Aortic peak flow variation as a predictor of fluid responsiveness in pediatric septic shock patients under mechanical ventilation

Abstract

Introduction: effective fluid management is crucial in pediatric critical care, particularly for patients with septic shock. Aortic Peak Flow Variation (APFV) has emerged as a potential predictor of fluid responsiveness, yet its utility in pediatric septic shock patients under mechanical ventilation remains underexplored.Objective: to evaluate the predictive accuracy of APFV for fluid responsiveness in pediatric septic shock patients undergoing mechanical ventilation and to establish optimal APFV cutoff values for clinical application.Methods: in this prospective observational study conducted from January to September 2023 at the PICU of Hospital Padre Carollo "Un Canto a la Vida," 26 pediatric septic shock patients were enrolled. Hemodynamic variables were measured before and after a standard fluid bolus of 10 ml/kg. APFV was calculated using transthoracic echocardiography, with fluid responsiveness defined as a ≥10 % increase in stroke volume index post-fluid administration. Sensitivity, specificity, and ROC curve analyses were employed to evaluate APFV's predictive capability.Results: out of 26 patients, 17 (65,4 %) responded to fluid administration. The mean APFV across all patients was 12,5 %. ROC curve analysis determined an APFV cutoff of 13,4 % for predicting fluid responsiveness, yielding a sensitivity of 82 % and specificity of 83 %, with an AUROC of 0,83.Conclusions: APFV demonstrated a moderate to high level of accuracy in predicting fluid responsiveness in pediatric septic shock patients under mechanical ventilation. The identified APFV cutoff provides a practical reference for clinicians in fluid management decisions within this patient population