Dynamic Assessment of Fluid Responsiveness in the ICU: A Systematic Review, Meta-Analysis, and Cost-Analysis
CCCF ePoster library. Dave C. Nov 8, 2018; 233352
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Dr. Chintan Dave
Dr. Chintan Dave
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Abstract
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Background: Assessment of fluid responsiveness in the Intensive Care Unit (ICU) has been a cornerstone in management and development of treatment plans. An essential component to assessment of volume status have been the widespread use of static indices, such as CVP measurement; however, these have been proven to be inaccurate predictors of fluid responsiveness1,2,3. A new approach, using dynamic assessment of fluid responsiveness (FT-DYN), assesses changes in stroke volume (SV) or surrogate dynamic variables (e.g., SV variation [SVV], pulse pressure variation [PPV]) during alterations in cardiac preload provoked by ventilation, passive leg raise, or fluid challenge as more accurate measures of volume status2,4.A recent systematic review indicated that in adult patients admitted to the ICU who required acute volume resuscitation, goal-directed therapy guided by dynamic assessment of fluid responsiveness was associated with reduced mortality and duration of mechanical ventilation5.



Objective: The objective of this study was to assess the impact of employing dynamic assessment of fluid responsiveness on ICU length of stay. As secondary objectives, we provide a cost analysis of FT-DYN, and report the impact of FT-DYN versus standard care on hospital length of stay, and mortality.



Methods: Adapting a previous search strategy5 with a focus on ICU length of stay, we identified all randomized controlled trials (RCTs) through MEDLINE and EMBASE that examined adult patients in the critical care setting who were randomized to standard care or to functional assessment of fluid responsiveness from the year 2000 to September 2017. We included all randomized controlled trials in adult patients that compared functional assessment of fluid responsiveness to standard care. Two independent investigators reviewed search results and identified appropriate studies. Information was extracted using standardized case report forms.



Results: A total of 11 RCTs were included with a total of 1015 patients. The incorporation of functional assessment of fluid responsiveness led to shorter ICU length of stay (weighted mean difference, -1.43d; p<0.0001) and improved mortality (Odds Ratio, 0.55; 95%CI, 0.30 to 1.03). There was a decrease in total ICU-related costs per patient in people who received FT-DYN (weighted mean difference, $1618.47; 95% CI, 1063.26 to 2173.68). There was no significant difference in length of hospital stay (weighted mean difference, -1.96d; p=0.06) or total hospital costs between patients receiving standard care or FT-DYN ($172.71; 95% CI, -223.17 to 568.59).



Conclusion: Incorporation of functional assessment of fluid responsiveness in the ICU setting is related to decreased mortality, ICU length of stay, and ICU-related costs per patient.

 


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