Sethasathien Saviga, Jariyasakoolroj Theerapon, Silvilairat Suchaya, Srisurapanont Manit
Division of Pediatric Cardiology, Department of Pediatrics, Faculty of Medicine Chiang Mai University, Chiang Mai, Thailand.
Division of Pediatric Critical Care Medicine, Department of Pediatrics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Pediatr Crit Care Med. 2023 Jul 1;24(7):e352-e361. doi: 10.1097/PCC.0000000000003219. Epub 2023 Mar 1.
This meta-analysis aimed to determine the accuracy of the respiratory variations in aortic peak flow velocity (delta Vpeak) in predicting fluid responsiveness and the moderators of that accuracy.
We performed searches for studies that used delta Vpeak as a predictor of fluid responsiveness in mechanically ventilated children in PubMed, Embase, Scopus, and CINAHL from inception to June 20, 2022.
Fifteen studies ( n = 452) were included in this meta-analysis. The diagnostic test data of the included studies were synthesized as pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and the area under the curve (AUC) of the summary receiver operating characteristic of delta Vpeak.
The delta Vpeak cutoff values applied in these studies had a median of 12.3% (interquartile range, 11.50-13.25%). The pooled sensitivity and specificity of delta Vpeak were 0.80 (95% CI, 0.71-0.87) and 0.82 (95% CI, 0.75-0.87), respectively. The DOR of delta Vpeak was 23.41 (95% CI, 11.61-47.20). The AUC of delta Vpeak was 0.87. Subgroup analyses revealed that the accuracy of delta Vpeak was not moderated by ventilator settings, measures of delta Vpeak, gold standard index, the cutoff gold standard value of responders, type and volume of fluid, duration of fluid challenge, use of vasoactive drugs, general anesthesia, and cardiopulmonary bypass.
By using the cutoff of approximately 12.3%, the delta Vpeak appears to have good accuracy in predicting fluid responsiveness in mechanically ventilated children. The moderators of delta Vpeak predictability are not found.
本荟萃分析旨在确定主动脉峰值流速呼吸变化（ΔVpeak）预测液体反应性的准确性及其准确性的调节因素。
我们在PubMed、Embase、Scopus和CINAHL数据库中检索了从建库至2022年6月20日期间使用ΔVpeak作为机械通气儿童液体反应性预测指标的研究。
本荟萃分析纳入了15项研究（n = 452）。将纳入研究的诊断试验数据合并为汇总敏感性、特异性、诊断比值比（DOR）以及ΔVpeak的汇总受试者工作特征曲线下面积（AUC）。
这些研究中应用的ΔVpeak截断值中位数为12.3%（四分位间距，11.50 - 13.25%）。ΔVpeak的汇总敏感性和特异性分别为0.80（95%CI，0.71 - 0.87）和0.82（95%CI，0.75 - 0.87）。ΔVpeak的DOR为23.41（95%CI，11.61 - 47.20）。ΔVpeak的AUC为0.87。亚组分析显示，ΔVpeak的准确性不受呼吸机设置、ΔVpeak测量方法、金标准指标、反应者的截断金标准值、液体类型和容量、液体冲击持续时间、血管活性药物使用、全身麻醉以及体外循环的影响。
采用约12.3%的截断值时，ΔVpeak在预测机械通气儿童液体反应性方面似乎具有良好的准确性。未发现ΔVpeak预测性的调节因素。
