title: Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta-analysis.
abstract: BACKGROUND
  Dynamic indices of preload have been shown to better predict fluid responsiveness than static variables in mechanically ventilated adults. In children, dynamic predictors of fluid responsiveness have not yet been extensively studied.
  
  
  OBJECTIVE
  To evaluate the diagnostic accuracy of respiratory variation in aortic blood flow peak velocity (ΔVPeak) for the prediction of fluid responsiveness in mechanically ventilated children.
  
  
  METHODS
  PubMed, Embase, and the Cochrane Database of Systematic Reviews were screened for studies relevant to the use of ΔVPeak to predict fluid responsiveness in children receiving mechanical ventilation. Clinical trials published as full-text articles in indexed journals without language restriction were included. We calculated the pooled values of sensitivity, specificity, diagnostic odds ratio (DOR), and positive and negative likelihood ratio using a random-effects model.
  
  
  RESULTS
  In total, six studies (163 participants) met the inclusion criteria. Data are reported as point estimate with 95% confidence interval. The pooled sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and DOR of ΔVPeak to predict fluid responsiveness for the overall population were 92.0% (84.1-96.7), 85.5% (75.6-92.5), 4.89 (2.92-8.18), 0.13 (0.07-0.25), and 50.44 (17.70-143.74), respectively. The area under the summary receiver operating characteristic curve was 0.94. Cutoff values for ΔVPeak to predict fluid responsiveness varied across studies, ranging from 7% to 20%.
  
  
  CONCLUSIONS
  Our results confirm that the ΔVPeak is an accurate predictor of fluid responsiveness in children under mechanical ventilation. However, the question of the optimal cutoff value of ΔVPeak to predict fluid responsiveness remains uncertain, as there are important variations between original publications, and needs to be resolved in further studies. The potential impact of intraoperative cardiac output optimization using goal-directed fluid therapy based on ΔVPeak on the perioperative outcome in the pediatric population should be subsequently evaluated.
authors.affiliation: Department of Pediatric Anesthesia and Intensive Care Medicine, Femme Mère Enfant Teaching Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: François-Pierrick
authors.initials: FP
authors.lastname: Desgranges
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Sauvegarde Clinic, Claude Bernard Lyon 1 University, EA4169, SFR Lyon-Est Santé - INSERM US 7- CNRS UMS 3453, Lyon, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Desebbe
authors.affiliation: Department of Anesthesia, Montauban Hospital, Montauban, France.|Laboratory of Physics, Ecole Normale Supérieure de Lyon, Lyon, France.|Oeste Paulista University (UNOESTE), Presidente Prudente, São Paulo, Brasil.
authors.forename: Edmundo
authors.initials: E
authors.lastname: Pereira de Souza Neto
authors.affiliation: Department of Anesthesia and Perioperative Care, School of Medicine, University of California Irvine, Orange, CA, USA.
authors.forename: Darren
authors.initials: D
authors.lastname: Raphael
authors.affiliation: Department of Pediatric Anesthesia and Intensive Care Medicine, Femme Mère Enfant Teaching Hospital, Hospices Civils de Lyon, Claude Bernard Lyon 1 University, Lyon, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Chassard
mesh_terms: D001011:Aorta / Q000502:physiology*; D001783:Blood Flow Velocity / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D005440:Fluid Therapy; D006801:Humans; D007223:Infant; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D015656:Respiratory Mechanics / Q000502:physiology*; D012680:Sensitivity and Specificity
keywords: blood flow velocity; cardiac output; child; fluid therapy; hemodynamics