Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness

Oulego-Erróz, Ignacio; Terroba-Seara, Sandra; Alonso-Quintela, Paula; Rodrı́guez-Núñez, Antonio

doi:10.1097/pcc.0000000000002628

Cited by 10 publications

(8 citation statements)

References 48 publications

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“…In addition, serial echocardiography may help to better titrate the dose of vasoactive drugs or re ne other aspects of hemodynamic management such as potential deleterious effect of mechanical ventilation. [41] In our sensitivity analysis excluding infants exposed to hemodynamic interventions that may have been triggered by the use of early ECHO, the risk of IVH or death was not lower in the intervention group, which suggests that the sum of cointerventions and not only inotropes played a role in the observed reduction of IVH. Notably, the main difference between the present study and previous LSBF trials is that we assessed the effect of exposure to echocardiography instead of exposure to inotropes.…”

Section: Discussionmentioning

confidence: 72%

Association Between Early Echocardiography Screening and Intraventricular Hemorrhage in Preterm Infants: A Prospective Observational Multicenter Study

Terroba-Seara,

Oulego-Erroz,

Palanca-Arias

et al. 2023

Preprint

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Purpose:To determine whether the application of a protocolized early echocardiographic screening for low systemic blood flow and guided inotropic therapy is associated with reduced intraventricular hemorrhage in preterm infants. Methods: Prospective, observational multicenter study between September 2020 and September 2021 in nine neonatal intensive care units. Preterm infants below 33 weeks of gestational age were eligible. The exposure variable was early targeted neonatal echocardiography screening for low systemic blood flow. Five of the centers performed early screening and guided inotrope therapy (intervention group), and 4 centers did not (control group). Our main outcome was >grade II intraventricular hemorrhage or death within the first 7 days of life. Inverse probability of treatment weighting based on the propensity score accounting for the clustered nature of data was used for the main analysis. Results: 332 preterm infants (131 in the intervention group and 201 in thecontrol group) were included. Protocolized early echocardiography screening for low systemic blood flow and guided inotropic treatment was associated with a significant reduction in > grade II intraventricular hemorrhage or early death (odds ratio 0.285 (95% CI: 0.133-0.611); p=0.001) Conclusions: Early echocardiography screening for low systemic blood flow and guided inotropic treatment may reduce the incidence of intraventricular hemorrhage in preterm infants.

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Section: Discussionmentioning

confidence: 72%

Association Between Early Echocardiography Screening and Intraventricular Hemorrhage in Preterm Infants: A Prospective Observational Multicenter Study

Terroba-Seara,

Oulego-Erroz,

Palanca-Arias

et al. 2023

Preprint

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“…Nevertheless, this study found that whether the cutoff value of 10% or 15% was used, it did not significantly impact the sensitivity or specificity of the test. Regarding concurrent medication use, there were 11 studies which used vasoactive drugs such as dopamine, milrinone, adrenaline, and norepinephrine (18–20, 23, 24, 26–31). Inotropic and vasoactive drugs could affect contractility of the heart, the systemic vascular resistance, the pulmonic vascular resistance, and the venous return, depending on the mechanisms of action of each drug (35–38).…”

Section: Discussionmentioning

confidence: 99%

Aortic Peak Flow Velocity As a Predictor of Fluid Responsiveness in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis

Sethasathien

Jariyasakoolroj

Silvilairat

et al. 2023

Pediatric Critical Care Medicine

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Objectives: This meta-analysis aimed to determine the accuracy of the respiratory variations in aortic peak flow velocity (delta Vpeak) in predicting fluid responsiveness and the moderators of that accuracy. Data Sources: We performed searches for studies that used delta Vpeak as a predictor of fluid responsiveness in mechanically ventilated children in PubMed, Embase, Scopus, and CINAHL from inception to June 20, 2022. Study Selection and Data Extraction: Fifteen studies (n = 452) were included in this meta-analysis. The diagnostic test data of the included studies were synthesized as pooled sensitivity, specificity, and diagnostic odds ratio (DOR) and the area under the curve (AUC) of the summary receiver operating characteristic of delta Vpeak. Data Synthesis: The delta Vpeak cutoff values applied in these studies had a median of 12.3% (interquartile range, 11.50–13.25%). The pooled sensitivity and specificity of delta Vpeak were 0.80 (95% CI, 0.71–0.87) and 0.82 (95% CI, 0.75–0.87), respectively. The DOR of delta Vpeak was 23.41 (95% CI, 11.61–47.20). The AUC of delta Vpeak was 0.87. Subgroup analyses revealed that the accuracy of delta Vpeak was not moderated by ventilator settings, measures of delta Vpeak, gold standard index, the cutoff gold standard value of responders, type and volume of fluid, duration of fluid challenge, use of vasoactive drugs, general anesthesia, and cardiopulmonary bypass. Conclusions: By using the cutoff of approximately 12.3%, the delta Vpeak appears to have good accuracy in predicting fluid responsiveness in mechanically ventilated children. The moderators of delta Vpeak predictability are not found.

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“…Systolic blood pressure (SBP) response was discussed in even fewer articles (10/62, 16%), and only 20% of these articles (2/10, 20%) found a significant increase in SBP post-bolus. Only three articles assessed clinical response outside of blood pressure (n = 3/62, 5%) (39)(40)(41). Of this small sample, clinical response was assessed only through laboratory values (lactate, central venous oxygenation, base excess).…”

Section: Descriptive Summarymentioning

confidence: 99%

Performance of Tools and Measures to Predict Fluid Responsiveness in Pediatric Shock and Critical Illness: A Systematic Review and Meta-Analysis*

Walker

Winters

Schauer

et al. 2023

Pediatric Critical Care Medicine

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Objectives: In this systematic review and meta-analysis we asked: Do predictors of fluid responsiveness in children perform comparably: 1) in the PICU as in non-PICU settings? 2) in shock states compared with nonshock states? Additionally, 3) is there an association between preload responsiveness and clinical response? Data Sources: Ovid Medline, PubMed, and Embase databases were searched from inception through May 2022. Study Selection: Included studies reported physiological response to IV fluid administration in humans less than 18 years. Only studies reporting an area under the receiver operating characteristic curve (AUROC) were included for descriptive analysis. Only studies for which a se could be estimated were included for meta-analysis. Data Extraction: Title, abstract, full text screening, and extraction were completed by two authors (S.B.W., J.M.W.). Variables extracted included predictors (“tools”) and outcome measures (“reference tests”) of fluid responsiveness, demographic, and clinical variables. Data Synthesis: We identified 62 articles containing 204 AUROCs for 55 tools, primarily describing mechanically ventilated children in an operating room or PICU. Meta-analysis across all tools showed poor predictive performance (AUROC, 0.66; 95% CI, 0.63–0.69), although individual performance varied greatly (range, 0.49–0.87). After controlling for PICU setting and shock state, PICU setting was associated with decreased predictive performance (coefficient, –0.56; p = 0.0007), while shock state was associated with increased performance (0.54; p = 0.0006). Effect of PICU setting and shock state on each tool was not statistically significant but analysis was limited by sample size. The association between preload responsiveness and clinical response was rarely studied but results did not suggest an association. Ultrasound measurements were prone to inherent test review and incorporation biases. Conclusions: We suggest three opportunities for further research in fluid responsiveness in children: 1) assessing predictive performance of tools during resuscitation in shock states; 2) separating predictive tool from reference test when using ultrasound techniques; and 3) targeting decreasing time in a shock state, rather than just increase in preload.

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Respiratory Variation in Aortic Blood Flow Velocity in Hemodynamically Unstable, Ventilated Neonates: A Pilot Study of Fluid Responsiveness

Abstract: To assess whether respiratory variation in aortic blood flow peak velocity can predict preload responsiveness in mechanically ventilated and hemodynamically unstable neonates.

Cited by 10 publications

References 48 publications

Association Between Early Echocardiography Screening and Intraventricular Hemorrhage in Preterm Infants: A Prospective Observational Multicenter Study

Association Between Early Echocardiography Screening and Intraventricular Hemorrhage in Preterm Infants: A Prospective Observational Multicenter Study

Aortic Peak Flow Velocity As a Predictor of Fluid Responsiveness in Mechanically Ventilated Children: A Systematic Review and Meta-Analysis

Performance of Tools and Measures to Predict Fluid Responsiveness in Pediatric Shock and Critical Illness: A Systematic Review and Meta-Analysis*

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