Abstract
BackgroundFluid overloading is detrimental to organ function and results in a poor prognosis. It is necessary to evaluate fluid responsiveness before fluid loading. We performed a systematic meta-analysis to evaluate the diagnostic value of the respiratory variation in peripheral arterial blood flow peak velocity (△Vpeak PA) in predicting fluid responsiveness in mechanically ventilated patients.MethodsPubMed, Embase and The Cochrane Library databases were searched for studies that used △Vpeak PA to predict fluid responsiveness in mechanically ventilated patients. We calculated the pooled values of sensitivity, specificity and the area of the summary receiver operating characteristic curve by Meta-Disc 14.0 software.ResultsNine studies with a total of 402 patients were included. Two low quality studies were deleted in further analysis. Moreover, because of different locations of peripheral artery, the rest included studies were divided into brachial site group and carotid site group for meta-analysis individually. The pooled sensitivity, specificity and area under curve were 0.85 (95% confidence interval (CI) 0.77–0.92), 0.86 (95% CI 0.77–0.92) and 0.9268 in carotid site group. The pooled sensitivity, specificity and area under curve were 0.72 (95% CI 0.60–0.81), 0.85 (95% CI 0.74–0.93) and 0.8587 in brachial site group.Conclusions△Vpeak of carotid and brachial artery had a diagnostic value in predicting fluid responsiveness respectively. Moreover, △Vpeak of carotid artery had more value than brachial artery in predicting fluid responsiveness. However, there was some clinical heterogeneity; therefore, further studies are needed to confirm diagnostic accuracy.
Highlights
Fluid resuscitation is the basic therapy for shock, but fluid overloading is detrimental to organ function and results in a poor prognosis [1]
In this meta-study, we studied the value of peripheral artery peak velocity variation to predict fluid responsiveness in mechanically ventilated patients
We found that △Vpeak of carotid and brachial artery had a diagnostic value in predicting fluid responsiveness respectively
Summary
Fluid overloading is detrimental to organ function and results in a poor prognosis. Fluid resuscitation is the basic therapy for shock, but fluid overloading is detrimental to organ function and results in a poor prognosis [1]. In the condition of shock, the purpose of fluid loading is to increase the cardiac output to alleviate the hypo-perfusion. Static indicators (central venous pressure or pulmonary artery wedge pressure) are not recommended as good diagnostic indexes [3, 4]. Some dynamic indicators, such as stroke volume variation (SVV) and pulse pressure variation (PPV), have better diagnostic value for predicting fluid. When surgeons are conducting chest or abdominal operations, the anesthetists may not be able to obtain the transthoracic echocardiographic image
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