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Table 4 Summary of diagnostic accuracy studies

From: The haemodynamic dilemma in emergency care: Is fluid responsiveness the answer? A systematic review

Author Participants Intervention Criterion standard (FR definition) Rate of FR (%) SN SP AUC
Inclusion criteria No. Disease severity Base BP Base Lactate Spont. breathing Dynamic test Monitor Parameter measured Cutoff
Corl38 Age ≥18, clinically expected to be eu- or hypovolaemic 26 N/A SBP 114 N/A Yes PLR U/S ∆ Caval index N/A ≥10% increase in CI by TEB 4 min after PLR 31 N/A N/A 0.56 (0.31–0.81)
Duus41 Age ≥18 and decided to receive a fluid bolus 109 (100 were analysed) APACHE II 5 ± 3.6 MAP 126 ± 19 1.4 ± 0.6 Yes PLR Bioreactance ∆SV 10% ≥10% increase in SV by bioreactance after a fluid bolus (at least 5 ml/kg – no pre-defined infusion time or time frame for assessment) 60 80% (72%-88%) 61% (51%-71%) N/A
de Valk39 At least one clinical sign of shock and decided to receive a fluid bolus 52 (45 were analysed) N/A MAP 73.8 ± 14.2 1,9 ± 1.1 Yes Spontaneous breathing U/S Caval Index 36.5% (Not pre-defined) ≥10 mmHg increase in BP 15 min after a fluid bolus (500 ml NaCl 0.9% over 15 min) 27 83% 67% 0.741
Feissel40 Age ≥18, mechanically ventilated, sinus rhythm and septic shock 39 (31 were analysed) SOFA 14 ± 2 72 ± 19* N/A No MV Plethysmography Plethysmographic variability index (PVI) 19% (Not pre-defined) ≥15% increase in VTI by TTE 5 min after a fluid bolus (8 mL/kg HES over 20 min) 52 94% (69%-100%) 87% (61%-97%) 0.97 (0.83-0.99)
Jung42 Spontaneous breathing, sepsis-induced hypotension 26 (22 were analysed) N/A N/A N/A Yes None Oesophageal Doppler Baseline corrected flow time (FTc) 301 ms (Not pre-defined) ≥10% increase in SVI by oesophageal Doppler immediately after a fluid bolus (7 mL/kg HES over 30 min) 65 88.2% 88.8% 0.870 (0.708–0.979)
  1. *Combined from responders and non-responders estimates
  2. BP, blood pressure; FR, fluid responsiveness; SN, sensitivity; SP, specificity; AUC, area under the curve; PLR, passive leg raise; SVI, stroke volume index; SV, stroke volume; U/S, ultrasound; SOFA, sequential organ failure assessment; SBP, systolic blood pressure; MAP, mean arterial pressure; APACHE, Acute Physiology and Chronic Health Evaluation; MV, mechanical ventilation; CI, cardiac index; VTI, velocity time integral; TTE, trans-thoracic echocardiography; HES, hydroxylethyl starch