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Reliability of pulse pressure and stroke volume variation in assessing fluid responsiveness in the operating room: a metanalysis and a metaregression.
Messina, Antonio; Caporale, Mariagiovanna; Calabrò, Lorenzo; Lionetti, Giulia; Bono, Daniele; Matronola, Guia Margherita; Brunati, Andrea; Frassanito, Luciano; Morenghi, Emanuela; Antonelli, Massimo; Chew, Michelle S; Cecconi, Maurizio.
Affiliation
  • Messina A; Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy. antonio.messina@humanitas.it.
  • Caporale M; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy. antonio.messina@humanitas.it.
  • Calabrò L; Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
  • Lionetti G; Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy.
  • Bono D; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
  • Matronola GM; Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy.
  • Brunati A; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
  • Frassanito L; Department of Anaesthesia and Intensive Care Medicine, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089, Rozzano - Milan, Italy.
  • Morenghi E; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
  • Antonelli M; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
  • Chew MS; Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy.
  • Cecconi M; Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario 'A. Gemelli' IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Crit Care ; 27(1): 431, 2023 11 08.
Article in En | MEDLINE | ID: mdl-37940953
BACKGROUND: Pulse pressure and stroke volume variation (PPV and SVV) have been widely used in surgical patients as predictors of fluid challenge (FC) response. Several factors may affect the reliability of these indices in predicting fluid responsiveness, such as the position of the patient, the use of laparoscopy and the opening of the abdomen or the chest, combined FC characteristics, the tidal volume (Vt) and the type of anesthesia. METHODS: Systematic review and metanalysis of PPV and SVV use in surgical adult patients. The QUADAS-2 scale was used to assess the risk of bias of included studies. We adopted a metanalysis pooling of aggregate data from 5 subgroups of studies with random effects models using the common-effect inverse variance model. The area under the curve (AUC) of pooled receiving operating characteristics (ROC) curves was reported. A metaregression was performed using FC type, volume, and rate as independent variables. RESULTS: We selected 59 studies enrolling 2,947 patients, with a median of fluid responders of 55% (46-63). The pooled AUC for the PPV was 0.77 (0.73-0.80), with a mean threshold of 10.8 (10.6-11.0). The pooled AUC for the SVV was 0.76 (0.72-0.80), with a mean threshold of 12.1 (11.6-12.7); 19 studies (32.2%) reported the grey zone of PPV or SVV, with a median of 56% (40-62) and 57% (46-83) of patients included, respectively. In the different subgroups, the AUC and the best thresholds ranged from 0.69 and 0.81 and from 6.9 to 11.5% for the PPV, and from 0.73 to 0.79 and 9.9 to 10.8% for the SVV. A high Vt and the choice of colloids positively impacted on PPV performance, especially among patients with closed chest and abdomen, or in prone position. CONCLUSION: The overall performance of PPV and SVV in operating room in predicting fluid responsiveness is moderate, ranging close to an AUC of 0.80 only some subgroups of surgical patients. The grey zone of these dynamic indices is wide and should be carefully considered during the assessment of fluid responsiveness. A high Vt and the choice of colloids for the FC are factors potentially influencing PPV reliability. TRIAL REGISTRATION: PROSPERO (CRD42022379120), December 2022. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=379120.
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Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Operating Rooms / Hemodynamics Type of study: Systematic_reviews Limits: Adult / Humans Language: En Journal: Crit Care Year: 2023 Type: Article Affiliation country: Italy

Full text: 1 Collection: 01-internacional Database: MEDLINE Main subject: Operating Rooms / Hemodynamics Type of study: Systematic_reviews Limits: Adult / Humans Language: En Journal: Crit Care Year: 2023 Type: Article Affiliation country: Italy