Stroke volume variation induced by lung recruitment maneuver to predict fluid responsiveness in patients receiving mechanical ventilation: A systematic review and meta-analysis

IF 5 2区医学 Q1 ANESTHESIOLOGY Journal of Clinical Anesthesia Pub Date : 2024-07-05 DOI:10.1016/j.jclinane.2024.111545

Lu Li MD , Li Du MD , Guo Chen MD, PhD , Weiyi Zhang MD , Bin Du MD , Lu Zhang MD, PhD , Jianqiao Zheng MD, PhD

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Abstract

Study objective

The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSV_LRM) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis.

Methods

A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve.

Results

A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77–0.90) and 0.79 (95% CI, 0.70–0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62–64.34) and 0.90 (95% CI, 0.87–0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50–8.18) and 0.19 (95% CI, 0.11–0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively.

Conclusions

Based on the currently available evidence, ΔSV_LRM has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSV_LRM in predicting fluid responsiveness.

PROSPERO registration number: CRD42023490598.

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预测机械通气患者输液反应性的肺募集操作引起的冲程容积变化：系统回顾和荟萃分析

研究目的本研究旨在通过系统综述和荟萃分析，评估肺募集机动诱导的每搏容量变异（ΔSVLRM）在预测机械通气成人患者输液反应性方面的准确性。方法在PubMed、Web of Science、Cochrane Library、Ovid Medline、Embase和中文数据库（包括中国知网、万方和VIP数据库）中对相关文献进行了全面的电子检索。数据分析采用 Review Manager 5.4、Meta-DiSc 1.4 和 STATA 16.0，质量评估采用 QUADAS-2 工具。对所选研究的数据进行汇总，以获得敏感性、特异性、阳性和阴性的诊断可能性比（DLR）、诊断几率比（DOR）和汇总接收者操作特征曲线。每项纳入研究的偏倚风险和适用性均较低，且不存在明显的发表偏倚。非阈值效应存在中度到严重的异质性，但阈值效应不存在异质性。综合灵敏度和特异性分别为 0.84（95% CI，0.77-0.90）和 0.79（95% CI，0.70-0.86）。DOR和曲线下面积（AUC）分别为22.15（95%CI，7.62-64.34）和0.90（95%CI，0.87-0.92）。DLR的阳性和阴性预测值分别为4.53（95% CI，2.50-8.18）和0.19（95% CI，0.11-0.35）。Fagan提名图显示，在检测前概率为52%的情况下，阳性和阴性检测的检测后概率分别达到83%和17%。结论根据现有证据，ΔSVLRM对预测接受机械通气的成人患者的液体反应性具有良好的诊断价值。鉴于已发表数据的异质性和局限性，需要进一步开展大样本量和不同临床环境的研究，以确认ΔSVLRM 在预测输液反应性方面的诊断价值：CRD42023490598。

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来源期刊

Journal of Clinical Anesthesia 医学-麻醉学

CiteScore

7.40

自引率

4.50%

发文量

346

审稿时长

23 days

期刊介绍： The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained. The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.