Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta‐analysis

Abstract

Our results confirm that the ΔVPeak is an accurate predictor of fluid responsiveness in children under mechanical ventilation. However, the question of the optimal cutoff value of ΔVPeak to predict fluid responsiveness remains uncertain, as there are important variations between original publications, and needs to be resolved in further studies. The potential impact of intraoperative cardiac output optimization using goal-directed fluid therapy based on ΔVPeak on the perioperative outcome in the pediatric population should be subsequently evaluated.

Update on pediatric sepsis: a review

“…The reliability of ΔV peak to predict fluid responsiveness was also confirmed among mechanically ventilated children in another systematic review by Desgranges et al [48]. Unfortunately, so far, the optimal cutoff value of ΔV peak has not been identified to discriminate responders from non-responders because those values ranged from 7 to 20% across six included studies [48]. …”

“…The authors speculated that the difference in efficacy of dynamic variables might be affected by higher chest wall and lung compliance, more compliant arterial vasculature, and lower cardiac ventricular compliance in children compared with adults [47]. The reliability of ΔV peak to predict fluid responsiveness was also confirmed among mechanically ventilated children in another systematic review by Desgranges et al [48]. Unfortunately, so far, the optimal cutoff value of ΔV peak has not been identified to discriminate responders from non-responders because those values ranged from 7 to 20% across six included studies [48].…”

“…It should be noted that children with sepsis accounted for a limited percentage of the participants in these studies [47, 48, 52], so the significance of these dynamic indices has not been clarified yet in the hemodynamic management of pediatric sepsis. Moreover, in both adult and pediatric critical care, the concept that these dynamic indices are more predictable of fluid responsiveness than static hemodynamic parameters would be unchallenged any longer, but it must be taken into consideration that hemodynamic management based on these dynamic indices has never been validated to improve patients’ clinical outcomes so far.…”

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

“…Numerous dynamic parameters such as pulse pressure variation (PPV), systolic pressure variation (SPV), respiratory variation in aortic blood flow peak velocity (ΔVPeak) and Plethysmograph variability index (PVI) were investigated for prediction of fluid responsiveness in children [15]. There is no consensus on their predictive value in children except ΔVPeak [27]. …”

The European Society of Regional Anaesthesia and Pain Therapy/American Society of Regional Anesthesia and Pain Medicine Recommendations on Local Anesthetics and Adjuvants Dosage in Pediatric Regional Anesthesia

“…17,18 The dosage of LAs in children younger than 2 years should be reduced in view of the higher baseline heart rate, which increases vulnerability to cardiac toxicity of LAs. In children younger than 1 year, the risk of systemic toxicity is further enhanced by higher free plasma concentrations of LAs associated with consistently low serum proteins.…”