Desgranges François-Pierrick, Desebbe Olivier, Pereira de Souza Neto Edmundo, Raphael Darren, Chassard Dominique
Department of Pediatric Anesthesia and Intensive Care Medicine, Femme Mère Enfant Teaching Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France.
Department of Anesthesia and Intensive Care Medicine, Sauvegarde Clinic, Claude Bernard Lyon 1 University, EA4169, SFR Lyon-Est Santé - INSERM US 7- CNRS UMS 3453, Lyon, France.
Paediatr Anaesth. 2016 Jan;26(1):37-47. doi: 10.1111/pan.12803. Epub 2015 Nov 6.
Dynamic indices of preload have been shown to better predict fluid responsiveness than static variables in mechanically ventilated adults. In children, dynamic predictors of fluid responsiveness have not yet been extensively studied.
To evaluate the diagnostic accuracy of respiratory variation in aortic blood flow peak velocity (ΔVPeak) for the prediction of fluid responsiveness in mechanically ventilated children.
PubMed, Embase, and the Cochrane Database of Systematic Reviews were screened for studies relevant to the use of ΔVPeak to predict fluid responsiveness in children receiving mechanical ventilation. Clinical trials published as full-text articles in indexed journals without language restriction were included. We calculated the pooled values of sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio using a random-effects model.
In total, six studies (163 participants) met the inclusion criteria. Data are reported as point estimate with 95% confidence interval. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of ΔVPeak to predict fluid responsiveness for the overall population were 92.0% (84.1-96.7), 85.5% (75.6-92.5), 4.89 (2.92-8.18), 0.13 (0.07-0.25), and 50.44 (17.70-143.74), respectively. The area under the summary receiver operating characteristic curve was 0.94. Cutoff values for ΔVPeak to predict fluid responsiveness varied across studies, ranging from 7% to 20%.
Our results confirm that the ΔVPeak is an accurate predictor of fluid responsiveness in children under mechanical ventilation. However, the question of the optimal cutoff value of ΔVPeak to predict fluid responsiveness remains uncertain, as there are important variations between original publications, and needs to be resolved in further studies. The potential impact of intraoperative cardiac output optimization using goal-directed fluid therapy based on ΔVPeak on the perioperative outcome in the pediatric population should be subsequently evaluated.
在机械通气的成年人中，与静态变量相比，前负荷动态指标能更好地预测液体反应性。在儿童中，液体反应性的动态预测指标尚未得到广泛研究。
评估主动脉血流峰值速度呼吸变异（ΔVPeak）对机械通气儿童液体反应性预测的诊断准确性。
检索PubMed、Embase和Cochrane系统评价数据库，查找与使用ΔVPeak预测机械通气儿童液体反应性相关的研究。纳入在索引期刊上发表的全文文章形式的临床试验，无语言限制。我们使用随机效应模型计算敏感性、特异性、诊断比值比（DOR）以及阳性和阴性似然比的合并值。
共有6项研究（163名参与者）符合纳入标准。数据以点估计值及95%置信区间报告。ΔVPeak预测总体人群液体反应性的合并敏感性、特异性、阳性似然比、阴性似然比和DOR分别为92.0%（84.1 - 96.7）、85.5%（75.6 - 92.5）、4.89（2.92 - 8.18）、0.13（0.07 - 0.25）和50.44（17.70 - 143.74）。汇总受试者工作特征曲线下面积为0.94。不同研究中预测液体反应性的ΔVPeak截断值有所不同，范围为7%至20%。
我们的结果证实，ΔVPeak是机械通气儿童液体反应性的准确预测指标。然而，由于原始研究之间存在重要差异，ΔVPeak预测液体反应性的最佳截断值问题仍不确定，需要在进一步研究中解决。随后应评估基于ΔVPeak的目标导向液体治疗在术中优化心输出量对儿科人群围手术期结局的潜在影响。
