Does stroke volume variation predict fluid responsiveness in children: A systematic review and meta-analysis

Abstract

ObjectiveStroke volume variation (SVV) is a reliable predictor of fluid responsiveness in adult patients. However, the predictive value of SVV is uncertain in pediatric patients. We performed the first systematic meta-analysis to evaluate the diagnostic value of SVV in predicting fluid responsiveness in children.MethodsPUBMED, EMBASE, and Cochrane Central Register of Controlled Trials were searched up to December 2016. Original studies assessing the diagnostic accuracy of SVV in predicting fluid responsiveness in children were considered to be eligible. A random-effects model was used to calculate pooled values of sensitivity, specificity and diagnostic odds ratio with 95% CI. The summary receiver operating characteristic curve was estimated and area under the curve was calculated. Quality of the studies was assessed with the QUADAS-2 tool.ResultsSix studies with a total of 279 fluid boluses in 224 children were included. The analysis demonstrated a pooled sensitivity of 0.68 (95% CI,0.59–0.76), pooled specificity of 0.65 (95% CI, 0.57–0.73), pooled diagnostic odds ratio of 8.24 (95% CI, 2.58–26.30), and the summary area under the summary receiver operating characteristic curve of 0.81. However, significant inter-study heterogeneity was found (p<0.05, I2 = 61.3%), likely due to small sample size and diverse study characteristics.ConclusionsCurrent evidence suggests that SVV was of diagnostic value in predicting fluid responsiveness in children under mechanical ventilation. Given the high heterogeneity of published data, further studies are needed to confirm the diagnostic accuracy of SVV in predicting fluid responsiveness in pediatric patients.

Accuracy of dynamic preload variables for predicting fluid responsiveness in patients with pediatric liver cirrhosis: A prospective study

“…During the measurement of hemodynamic variables, the surgical and anesthetic teams were asked to hold for 1 minute without any stimulation to the patient. Patients were considered SV responders if their SV index increased by at least 15% after the fluid challenge . Because the ability of PPV, SVV, and PVI to predict fluid responsiveness may be affected by liver cirrhosis–induced cardiovascular pathophysiological changes, a subanalysis of the accuracy of the dynamic preload variables was also conducted among patients with less severe liver cirrhosis, defined as a pediatric model of end‐liver disease (PELD) score of <21…”

Hemodynamic monitoring in children with heart disease: Overview of newer technologies

“…Validation of dynamic indictors of filling in children is ongoing, but is complicated by the differences in size, physiology and ventilation practice across age groups. In small cohorts of similar patients, these indicators perform well, but across large heterogeneous populations the aggregate results are less reliable, though still better than the use of the CVP (which approximates a coin toss in its predictive ability in several studies). Clinicians wanting to utilize these metrics in 2019 need to understand them in detail, and the most recent evidence relevant to their pediatric anesthesia practice.…”

Contemporary perioperative haemodynamic monitoring

“…Both invasive arterial wave monitoring and non-invasive stroke volume monitoring permit monitoring of PPV or SVV. Nevertheless, several important issues should be recognized: 1) tidal volume should be at least 8 mL kg -1 ideal body weight [29], 2) though only applicable in passively mechanically ventilated patients, specific triggered ventilatory settings could still reveal PPV [30], 3) absent arrhythmia, 4) spontaneous breathing could hamper proper interpretation, 5) acute cor pulmonale or acute respiratory failure could reduce the impact of intrathoracic pressure changes, 6) open chest mechanical ventilation will greatly abolish intrathoracic pressure swings, 7) in children, as the ages varies, the cardiovascular physiology changes might thereafter affect the value of SVV [31].…”