Chaves Renato Carneiro de Freitas, Corrêa Thiago Domingos, Neto Ary Serpa, Bravim Bruno de Arruda, Cordioli Ricardo Luiz, Moreira Fabio Tanzillo, Timenetsky Karina Tavares, de Assunção Murillo Santucci Cesar
Intensive Care Unit, Hospital Israelita Albert Einstein, Av. Albert Einstein, 627/701, 5th Floor, São Paulo, SP, 05651-901, Brazil.
Intensive Care Unit, Hospital Municipal Dr. Moysés Deutsch - M'Boi Mirim, São Paulo, SP, Brazil.
Ann Intensive Care. 2018 Feb 9;8(1):21. doi: 10.1186/s13613-018-0365-y.
Patients who increase stoke volume or cardiac index more than 10 or 15% after a fluid challenge are usually considered fluid responders. Assessment of fluid responsiveness prior to volume expansion is critical to avoid fluid overload, which has been associated with poor outcomes. Maneuvers to assess fluid responsiveness are well established in mechanically ventilated patients; however, few studies evaluated maneuvers to predict fluid responsiveness in spontaneously breathing patients. Our objective was to perform a systematic review of literature addressing the available methods to assess fluid responsiveness in spontaneously breathing patients. Studies were identified through electronic literature search of PubMed from 01/08/2009 to 01/08/2016 by two independent authors. No restrictions on language were adopted. Quality of included studies was evaluated with Quality Assessment of Diagnostic Accuracy Studies tool. Our search strategy identified 537 studies, and 9 studies were added through manual search. Of those, 15 studies (12 intensive care unit patients; 1 emergency department patients; 1 intensive care unit and emergency department patients; 1 operating room) were included in this analysis. In total, 649 spontaneously breathing patients were assessed for fluid responsiveness. Of those, 340 (52%) were deemed fluid responsive. Pulse pressure variation during the Valsalva maneuver (∆PPV) of 52% (AUC ± SD: 0.98 ± 0.03) and passive leg raising-induced change in stroke volume (∆SV-PLR) > 13% (AUC ± SD: 0.96 ± 0.03) showed the highest accuracy to predict fluid responsiveness in spontaneously breathing patients. Our systematic review indicates that regardless of the limitations of each maneuver, fluid responsiveness can be assessed in spontaneously breathing patients. Further well-designed studies, with adequate simple size and power, are necessary to confirm the real accuracy of the different methods used to assess fluid responsiveness in this population of patients.
在液体负荷试验后，心输出量或心脏指数增加超过10%或15%的患者通常被视为液体反应型患者。在扩容前评估液体反应性对于避免液体过载至关重要，液体过载与不良预后相关。评估液体反应性的方法在机械通气患者中已得到充分确立；然而，很少有研究评估用于预测自主呼吸患者液体反应性的方法。我们的目的是对有关评估自主呼吸患者液体反应性的现有方法的文献进行系统综述。两名独立作者通过对2009年8月1日至2016年8月1日期间PubMed的电子文献检索来识别研究。未采用语言限制。使用诊断准确性研究质量评估工具评估纳入研究的质量。我们的检索策略识别出537项研究，通过手动检索又增加了9项研究。其中，15项研究（12项针对重症监护病房患者；1项针对急诊科患者；1项针对重症监护病房和急诊科患者；1项针对手术室患者）纳入本分析。总共对649名自主呼吸患者进行了液体反应性评估。其中，340名（52%）被判定为液体反应型。瓦尔萨尔瓦动作期间的脉压变异（∆PPV）为52%（AUC±SD：0.98±0.03）以及被动抬腿引起的每搏量变化（∆SV-PLR）>13%（AUC±SD：0.96±0.03）在预测自主呼吸患者液体反应性方面显示出最高准确性。我们的系统综述表明，尽管每种方法都有局限性，但仍可对自主呼吸患者的液体反应性进行评估。需要进一步设计良好、样本量和效能足够的研究来证实用于评估该患者群体液体反应性的不同方法的实际准确性。
