Haemodynamics, fluids & transfusion
Assessment of fluid responsiveness using pulse pressure variation, stroke volume variation, plethysmographic variability index, central venous pressure, and inferior vena cava variation in patients undergoing mechanical ventilation: a systematic review and meta-analysis
Authors' conclusion
Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC.
Study context
- Population
- Mechanically ventilated patients
- Participants
- 2,711 participants · 69 studies
- Comparison
- PPV vs stroke volume variation (SVV) vs plethysmographic variability index (PVI) vs central venous pressure (CVP) vs ∆IVC for predicting fluid responsiveness
- PPVn = 40 studies
- SVVn = 24 studies
- PVIn = 17 studies
- CVPn = 12 studies
- ∆IVCn = 8 studies
- Outcome
- Mean threshold and AUC for fluid responsiveness
Methodological detailstraditional and Bayesian meta-analysis
- Traditional and Bayesian meta-analysis
Pooled result
As reported in the abstract
| Group | Value | AUC (95% CI) | AUC |
|---|---|---|---|
| PPV | mean threshold 11.5 (95% CI 10.5–12.4) % | 0.87 (0.84-0.90) | |
| SVV | mean threshold 12.1 (95% CI 10.9–13.3) % | 0.87 (0.84-0.91) | |
| PVI | mean threshold 13.8 (interval 12.3–15.3) % | 0.88 (0.82-0.94) | |
| CVP | mean threshold 9.0 (95% CI 7.7–10.1) mmHg | 0.77 (0.69-0.87) | |
| ∆IVC | mean threshold 15.4 (interval 13.3–17.6) % | 0.83 (0.78-0.89) |
Value
PPVmean threshold 11.5 (95% CI 10.5–12.4) %
SVVmean threshold 12.1 (95% CI 10.9–13.3) %
PVImean threshold 13.8 (interval 12.3–15.3) %
CVPmean threshold 9.0 (95% CI 7.7–10.1) mmHg
∆IVCmean threshold 15.4 (interval 13.3–17.6) %
AUC (95% CI)
PPV0.87 (0.84-0.90)
SVV0.87 (0.84-0.91)
PVI— not stated in the abstract
CVP0.77 (0.69-0.87)
∆IVC0.83 (0.78-0.89)
AUC
PPV— not stated in the abstract
SVV— not stated in the abstract
PVI0.88 (0.82-0.94)
CVP— not stated in the abstract
∆IVC— not stated in the abstract
Further pooled results
- Prevalence of fluid responsiveness
- 49.9%
Original publication
Assessment of fluid responsiveness using pulse pressure variation, stroke volume variation, plethysmographic variability index, central venous pressure, and inferior vena cava variation in patients undergoing mechanical ventilation: a systematic review and meta-analysis. Crit Care. Published 31 August 2024. doi:10.
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