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

• Published in: Journal of clinical anesthesia 2024-10, Vol.97, p.111545-111545, Article 111545
• Main Authors: Li, Lu, MD, Du, Li, MD, Chen, Guo, MD, PhD, Zhang, Weiyi, MD, Du, Bin, MD, Zhang, Lu, MD, PhD, Zheng, Jianqiao, MD, PhD
• Format: Article
• Language: English
• Subjects: Accuracy; Anesthesia; Clinical trials; Continuous positive airway pressure; Fluid responsiveness; Fluid Therapy - methods; Hemodynamics; Humans; Intensive care; Keywords; Li Du; Lung recruitment maneuver; meta-analysis; Pain Medicine; Patients; Perioperative care; Respiration, Artificial - methods; Respiration, Artificial - statistics & numerical data; Sensitivity analysis; Sensitivity and Specificity; Stroke; Stroke Volume - physiology; Stroke volume variation; Systematic review; Ventilation; Ventilators
• ISSN: 0952-8180; 1873-4529; 1873-4529
• DOI: 10.1016/j.jclinane.2024.111545

AbstractStudy objectiveThe 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. MethodsA 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. ResultsA 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. ConclusionsBased 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.