Abstract
BackgroundWe performed a systematic review and meta-analysis of studies assessing the end-expiratory occlusion test (EEXPO test)-induced changes in cardiac output (CO) measured by any haemodynamic monitoring device, as indicators of preload responsiveness.MethodsMEDLINE, EMBASE and Cochrane Database were screened for original articles. Bivariate random-effects meta-analysis determined the Area under the Summary Receiver Operating Characteristic (AUSROC) curve of EEXPO test-induced changes in CO to detect preload responsiveness, as well as pooled sensitivity and specificity and the best diagnostic threshold.ResultsThirteen studies (530 patients) were included. Nine studies were performed in the intensive care unit and four in the operating room. The pooled sensitivity and the pooled specificity for the EEXPO test-induced changes in CO were 0.85 [0.77–0.91] and 0.88 [0.83–0.91], respectively. The AUSROC curve was 0.91 [0.86–0.94] with the best threshold of CO increase at 5.1 ± 0.2%. The accuracy of the test was not different when changes in CO were monitored through pulse contour analysis compared to other methods (AUSROC: 0.93 [0.91–0.95] vs. 0.87 [0.82–0.96], respectively, p = 0.62). Also, it was not different in studies in which the tidal volume was ≤ 7 mL/kg compared to the remaining ones (AUSROC: 0.96 [0.92–0.97] vs. 0.89 [0.82–0.95] respectively, p = 0.44). Subgroup analyses identified one possible source of heterogeneity.ConclusionsEEXPO test-induced changes in CO reliably detect preload responsiveness. The diagnostic performance is not influenced by the method used to track the EEXPO test-induced changes in CO.Trial registration The study protocol was prospectively registered on PROSPERO: CRD42019138265.
Highlights
We performed a systematic review and meta-analysis of studies assessing the end-expiratory occlusion test (EEXPO test)-induced changes in cardiac output (CO) measured by any haemodynamic monitoring device, as indicators of preload responsiveness
Identification of records Our aim was to identify all studies evaluating the ability of the EEXPO test to predict a significant increase in CO or surrogate compared to the one induced by a subsequent volume expansion or by a passive leg raising (PLR) test
Characteristics of the included studies We identified 13 studies (530 patients) [8, 11,12,13,14,15,16,17,18,19,20,21,22] that reported the ability of the EEXPO test to assess preload responsiveness
Summary
We performed a systematic review and meta-analysis of studies assessing the end-expiratory occlusion test (EEXPO test)-induced changes in cardiac output (CO) measured by any haemodynamic monitoring device, as indicators of preload responsiveness. Over the last 20 years, many dynamic tests were developed and validated to predict whether a fluid bolus will increase cardiac output (CO) significantly [1] They all consist in observing the effects on CO of variations in Gavelli et al Ann. Intensive Care (2020) 10:65 but intra-abdominal hypertension is responsible for some false-negatives [6] and it is not very convenient to perform [7]. No subgroup analysis was performed to look for factors of heterogeneity, whilst some of them might be significant This might be the case, for instance, for the duration of the EEXPO or the technique used to monitor CO [10]. Taking advantage of the large number of patients pooled, we aimed at looking for factors influencing the reliability of the EEXPO test
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