Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness

Messina, Antonio; Dell’Anna, Antonio; Baggiani, Marta; Torrini, Flavia; Maresca, Gian Marco; Bennett, Victoria; Saderi, Laura; Sotgiu, Giovanni; Antonelli, Massimo; Cecconi, Maurizio

doi:10.1186/s13054-019-2545-z

Critical Care

Table 3 Reported ROC values of the included studies

From: Functional hemodynamic tests: a systematic review and a metanalysis on the reliability of the end-expiratory occlusion test and of the mini-fluid challenge in predicting fluid responsiveness

	Studies	Functional hemodynamic test	Parameter	AUC (95%CI)	Sensitivity (%)	Specificity (%)	Y	+PV	−PV	+LR	−LR	Threshold	GZ high	GZ low	Pt in GZ (%)
Operating room	Guinot et al. [33]	EEOT: ventilation interrupted for 15 s	DELTA SV (%)	0.78 (0.63–0.89)	82	71	NA	85	67	2.87	0.25	2.3	NA	NA	NA
	Biais et al. [34]	EEOT: ventilation interrupted for 30 s	DELTA SV (%)	0.91 (0.81–1.0)	100	81	0.81	84	100	NA	NA	5	8	4	17
	Biais et al. [35]	Mini-FC: 100 ml in 120 s	DELTA SV (%)	0.95 (0.90–0.99)	93	85	0.78	NA	NA	NA	NA	6	7	4	19
	Guinot et al. [36]	Mini-FC: 100 ml in 60 s	DELTA SV (%)	0.93 (0.84–0.97)	89	89	NA	83	93	8.18	0.12	7	8	3	14
	Preisman et al. [37]	RSVT: decrease in SAP after successive incremental pressure-controlled breaths (10, 20, and 30 cmH₂O)	RSVT (slope, mmHg/cmH₂O)	0.96 (0.92–1.0)	93	89	NA	NA	NA	NA	NA	0.51	NA	NA	NA
	Biais et al. [38]	LRM: 30 cmH20/30 s	DELTA SV (%)	0.96 (0.81–0.99)	88	92	NA	NA	NA	NA	NA	30	− 22	− 37	36
	De Broca et al. [39]	LRM: 25 cmH20/25 s	DELTA SV (%)	0.95 (0.91–0.99)	92	96	0.92	100	89	NA	NA	16	− 15	− 17	8
Intensive care unit	Wu et al. [40]	Mini-FC: 50 ml in 10 s	DELTA VTI (%)	0.83 (0.69–0.96)	74	95	NA	94	79	NA	NA	9	NA	NA	NA
	Smorenberg et al. [41]	Mini-FC: 100 ml in 120 s	DELTA CO (%)	0.85 (0.63–0.97)	NA	NA	NA	92	88	NA	NA	2.3	NA	NA	NA
	Muller et al. [29]	Mini-FC: 100 ml in 60 s	DELTA VTI (%)	0.92 (0.78–0.98)	95	78	NA	NA	NA	NA	NA	3	NA	NA	NA
	Monge Garcia et al. [42]	Airway pressure elevated up to 30 cmH20 for 10 s	DELTA PP (%)	0.98 (0.84–0.99)	91	95	NA	91	95	NA	NA	52	NA	NA	NA
	Perel et al. [28]	RSVT: decrease in SAP after successive incremental pressure-controlled breaths (5,10, 15, and 20 cmH₂O)	RSVT (slope, mmHg/cmH₂O)	0.89 (0.72–1.0)	87.5	83	NA	NA	NA	NA	NA	0.24	NA	NA	NA
	Yonis et al. [43]	EEOT: ventilation interrupted for 15 s	DELTA CI (%)	0.65 (0.46–0.84)	33	100	NA	NA	NA	INF	0.67	10	11	− 4	79
	Yonis et al. [43]	Trendelemburg maneuver	DELTA CI (%)	0.9 (0.8–1.0)	87	89	NA	NA	NA	7.9	0.15	8	12	5	30
	Xiao-ting et al. [44]	Mini-FC: 100 ml in 60 s	DELTA CI (%)	0.83 (0.69–0.96)	73.2	60.6	NA	NA	NA	NA	NA	5.4	NA	NA	NA
	Mallat et al. [45]	Mini-FC: 100 ml in 60 s	DELTA CI (%)	0.78 (0.64–0.88)	77	74	NA	NA	NA	NA	NA	5.2	12.6	− 1.5	67
	Georges et al. [46]	EEOT: ventilation interrupted for 12 s	DELTA VTI (%)	0.96 ± 0.03	89	95	0.85	NA	NA	NA	NA	9	10	6	20
	Wilkman et al. [47]	PEEP elevated from 10 to 20 cmH₂O for 60–120 s	DELTA MAP (%)	0.91 (0.77–1.0)	83	86	NA	71	92	NA	NA	− 10.2	NA	NA	NA
	Jozwiak et al. [48]	EEOT: ventilation interrupted for 15 s	DELTA CI (%)	0.98 (0.85–1.0)	93	100	0.93	NA	NA	NA	NA	4	NA	NA	NA
	Monnet et al. [23]	EEOT: ventilation interrupted for 15 s	DELTA CI (%)	0.97 (0.85–0.99)	91	100	NA	NA	NA	NA	NA	5	NA	NA	NA
	Myatra et al. [49]	Vt raised up from 6 to 8 ml/kg for 1 min	DELTA PPV (%)	0.99 (0.98–1.0)	94	100	NA	100	93	NA	NA	3.5	NA	NA	NA
	Myatra et al. [49]	Vt raised up from 6 to 8 ml/kg for 1 min	DELTA SVV (%)	0.97 (0.92–1.0)	88	100	NA	100	88	NA	NA	2.5	NA	NA	NA
	Myatra et al. [49]	EEOT: ventilation interrupted for 15 s (6 ml/kg ventilation)	DELTA CI (%)	0.44 (0.23–0.66)	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA	NA
	Myatra et al. [49]	EEOT: ventilation interrupted for 15 s (8 ml/kg ventilation)	DELTA CI (%)	0.95 (0.88–1.0)	88	93	NA	93	78	NA	NA	4.1	NA	NA	NA
	Monnet et al. [50]	EEOT: ventilation interrupted for 15 s (Crs < 30 cmH₂O/ml)	DELTA CI (%)	0.97 ± 0.03	93	91	0.85	93	91	NA	NA	5	NA	NA	NA
	Monnet et al. [50]	EEOT: ventilation interrupted for 15 s (Crs > 30 cmH₂O/ml)	DELTA CI (%)	0.93 ± 0.05	93	92	0.84	93	92	NA	NA	5	NA	NA	NA

The area under the receiving operating characteristic (ROC) curve (AUC) of each study is reported as median (25th–75th interquartile) or mean (± standard deviation), as stated in the original article
NA data not available, CI cardiac index, CO cardiac output, SV stroke volume, SVI stroke volume index, SVV stroke volume variation, PPV pulse pressure variation, VTI velocity time integral, RSVT respiratory systolic variation test, PP pulse pressure, MAP mean arterial pressure, SAP systolic arterial pressure, ND not defined, Vt tidal volume, Crs respiratory compliance, EEOT end-expiratory occlusion test, LRM lung recruitment maneuver, RSVT respiratory systolic variation test, PEEP positive end-expiratory pressure, FC fluid challenge, Y Youden index, +PV positive predictive value, −PV negative predictive value, +LR positive likelihood ration, −LR negative likelihood ratio, GZ gray zone, Pt patients, INF infinite

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