Abstract
OBJECTIVES: In this systematic review and meta-Analysis we asked: Do predictors of fluid responsiveness in children perform comparably: 1) in the PICU as in non-PICU settings? 2) in shock states compared with nonshock states? Additionally, 3) is there an association between preload responsiveness and clinical response? DATA SOURCES: Ovid Medline, PubMed, and Embase databases were searched from inception through May 2022. STUDY SELECTION: Included studies reported physiological response to IV fluid administration in humans less than 18 years. Only studies reporting an area under the receiver operating characteristic curve (AUROC) were included for descriptive analysis. Only studies for which a se could be estimated were included for meta-Analysis. DATA EXTRACTION: Title, abstract, full text screening, and extraction were completed by two authors (S.B.W., J.M.W.). Variables extracted included predictors ("tools") and outcome measures ("reference tests") of fluid responsiveness, demographic, and clinical variables. DATA SYNTHESIS: We identified 62 articles containing 204 AUROCs for 55 tools, primarily describing mechanically ventilated children in an operating room or PICU. Meta-Analysis across all tools showed poor predictive performance (AUROC, 0.66; 95% CI, 0.63-0.69), although individual performance varied greatly (range, 0.49-0.87). After controlling for PICU setting and shock state, PICU setting was associated with decreased predictive performance (coefficient,-0.56; p = 0.0007), while shock state was associated with increased performance (0.54; p = 0.0006). Effect of PICU setting and shock state on each tool was not statistically significant but analysis was limited by sample size. The association between preload responsiveness and clinical response was rarely studied but results did not suggest an association. Ultrasound measurements were prone to inherent test review and incorporation biases. CONCLUSIONS: We suggest three opportunities for further research in fluid responsiveness in children: 1) assessing predictive performance of tools during resuscitation in shock states; 2) separating predictive tool from reference test when using ultrasound techniques; and 3) targeting decreasing time in a shock state, rather than just increase in preload.
Original language | English (US) |
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Pages (from-to) | 24-36 |
Number of pages | 13 |
Journal | Pediatric Critical Care Medicine |
Volume | 25 |
Issue number | 1 |
DOIs | |
State | Published - Jan 1 2024 |
Funding
This article was supported, in part, by the National Institutes of Health’s National Center for Advancing Translational Sciences, Grant Number TL1TR001423 and CTSA grant UL1TR001422. Dr. Walker’s institution received funding from the National Center for Advancing Translational Sciences (TL1TR001423 and Clinical and Translational Science Awards grant UL1TR001422). Dr. Walker received funding from the Fellow Research Scholar Award, Stanley Manne Children’s Research Institute, and Ann & Robert H. Lurie Children’s Hospital of Chicago. Drs. Walker, Schauer, and Murphy received support for article research from the National Institutes of Health. Dr. Winters’ institution received funding from the Fellow Research Scholar Award, Stanley Manne Children’s Research Institute, and Ann & Robert H. Lurie Children’s Hospital of Chicago. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Keywords
- fluid therapy
- pediatric
- predictive value of tests
- receiver operating characteristic curve
- shock treatment
ASJC Scopus subject areas
- Pediatrics, Perinatology, and Child Health
- Critical Care and Intensive Care Medicine