Yenjabog Patcha, Kanchongkittiphon Wacharoot, Chutipongtanate Somchai, Lertbunrian Rojjanee, Ungprasert Patompong
Division of Pediatric Critical Care, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Division of Allergy and Immunology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Front Pediatr. 2022 Oct 21;10:1010600. doi: 10.3389/fped.2022.1010600. eCollection 2022.
Fluid administration is the initial step of treatment of unstable pediatric patients. Evaluation of fluid responsiveness is crucial in mechanically ventilated children to avoid fluid overload, which increases mortality. We aim to review and compare the diagnostic performance of dynamically hemodynamic parameters for predicting fluid responsiveness in mechanically ventilated children.
A systematic review was performed using four electronic databases, including PubMed, EMBASE, Scopus, and Central, for published articles from 1 January 2010 to 31 December 2020. Studies were included if they described diagnostic performance of dynamic parameters after fluid challenge was performed in mechanically ventilated children.
Pediatric intensive and cardiac intensive care unit, and operative room.
Children aged 1 month to 18 years old who were under mechanical ventilation and required an intravenous fluid challenge.
Twenty-seven studies were included in the systematic review, which included 1,005 participants and 1,138 fluid challenges. Respiratory variation in aortic peak velocity was reliable among dynamic parameters for predicting fluid responsiveness in mechanically ventilated children. All studies of respiratory variation in aortic peak velocity showed that the area under the receiver operating characteristic curve ranged from 0.71 to 1.00, and the cutoff value for determining fluid responsiveness ranged from 7% to 20%. Dynamic parameters based on arterial blood pressure (pulse pressure variation and stroke volume variation) were also used in children undergoing congenital heart surgery. The plethysmography variability index was used in children undergoing neurological and general surgery, including the pediatric intensive care patients.
The respiratory variation in aortic peak velocity exhibited a promising diagnostic performance across all populations in predicting fluid responsiveness in mechanically ventilated children. High sensitivity is advantageous in non-cardiac surgical patients and the pediatric intensive care unit because early fluid resuscitation improves survival in these patients. Furthermore, high specificity is beneficial in congenital heart surgery because fluid overload is particularly detrimental in this group of patients.
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206400.
液体输注是不稳定儿科患者治疗的初始步骤。评估液体反应性对于机械通气儿童至关重要，可避免液体超负荷，因为这会增加死亡率。我们旨在回顾和比较动态血流动力学参数预测机械通气儿童液体反应性的诊断性能。
使用四个电子数据库（包括PubMed、EMBASE、Scopus和Central）对2010年1月1日至2020年12月31日发表的文章进行系统综述。如果研究描述了对机械通气儿童进行液体冲击后动态参数的诊断性能，则纳入研究。
儿科重症监护病房、心脏重症监护病房和手术室。
年龄在1个月至18岁之间、接受机械通气且需要进行静脉液体冲击的儿童。
系统综述纳入了27项研究，包括1005名参与者和1138次液体冲击。在预测机械通气儿童液体反应性的动态参数中，主动脉峰值流速的呼吸变化是可靠的。所有关于主动脉峰值流速呼吸变化的研究表明，受试者工作特征曲线下面积范围为0.71至1.00，确定液体反应性的截断值范围为7%至20%。基于动脉血压的动态参数（脉压变异和每搏量变异）也用于先天性心脏病手术患儿。体积描记法变异指数用于接受神经外科和普通外科手术的儿童，包括儿科重症监护患者。
主动脉峰值流速的呼吸变化在预测机械通气儿童液体反应性方面，在所有人群中均表现出良好的诊断性能。高敏感性在非心脏手术患者和儿科重症监护病房中具有优势，因为早期液体复苏可提高这些患者的生存率。此外，高特异性在先天性心脏病手术中有益，因为液体超负荷对该组患者特别有害。
https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=206400 。
