Combined analysis of cardiac output and CVP changes remains the best way to titrate fluid administration in shocked patients

Vallée, Fabrice; Mari, Arnaud; Perner, Anders; Vallet, B.

doi:10.1007/s00134-010-1831-7

Cited by 8 publications

(3 citation statements)

References 18 publications

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“…A recent analysis by Vallee F shows that increase in thermodilution CO following a fluid bolus can predict fluid responsiveness [26]. The invasive techniques such as PiCCO, Vigileo, and arterial BP transducer are widely used in ICU to assess the patients' volume statue.…”

Section: Specificity (95% Ci)mentioning

confidence: 99%

Meta-Analysis of Invasive versus Non-Invasive Techniques to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill

Xiang¹,

Cao²,

Wu³

et al. 2016

IJCM

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Objective: To analyze the accuracy and specificity of recent studies to compare the ability of predicting fluid responsiveness with Passive Leg Raising (PLR) by using invasive or non-invasive techniques during passive leg raising. Data Sources: MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews were systematically searched. Study Selection: Clinical trials that reported the sensitivity, specificity and area under the receiver operating characteristic curve (AUC) between the responder and non-responder induced by passive leg raising and Volume Expansion (VE) in critical ill patients were selected. 246 studies were screened, 14 studies were included for data extraction, which met our inclusion criteria. Data Extraction: Data were abstracted on study characteristics, patient population, type and amount of VE, time of VE, definition of responders, position, techniques used for measuring hemodynamic change, number and percentage of responders, the correlation coefficient, sensitivity, specificity, best threshold and area under the ROC curve (AUC). Meta-analytic techniques were used to summarize the data. Data Synthesis: A total of 524 critical ill patients from 14 studies were analyzed. Data are reported as point estimate (95% confidence intervals). The pooled sensitivity and specificity of invasive techniques were 80% (73% -85%) and 89% (84% -93%) respectively with the area under the sROC of 0.94. While, the pooled sensitivity and specificity of non-invasive techniques were 88% (84% -92%) and 91% (86% -94%) respectively with the area under the sROC of 0.95. The pooled DOR of invasive techniques was 32.2 (13.6 -76.8), which was much lower than that of non-invasive techniques with the value of 64.3 (33.9 -121.7). Conclusions: The hemodynamic indexes changes induced by PLR could reliably predict fluid responsiveness. Non-invasive hemodynamic techniques with their accuracy and safety can benefit the daily work in ICUs. Because the numHow to cite this paper:

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Section: Specificity (95% Ci)mentioning

confidence: 99%

Meta-Analysis of Invasive versus Non-Invasive Techniques to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill

Xiang¹,

Cao²,

Wu³

et al. 2016

IJCM

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show abstract

“…However, one limitation of such indices is the need for impractical and/or infeasible invasive devices. Thus, there is an increasing need for less invasive approaches [ 18 ]. These may include bedside ultrasound measurements such as variation in inferior vena cava dimensions and Doppler measurements of the left ventricular outflow tract (LVOT) as a stroke volume surrogate.…”

Section: Introductionmentioning

confidence: 99%

Usefulness of the velocity–time integral of the left ventricular outflow tract variability index to predict fluid responsiveness in patients undergoing cardiac surgery

Pérez-Manjarrez,

García-Cruz,

Gopar-Nieto

et al. 2023

Echo Res Pract

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Background Haemodynamic monitoring of patients after cardiac surgery using echocardiographic evaluation of fluid responsiveness is both challenging and increasingly popular. We evaluated fluid responsiveness in the first hours after surgery by determining the variability of the velocity–time integral of the left ventricular outflow tract (VTI-LVOT). Methods We conducted a cross-sectional study of 50 consecutive adult patients who underwent cardiac surgery and in whom it was possible to obtain VTI-LVOT measurements. We then determined the variability and correlations with our pulse pressure variation (PPV) measurements to predict fluid responsiveness. Results A strong positive correlation was seen between the VTI-LVOT variability index absolute values and PPV for predicting fluid responsiveness in the first hours after cardiac surgery. We also found that the VTI-LVOT variability index has high specificity and a high positive likelihood ratio compared with the gold standard using a cut-off point of ≥ 12%. Conclusions The VTI-LVOT variability index is a valuable tool for determining fluid responsiveness during the first 6 postoperative hours in patients undergoing cardiac surgery.

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“…CVP gives an indication of the interaction between heart and venous return [9]. Hence, the change of CVP and cardiac output (CO) should be combined to titrate fluid administration in septic patients [10,11], minimal changes in CVP with increases in CO could indicate fluid responsiveness. Besides, since the CVP is the backpressure to extrathoracic organs, CVP can be used as a safety variable during the fluid challenge [12].…”

Section: Introductionmentioning

confidence: 99%

Measurement of central venous pressure is associated with better outcomes in septic patients: a retrospective observational study

Chen

Zhu

Zhao

et al. 2020

Preprint

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Purpose: With the proper insights, measurement of central venous pressure (CVP) can be a useful clinical aid. However, the formal utility of CVP measurement on mortality in septic patients has never been proved.Methods: The Medical Information Mart for Intensive Care III (MIMIC-III) was applied to identify septic patients who had and did not have CVP measured. The primary outcome was 28-day mortality. The statistical approaches including multivariate regression, propensity score matching (PSM) and an inverse probability of treatment weighing (IPTW) and causal mediation analysis (CMA) were utilized to elucidate the relationship between CVP measurement and 28-day mortality.Results: A total of 10275 patients were included in our study, of which 4516 patients (44%) had CVP measured within 24 h after ICU admission. A significant beneficial effect of CVP measurement in terms of 28-day mortality was observed (OR 0.60 (95% CI 0.51–0.70; p<0.001)). Patients in CVP group received more fluid on day 1, had a shorter duration of mechanical ventilation and vasopressor use, and the reduction of serum lactate was higher than that in the no CVP group. The mediation effect of serum lactate reduction was significant for the whole cohort (p=0.04 for average causal mediation effect (ACME)) and patients in the CVP group with an initial CVP level below 8mmHg (p=0.04 for ACME).Conclusion: CVP measurement is associated with a lower risk-adjusted 28-day mortality among patients with sepsis, which is proportionally mediated through serum lactate reduction.

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Combined analysis of cardiac output and CVP changes remains the best way to titrate fluid administration in shocked patients

Cited by 8 publications

References 18 publications

Meta-Analysis of Invasive versus Non-Invasive Techniques to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill

Meta-Analysis of Invasive versus Non-Invasive Techniques to Predict Fluid Responsiveness by Passive Leg Raising in the Critically Ill

Usefulness of the velocity–time integral of the left ventricular outflow tract variability index to predict fluid responsiveness in patients undergoing cardiac surgery

Measurement of central venous pressure is associated with better outcomes in septic patients: a retrospective observational study

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