Predictive performance of dynamic arterial elastance for arterial pressure response to fluid expansion in mechanically ventilated hypotensive adults: a systematic review and meta-analysis of observational studies

作者：Xiaoyang Zhou, Weihao Pan, Bixin Chen, Zhaojun Xu, Jianneng Pan · 发表于：Annals of Intensive Care · 年份：2021 · DOI：10.1186/s13613-021-00909-2 · 被引用次数：38 · 研究领域：Hemodynamic Monitoring and Therapy、Cardiac, Anesthesia and Surgical Outcomes、Sepsis Diagnosis and Treatment

Abstract Background Dynamic arterial elastance (Ea dyn ) has been extensively considered as a functional parameter of arterial load. However, conflicting evidence has been obtained on the ability of Ea dyn to predict mean arterial pressure (MAP) changes after fluid expansion. This meta-analysis sought to assess the predictive performance of Ea dyn for the MAP response to fluid expansion in mechanically ventilated hypotensive patients. Methods We systematically searched electronic databases through November 28, 2020, to retrieve studies that evaluated the association between Ea dyn and fluid expansion-induced MAP increases in mechanically ventilated hypotensive adults. Given the diverse threshold value of Ea dyn among the studies, we only reported the area under the hierarchical summary receiver operating characteristic curve (AUHSROC) as the primary measure of diagnostic accuracy. Results Eight observational studies that included 323 patients with 361 fluid expansions met the eligibility criteria. The results showed that Ea dyn was a good predictor of MAP increases in response to fluid expansion, with an AUHSROC of 0.92 [95% confidence interval (CI) 0.89 to 0.94]. Six studies reported the cut-off value of Ea dyn , which ranged from 0.65 to 0.89. The cut-off value of Ea dyn was nearly conically symmetrical, most data were centred between 0.7 and 0.8, and the mean and median values were 0.77 and 0.75, respectively. The subgroup analyses indicated that the AUHSROC was slightly h...