Department of Anaesthesiology and Intensive Care, Catholic University School of Medicine, Largo Gemelli 8, 00168, Rome, Italy.
Intensive Care Med. 2012 Sep;38(9):1429-37. doi: 10.1007/s00134-012-2621-1. Epub 2012 Jun 26.
To systematically review the accuracy of the variation in pulse oxymetry plethysmographic waveform amplitude (∆POP) and the Pleth Variability Index (PVI) as predictors of fluid responsiveness in mechanically ventilated adults.
MEDLINE, Scopus and the Cochrane Database of Systematic Reviews were screened for clinical studies in which the accuracy of ∆POP/PVI in predicting the hemodynamic response to a subsequent fluid bolus had been investigated. Random-effects meta-analysis was used to summarize the results. Data were stratified according to the amount of fluid bolus (large vs. small) and to the study index (∆POP vs. PVI).
Ten studies in 233 patients were included in this meta-analysis. All patients were in normal sinus rhythm. The pooled area under the receiver operating characteristic curve (AUC) for identification of fluid responders was 0.85 [95 % confidence interval (CI) 0.79-0.92]. Pooled sensitivity and specificity were 0.80 (95 % CI 0.74-0.85) and 0.76 (0.68-0.82), respectively. No heterogeneity was found within studies with the same amount of fluid bolus, nor between studies on ∆POP and those on PVI. The AUC was significantly larger in studies with a large bolus amount than in those with a small bolus [0.92 (95 % CI 0.87-0.96) vs. 0.70 (0.62-0.79); p < 0.0001]. Sensitivity and specificity were also higher in studies with a large bolus [0.84 (95 % CI 0.77-0.90) vs. 0.72 (0.60-0.82) (small bolus), p = 0.08 and 0.86 (95 % CI 0.75-0.93) vs. 0.68 (0.56-0.77) (small bolus), p = 0.02], respectively.
Based on our meta-analysis, we conclude that ∆POP and PVI are equally effective for predicting fluid responsiveness in ventilated adult patients in sinus rhythm. Prediction is more accurate when a large fluid bolus is administered.
系统回顾脉搏血氧容积描记波幅度（∆POP）和脉搏变异指数（PVI）变化预测机械通气成人患者液体反应性的准确性。
对 MEDLINE、Scopus 和 Cochrane 系统评价数据库进行了筛选，以寻找研究 ∆POP/PVI 预测随后液体冲击反应准确性的临床研究。采用随机效应荟萃分析对结果进行汇总。根据液体冲击量（大剂量与小剂量）和研究指标（∆POP 与 PVI）对数据进行分层。
本荟萃分析纳入了 10 项共 233 例患者的研究。所有患者均为窦性心律。识别液体反应者的受试者工作特征曲线下面积（AUC）为 0.85 [95%置信区间（CI）0.79-0.92]。汇总敏感性和特异性分别为 0.80（95%CI 0.74-0.85）和 0.76（0.68-0.82）。在使用相同液体冲击量的研究中以及在 ∆POP 研究和 PVI 研究之间均未发现异质性。大剂量液体冲击量研究的 AUC 显著大于小剂量液体冲击量研究 [0.92（95%CI 0.87-0.96）vs. 0.70（0.62-0.79）；p<0.0001]。大剂量液体冲击量研究的敏感性和特异性也更高[0.84（95%CI 0.77-0.90）vs. 0.72（0.60-0.82）（小剂量），p=0.08 和 0.86（95%CI 0.75-0.93）vs. 0.68（0.56-0.77）（小剂量），p=0.02]。
根据我们的荟萃分析，我们得出结论，在窦性心律的机械通气成年患者中，∆POP 和 PVI 预测液体反应性的效果相当。给予大剂量液体冲击时，预测更为准确。
