Stroke volume variation induced by lung recruitment maneuver to predict fluid responsiveness in patients receiving mechanical ventilation: A systematic review and meta-analysis - 11/09/24
Abstract |
Study objective |
The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSVLRM) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis.
Methods |
A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve.
Results |
A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77–0.90) and 0.79 (95% CI, 0.70–0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62–64.34) and 0.90 (95% CI, 0.87–0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50–8.18) and 0.19 (95% CI, 0.11–0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively.
Conclusions |
Based on the currently available evidence, ΔSVLRM has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSVLRM in predicting fluid responsiveness.
PROSPERO registration number: CRD42023490598.
Le texte complet de cet article est disponible en PDF.Highlights |
• | Inappropriate fluid administration can be detrimental to patient prognosis. |
• | Reliable predictors of fluid responsiveness are the basis for fluid administration. |
• | Predictive performance of SVV for fluid responsiveness is limited. |
• | We evaluated the predictive accuracy of lung recruitment maneuver induced stroke volume variation in fluid responsiveness. |
• | Lung recruitment maneuver induced stroke volume variation is a reliable predictor for predicting fluid responsiveness. |
• | Studies with large sample sizes and different clinical settings are needed to validate the diagnostic value. |
Keywords : Stroke volume variation, Lung recruitment maneuver, Fluid responsiveness, meta-analysis
Plan
Vol 97
Article 111545- octobre 2024 Retour au numéro
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