Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness
Abstract Background Bedside functional hemodynamic assessment has gained in popularity in the last years to overcome the limitations of static or dynamic indexes in predicting fluid responsiveness. The aim of this systematic review and metanalysis of studies is to investigate the reliability of the...
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2019-07-01
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Online Access: | http://link.springer.com/article/10.1186/s13054-019-2545-z |
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Article |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Antonio Messina Antonio Dell’Anna Marta Baggiani Flavia Torrini Gian Marco Maresca Victoria Bennett Laura Saderi Giovanni Sotgiu Massimo Antonelli Maurizio Cecconi |
spellingShingle |
Antonio Messina Antonio Dell’Anna Marta Baggiani Flavia Torrini Gian Marco Maresca Victoria Bennett Laura Saderi Giovanni Sotgiu Massimo Antonelli Maurizio Cecconi Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness Critical Care Functional hemodynamic test Fluid responsiveness End-expiratory occlusion test Mini-fluid challenge |
author_facet |
Antonio Messina Antonio Dell’Anna Marta Baggiani Flavia Torrini Gian Marco Maresca Victoria Bennett Laura Saderi Giovanni Sotgiu Massimo Antonelli Maurizio Cecconi |
author_sort |
Antonio Messina |
title |
Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness |
title_short |
Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness |
title_full |
Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness |
title_fullStr |
Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness |
title_full_unstemmed |
Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness |
title_sort |
functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness |
publisher |
BMC |
series |
Critical Care |
issn |
1364-8535 |
publishDate |
2019-07-01 |
description |
Abstract Background Bedside functional hemodynamic assessment has gained in popularity in the last years to overcome the limitations of static or dynamic indexes in predicting fluid responsiveness. The aim of this systematic review and metanalysis of studies is to investigate the reliability of the functional hemodynamic tests (FHTs) used to assess fluid responsiveness in adult patients in the intensive care unit (ICU) and operating room (OR). Methods MEDLINE, EMBASE, and Cochrane databases were screened for relevant articles using a FHT, with the exception of the passive leg raising. The QUADAS-2 scale was used to assess the risk of bias of the included studies. In-between study heterogeneity was assessed through the I 2 indicator. Bias assessment graphs were plotted, and Egger’s regression analysis was used to evaluate the publication bias. The metanalysis determined the pooled area under the receiving operating characteristic (ROC) curve, sensitivity, specificity, and threshold for two FHTs: the end-expiratory occlusion test (EEOT) and the mini-fluid challenge (FC). Results After text selection, 21 studies met the inclusion criteria, 7 performed in the OR, and 14 in the ICU between 2005 and 2018. The search included 805 patients and 870 FCs with a median (IQR) of 39 (25–50) patients and 41 (30–52) FCs per study. The median fluid responsiveness was 54% (45–59). Ten studies (47.6%) adopted a gray zone analysis of the ROC curve, and a median (IQR) of 20% (15–51) of the enrolled patients was included in the gray zone. The pooled area under the ROC curve for the end-expiratory occlusion test (EEOT) was 0.96 (95%CI 0.92–1.00). The pooled sensitivity and specificity were 0.86 (95%CI 0.74–0.94) and 0.91 (95%CI 0.85–0.95), respectively, with a best threshold of 5% (4.0–8.0%). The pooled area under the ROC curve for the mini-FC was 0.91 (95%CI 0.85–0.97). The pooled sensitivity and specificity were 0.82 (95%CI 0.76–0.88) and 0.83 (95%CI 0.77–0.89), respectively, with a best threshold of 5% (3.0–7.0%). Conclusions The EEOT and the mini-FC reliably predict fluid responsiveness in the ICU and OR. Other FHTs have been tested insofar in heterogeneous clinical settings and, despite promising results, warrant further investigations. |
topic |
Functional hemodynamic test Fluid responsiveness End-expiratory occlusion test Mini-fluid challenge |
url |
http://link.springer.com/article/10.1186/s13054-019-2545-z |
work_keys_str_mv |
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doaj-6cb23278c88549fabd30e4cf8c6ce2b52020-11-25T01:58:44ZengBMCCritical Care1364-85352019-07-0123111610.1186/s13054-019-2545-zFunctional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsivenessAntonio Messina0Antonio Dell’Anna1Marta Baggiani2Flavia Torrini3Gian Marco Maresca4Victoria Bennett5Laura Saderi6Giovanni Sotgiu7Massimo Antonelli8Maurizio Cecconi9Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCSDepartment of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione “Policlinico Universitario A. Gemelli”Department of Anesthesiology and Intensive Care Medicine, A.O.U. Maggiore della CaritàDepartment of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione “Policlinico Universitario A. Gemelli”Department of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione “Policlinico Universitario A. Gemelli”Department of Intensive Care Medicine, St George’s University Hospital NHS Foundation TrustClinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU SassariClinical Epidemiology and Medical Statistics Unit, Department of Biomedical Sciences, University of Sassari, Research, Medical Education and Professional Development Unit, AOU SassariDepartment of Anesthesiology and Intensive Care Medicine, Catholic University of the Sacred Heart, Fondazione “Policlinico Universitario A. Gemelli”Department of Anesthesia and Intensive Care Medicine, Humanitas Clinical and Research Center – IRCCSAbstract Background Bedside functional hemodynamic assessment has gained in popularity in the last years to overcome the limitations of static or dynamic indexes in predicting fluid responsiveness. The aim of this systematic review and metanalysis of studies is to investigate the reliability of the functional hemodynamic tests (FHTs) used to assess fluid responsiveness in adult patients in the intensive care unit (ICU) and operating room (OR). Methods MEDLINE, EMBASE, and Cochrane databases were screened for relevant articles using a FHT, with the exception of the passive leg raising. The QUADAS-2 scale was used to assess the risk of bias of the included studies. In-between study heterogeneity was assessed through the I 2 indicator. Bias assessment graphs were plotted, and Egger’s regression analysis was used to evaluate the publication bias. The metanalysis determined the pooled area under the receiving operating characteristic (ROC) curve, sensitivity, specificity, and threshold for two FHTs: the end-expiratory occlusion test (EEOT) and the mini-fluid challenge (FC). Results After text selection, 21 studies met the inclusion criteria, 7 performed in the OR, and 14 in the ICU between 2005 and 2018. The search included 805 patients and 870 FCs with a median (IQR) of 39 (25–50) patients and 41 (30–52) FCs per study. The median fluid responsiveness was 54% (45–59). Ten studies (47.6%) adopted a gray zone analysis of the ROC curve, and a median (IQR) of 20% (15–51) of the enrolled patients was included in the gray zone. The pooled area under the ROC curve for the end-expiratory occlusion test (EEOT) was 0.96 (95%CI 0.92–1.00). The pooled sensitivity and specificity were 0.86 (95%CI 0.74–0.94) and 0.91 (95%CI 0.85–0.95), respectively, with a best threshold of 5% (4.0–8.0%). The pooled area under the ROC curve for the mini-FC was 0.91 (95%CI 0.85–0.97). The pooled sensitivity and specificity were 0.82 (95%CI 0.76–0.88) and 0.83 (95%CI 0.77–0.89), respectively, with a best threshold of 5% (3.0–7.0%). Conclusions The EEOT and the mini-FC reliably predict fluid responsiveness in the ICU and OR. Other FHTs have been tested insofar in heterogeneous clinical settings and, despite promising results, warrant further investigations.http://link.springer.com/article/10.1186/s13054-019-2545-zFunctional hemodynamic testFluid responsivenessEnd-expiratory occlusion testMini-fluid challenge |