• ChavesRenato Carneiro de FreitasRCFDepartment of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.com.Department of Anesthesiology, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.co, BarbasCarmen Silvia ValenteCSVDepartment of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.Department of Pneumology, Instituto do Coração (INCOR), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São , Veronica Neves Fialho Queiroz, Ary Serpa Neto, Rodrigo Octavio Deliberato, Adriano José Pereira, Karina Tavares Timenetsky, João Manoel Silva Júnior, Flávio Takaoka, Daniel de Backer, Leo Anthony Celi, and Thiago Domingos Corrêa.
• Department of Intensive Care, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. chavesrcf@hotmail.com.
• Crit Care. 2024 Aug 31; 28 (1): 289289.

ImportanceManeuvers assessing fluid responsiveness before an intravascular volume expansion may limit useless fluid administration, which in turn may improve outcomes.ObjectiveTo describe maneuvers for assessing fluid responsiveness in mechanically ventilated patients.RegistrationThe protocol was registered at PROSPERO: CRD42019146781.Information Sources And SearchPubMed, EMBASE, CINAHL, SCOPUS, and Web of Science were search from inception to 08/08/2023.Study Selection And Data CollectionProspective and intervention studies were selected.Statistical AnalysisData for each maneuver were reported individually and data from the five most employed maneuvers were aggregated. A traditional and a Bayesian meta-analysis approach were performed.ResultsA total of 69 studies, encompassing 3185 fluid challenges and 2711 patients were analyzed. The prevalence of fluid responsiveness was 49.9%. Pulse pressure variation (PPV) was studied in 40 studies, mean threshold with 95% confidence intervals (95% CI) = 11.5 (10.5-12.4)%, and area under the receiver operating characteristics curve (AUC) with 95% CI was 0.87 (0.84-0.90). Stroke volume variation (SVV) was studied in 24 studies, mean threshold with 95% CI = 12.1 (10.9-13.3)%, and AUC with 95% CI was 0.87 (0.84-0.91). The plethysmographic variability index (PVI) was studied in 17 studies, mean threshold = 13.8 (12.3-15.3)%, and AUC was 0.88 (0.82-0.94). Central venous pressure (CVP) was studied in 12 studies, mean threshold with 95% CI = 9.0 (7.7-10.1) mmHg, and AUC with 95% CI was 0.77 (0.69-0.87). Inferior vena cava variation (∆IVC) was studied in 8 studies, mean threshold = 15.4 (13.3-17.6)%, and AUC with 95% CI was 0.83 (0.78-0.89).ConclusionsFluid responsiveness can be reliably assessed in adult patients under mechanical ventilation. Among the five maneuvers compared in predicting fluid responsiveness, PPV, SVV, and PVI were superior to CVP and ∆IVC. However, there is no data supporting any of the above mentioned as being the best maneuver. Additionally, other well-established tests, such as the passive leg raising test, end-expiratory occlusion test, and tidal volume challenge, are also reliable.© 2024. The Author(s).

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