by Xiaoying Wang,
Shuai Liu, Ju Gao, Yang Zhang and Tianfeng Huang
Critical Care volume 27,
Article number: 45 (2023)
Background
Pulse pressure variation (PPV) has been widely used in
hemodynamic assessment. Nevertheless, PPV is limited in low tidal volume
ventilation. We conducted this systematic review and meta-analysis to evaluate
whether the tidal volume challenge (TVC) could improve the feasibility of PPV
in patients ventilated at low tidal volumes.
Methods
PubMed, Embase and Cochrane Library inception to October
2022 were screened for diagnostic researches relevant to the predictability of
PPV change after TVC in low tidal volume ventilatory patients. Summary
receiving operating characteristic curve (SROC), pooled sensitivity and
specificity were calculated. Subgroup analyses were conducted for possible
influential factors of TVC.
Results
Ten studies with a total of 429 patients and 457
measurements were included for analysis. The predictive performance of PPV was
significantly lower than PPV change after TVC in low tidal volume, with mean
area under the receiving operating characteristic curve (AUROC) of 0.69 ± 0.13
versus 0.89 ± 0.10. The SROC of PPV change yielded an area under the curve of
0.96 (95% CI 0.94, 0.97), with overall pooled sensitivity and specificity of
0.92 (95% CI 0.83, 0.96) and 0.88 (95% CI 0.76, 0.94). Mean and median cutoff
value of the absolute change of PPV (△PPV) were 2.4% and 2%, and that of
the percentage change of PPV (△PPV%) were 25% and 22.5%. SROC of
PPV change in ICU group, supine or semi-recumbent position group, lung
compliance less than 30 cm H2O group, moderate positive end-expiratory pressure
(PEEP) group and measurements devices without transpulmonary thermodilution
group yielded 0.95 (95%0.93, 0.97), 0.95 (95% CI 0.92, 0.96), 0.96 (95% CI
0.94, 0.97), 0.95 (95% CI 0.93, 0.97) and 0.94 (95% CI 0.92, 0.96) separately.
The lowest AUROCs of PPV change were 0.59 (95% CI 0.31, 0.88) in prone position
and 0.73 (95% CI 0.60, 0.84) in patients with spontaneous breathing activity.
Conclusions
TVC is capable to help PPV overcome limitations in low tidal
volume ventilation, wherever in ICU or surgery. The accuracy of TVC is not
influenced by reduced lung compliance, moderate PEEP and measurement tools, but
TVC should be cautious applied in prone position and patients with spontaneous
breathing activity.
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