Dynamic Assessment of Fluid Responsiveness in Surgical ICU Patients Through Stroke Volume Variation is Associated With Decreased Length of Stay and Costs: A Systematic Review and Meta-Analysis
Restricted accessReview articleFirst published online January, 2020
Dynamic Assessment of Fluid Responsiveness in Surgical ICU Patients Through Stroke Volume Variation is Associated With Decreased Length of Stay and Costs: A Systematic Review and Meta-Analysis
Static indices, such as the central venous pressure, have proven to be inaccurate predictors of fluid responsiveness. An emerging approach uses dynamic assessment of fluid responsiveness (FT-DYN), such as stroke volume variation (SVV) or surrogate dynamic variables, as more accurate measures of volume status. Recent work has demonstrated that goal-directed therapy guided by FT-DYN was associated with reduced intensive care unit (ICU) mortality; however, no study has specifically assessed this in surgical ICU patients. This study aimed to conduct a systematic review and meta-analysis on the impact of employing FT-DYN in the perioperative care of surgical ICU patients on length of stay in the ICU. As secondary objectives, we performed a cost analysis of FT-DYN and assessed the impact of FT-DYN versus standard care on hospital length of stay and mortality. We identified all randomized controlled trials (RCTs) through MEDLINE, EMBASE, and CENTRAL that examined adult patients in the ICU who were randomized to standard care or to FT-DYN from inception to September 2017. Two investigators independently reviewed search results, identified appropriate studies, and extracted data using standardized spreadsheets. A random effect meta-analysis was carried out. Eleven RCTs were included with a total of 1015 patients. The incorporation of FT-DYN through SVV in surgical patients led to shorter ICU length of stay (weighted mean difference [WMD], −1.43d; 95% confidence interval [CI], −2.09 to −0.78), shorter hospital length of stay (WMD, −1.96d; 95% CI, −2.34 to −1.59), and trended toward improved mortality (odds ratio, 0.55; 95% CI, 0.30-1.03). There was a decrease in daily ICU-related costs per patient for those who received FT-DYN in the perioperative period (WMD, US$ −1619; 95% CI, −2173.68 to −1063.26). Incorporation of FT-DYN through SVV in the perioperative care of surgical ICU patients is associated with decreased ICU length of stay, hospital length of stay, and ICU costs.
BednarczykJMFridfinnsonJAKumarA, et al.Incorporating dynamic assessment of fluid responsiveness into goal-directed therapy. Crit Care Med. 2017;45(9):1538–1545.
2.
MicekSTMcEvoyCMcKenzieMHamptonNDohertyJAKollefMH. Fluid balance and cardiac function in septic shock as predictors of hospital mortality. Crit Care. 2013;17(5):R246.
3.
RosenbergALDechertREParkPKBartlettRH. NIH NHLBI ARDS Network. Review of a largeclinical series: association of cumulative fluid balance on outcome in acute lung injury: a retrospective review of the ARDSnet tidal volume study cohort. J Intensive Care Med. 2009;24(1):35–46.
4.
BoydJHForbesJNakadaTAWalleyKRRussellJA. Fluid resuscitation in septic shock: a positive fluid balance and elevated central venous pressure are associated with increased mortality. Crit Care Med. 2011;39(2):259–265.
5.
SilvaJMJrde OliveiraAMNogueiraFA, et al.The effect of excess fluid balance on the mortality rate of surgical patients: a multicenter prospective study. Crit Care. 2013;17(6):R288.
6.
MaitlandKKiguliSOpokaRO, et al.; FEAST Trial Group. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011;364(26):2483–2495.
7.
De-MadariaESoler-SalaGSánchez-PayáJ, et al.Influence of fluid therapy on the prognosis of acute pancreatitis: a prospective cohort study. Am J Gastroenterol. 2011;106(10):1843–1850.
8.
MarikPBellomoR. A rational approach to fluid therapy in sepsis. Br J Anaesth. 2016;116(3):339–349.
9.
UeyamaHKiyonakaS. Predicting the need for fluid therapy – does fluid responsiveness work?J Intensive Care. 2017;5:34. doi:10.1186/s40560-017-0210-7.
10.
RotheCF. Reflex control of veins and vascular capacitance. Physiol Rev. 1983;63(4):1281–1342.
11.
KanjiHDMcCallumJSirounisDMacRedmondRMossRBoydJH. Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes. J Crit Care. 2014;29(5):700–705.
12.
RighettiFCastellanoG. Fluid responsiveness in septic shock. Crit Care. 2014;18.
13.
LakhalKEhrmannSPerrotinDWolffMBoulainT. Fluid challenge: tracking changes in cardiac output with blood pressure monitoring (invasive or non-invasive). Intensive Care Med. 2013;39(11):1953–1962.
14.
LeismanDEDoerflerMESchneiderSMMasickKDD’AmoreJAD’AngeloJK. Predictors, prevalence, and outcomes of early crystalloid responsiveness among initially hypotensive patients with sepsis and septic shock. Crit Care Med. 2018;46(2):189–198.
15.
KumarAAnelRBunnellE, et al.Pulmonary artery occlusion pressure and central venous pressure fail to predict ventricular filling volume, cardiac performance, or the response to volume infusion in normal subjects. Crit Care Med. 2004;32(3):691–699.
16.
GuerinLMonnetXTeboulJL. Monitoring volume and fluid responsiveness: from static to dynamic indicators. Best Pract Res Clin Anaesthesiol. 2013;27(2):177–185.
17.
MonnetXMarikPETeboulJL. Prediction of fluid responsiveness: an update. Ann Intensive Care. 2016;6(1):111.
18.
SevranskyJE.Dynamic measures to determine volume responsiveness: logical, biologically plausible, and unproven. Crit Care Med. 2016;44(10):1923–1926. doi:10.1097/CCM.0000000000001997.
19.
FarrugiaABansalMBalboniSKimberMCMartinGSCassarJ. Choice of fluids in severe septic patients – a cost-effectiveness analysis informed by recent clinical trials. Rev Recent Clin Trials. 2014;9(1):21–30.
AngusDCThe PRISM Investigators. Early, goal-directed therapy for septic shock- a patient-level meta-analysis. N Engl J Med. 2017;377(10):994–995.
22.
MoherDLiberatiATetzlaffJAltmanDG. The PRISMA group: preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(6):e1000097.
23.
HigginsJPTGreenS. Cochrane Handbook for Systematic Reviews of Interventions. Version 5.1.0 edition. London, UK: The Cochrane Collaboration; 2011.
24.
Kupersztych-HagegeETeboulJLArtigasA, et al.Bioreactance is not reliable for estimating cardiac output and the effects of passive leg raising in critically ill patients. Br J Anaesth. 2013;111(6):961–966. doi:10.1093/bja/aet282.
25.
KahnJGKronickRKregerMGansDN. The cost of health insurance administration in California: estimates for insurers, physicians, and hospitals. Health Aff (Millwood). 2005;24(6):1629–1639.
26.
HerrittBChaudhuriDThavornKKubelikDKyeremantengK. Early vs. late tracheostomy in intensive care settings: impact on ICU and hospital costs. J Crit Care. 2018;44:285–288. doi:0.1016/j.jcrc.2017.11.037.
27.
ChaudhuriDHerrittBHeylandD, et al.Early renal replacement therapy versus standard care in the ICU. J Intensive Care Med. 2017. doi:10.1177/0885066617698635.
28.
KyeremantengKGagnonLPThavornKHeylandDD’EgidioG. The impact of palliative care consultation in the ICU on length of stay: a systematic review and cost evaluation. J Intensive Care Med. 2016. doi:10.1177/0885066616664329.
29.
KyeremantengKGagnonLPRobidouxR, et al.Cost Analysis of Noninvasive Helmet Ventilation Compared with Use of Noninvasive Face Mask in ARDS. Canadian Respiratory Journal. 2018. doi:10.1155/2018/6518572
BuettnerMSchummerWHuettemannESchenkeSvan HoutNSakkaSG. Influence of systolic-pressure-variation-guided intraoperative fluid management on organ function and oxygen transport. Br J Anaesthesia. 2008;101(2):194–199.
32.
GoepfertMSRichterHPZu EulenburgC, et al.Individually optimized hemodynamic therapy reduces complications and length of stay in the intensive care unit. Survey Anesthesiol. 2014;58(4):160–162.
33.
KapoorPMKakaniMChowdhuryUChoudhuryMLakshmyKiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth. 2008;11(1):27–34.
34.
ScheerenTWWiesenackCGerlachHMarxG. Goal-directed intraoperative fluid therapy guided by stroke volume and its variation in high risk surgical patients: a prospective randomized multicentre study. J Clin Monit Comput. 2013;27(3):225–233.
35.
MayerJBoldtJMengistuAMRöhmKDSuttnerS. Goal-directed intraoperative therapy based on autocalibrated arterial pressure waveform analysis reduces hospital stay in high-risk surgical patients: a randomized, controlled trial. Crit Care. 2010;14(1):R18.
36.
KumarLRajanSBaalachandranR. Outcomes associated with stroke volume variation versus central venous pressure guided fluid replacements during major abdominal surgery. J Anaesthesiol Clin Pharmacol. 2016;32(2):182–186.
37.
ElgendyMAEsmatIMKassimcDY. Outcome of intraoperative goal-directed therapy using Vigileo/FloTrac in high-risk patients scheduled for major abdominal surgeries: a prospective randomized trial. Egypt J Anaesthesia. 2017;33(3):263–269.
38.
KapoorPMMagoonRRawatRS, et al.Goal-directed therapy improves the outcome of high-risk cardiac patients undergoing off-pump coronary artery bypass. Ann Cardiac Anaesthesia. 2017;20(1):83–89.
39.
LuoJXueJLiuJLiuBLiuLChenG. Goal-directed fluid restriction during brain surgery: a prospective randomized controlled trial. Ann Intensive Care. 2017;7(1):16.
40.
HabicherMBalzerFMezgerV, et al.Implementation of goal-directed fluid therapy during hip revision arthroplasty: a matched cohort study. Perioperat Med. 2016;5(1):31.
41.
FunkDJHayGlassKTKoulackJHardingGBoydABrinkmanR. A randomized controlled trial on the effects of goal-directed therapy on the inflammatory response open abdominal aortic aneurysm repair. Crit Care. 2015;19(1):247.
42.
RhodesAEvansLEAlhazzaniW, et al.Surviving sepsis campaign: international guidelines for management of sepsis and septic shock: 2016. Crit Care Med. 2017;45(3):491–493.
43.
McIntyreLAHébertPCFergussonDCookDJAzizA; Canadian Critical Care Trials Group. A survey of Canadian intensivists’ resuscitation practices in early septic shock. Crit Care. 2007;11(4):R74.
44.
AroraSSinghPMGoudraBGSinhaAC. Changing trends of hemodynamic monitoring in ICU – from invasive to non-invasive methods: are we there yet?Int J Crit Illn Inj Sci. 2014;4(2):168–177.
45.
MarikPEBaramMVahidB. Does central venous pressure predict fluid responsiveness? A systematic review of the literature and the tale of seven mares. Chest. 2008;134(1):172–178.
46.
BenesJGiglioMBrienzaNMichardF. The effects of goal-directed fluid therapy based on dynamic parameters on post-surgical outcome: a meta-analysis of randomized controlled trials. Crit Care. 2014;18(5):584.
47.
BihariSParkeRDixonDL, et al.Fluid resuscitation is associated with elevated angiopoietin-2 and length of stay following cardiac surgery. Am J Respir Crit Care Med. 2017;195.
48.
KellumJAShawAD. Assessing toxicity of intravenous crystalloids in critically ill patients. JAMA. 2015;314(16):1695–1697.
49.
RaghunathanKShawANathansonB, et al.Association between the choice of IV crystalloid and in-hospital mortality among critically ill adults with sepsis. Crit Care Med. 2014;42(7):1585–1591.
50.
YangXDuB. Does pulse pressure variation predict fluid responsiveness in critically ill patients? A systematic review and meta-analysis. Crit Care. 2014;18(6):650. doi:10.1186/s13054-014-0650-6.
51.
MonnetXDresMFerréA, et al.Prediction of fluid responsiveness by a continuous non-invasive assessment of arterial pressure in critically ill patients: Comparison with four other dynamic indices. Br J Anaesthesia. 2012;109(3):330–338. doi:10.1093/bja/aes182.
52.
DastaJFMcLaughlinTPModySHPiechCT. Daily cost of an intensive care unit day: the contribution of mechanical ventilation. Crit Care Med. 2005;33(6):1266–1271.
53.
HammondNETaylorCFinferS, et al.Fluid-TRIPS and Fluidos Investigators, George Institute for Global Health, the Anzics Clinical Trials Group, BRICNET, and the REVA research network: patterns of intravenous fluid resuscitation use in adult intensive care patients between 2007 and 2014: an international cross-sectional study. PLoS One. 2017;12(5):e0176292.
54.
KyeremantengKGagnonLPThavornKHeylandDD’EgidioG. The impact of palliative care consultation in the ICU on length of stay. J Intensive Care Med. 2016. doi:10.1177/0885066616664329.
WunschHAngusDCHarrisonDA, et al.Variation in critical care services across North America and Western Europe. Crit Care Med. 2008;36(10):2787–2789.
57.
MullinsPMGoyalMPinesJM. National growth in intensive care unit admissions from emergency departments in the united states from 2002 to 2009. Acad Emerg Med2013;20(5):479–486.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
