diagnosis.

Our study was conducted in accordance with the Preferred Reported Items for Systematic Reviews and Meta-Analysis checklist. The protocol was registered in PROSPERO (CRD42023421462) on May 26, 2023. We included prospective observational studies from the MEDLINE and Embase databases through May 2023. Five studies involving 183 patients were included in the quantitative analysis. We extracted data related to patient clinical characteristics, and information about Ea_dyn measurement methods, results, and norepinephrine dose. Most patients (76%) were diagnosed with septic shock, while the remaining patients required norepinephrine for other reasons. The average pressure responsiveness rate was 36.20%. The synthesized results yielded an area under the curve of 0.85, with a sensitivity of 0.87 (95% CI 0.74-0.93), specificity of 0.76 (95% CI 0.68-0.83), and diagnostic odds ratio of 19.07 (95% CI 8.47-42.92). Subgroup analyses indicated no variations in the Ea_dyn based on norepinephrine dosage, the Ea_dyn measurement device, or the Ea_dyn diagnostic cutoff to predict cessation of vasopressor support.

Ea_dyn, evaluated through subgroup analyses, demonstrated good predictive ability for the discontinuation of vasopressor support in critically ill patients.