Value of variation of end-tidal carbon dioxide for predicting fluid responsiveness during the passive leg raising test in patients with mechanical ventilation: a systematic review and meta-analysis

Abstract Background The ability of end-tidal carbon dioxide (ΔEtCO2) for predicting fluid responsiveness has been extensively studied with conflicting results. This meta-analysis aimed to explore the value of ΔEtCO2 for predicting fluid responsiveness during the passive leg raising (PLR) test in patients with mechanical ventilation. Methods PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2021. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. Q test and I2 statistics were used for study heterogeneity and publication bias was assessed by Deeks’ funnel plot asymmetry test. We performed meta-regression analysis for heterogeneity exploration and sensitivity analysis for the publication bias. Results Overall, six studies including 298 patients were included in this review, of whom 149 (50%) were fluid responsive. The cutoff values of ΔEtCO2 in four studies was 5%, one was 5.8% and the other one was an absolute increase 2 mmHg. Heterogeneity between studies was assessed with an overall Q = 4.098, I2 = 51%, and P = 0.064. The pooled sensitivity and specificity for the overall population were 0.79 (95% CI 0.72–0.85) and 0.90 (95% CI 0.77–0.96), respectively. The DOR was 35 (95% CI 12–107). The pooled AUROC was 0.81 (95% CI 0.77–0.84). On meta-regression analysis, the number of patients was sources of heterogeneity. The sensitivity analysis showed that the pooled DOR ranged from 21 to 140 and the pooled AUC ranged from 0.92 to 0.96 when one study was omitted. Conclusions Though the limited number of studies included and study heterogeneity, our meta-analysis confirmed that the ΔEtCO2 performed moderately in predicting fluid responsiveness during the PLR test in patients with mechanical ventilation.

Download Full-text

Value of Variation of End-Tidal Carbon Dioxide for Predicting Fluid Responsiveness During the Passive Leg Raising Test in Patients with Mechanical Ventilation: A Systematic Review and Meta-Analysis

10.21203/rs.3.rs-1069765/v1 ◽

2021 ◽

Author(s):

Haijun Huang ◽

Chenxia Wu ◽

Qinkang Shen ◽

Yixin Fang ◽

Hua Xu

Keyword(s):

Carbon Dioxide ◽

Mechanical Ventilation ◽

Sensitivity Analysis ◽

Regression Analysis ◽

Fluid Responsiveness ◽

Meta Analysis ◽

End Tidal Carbon Dioxide ◽

Meta Regression ◽

Meta Regression Analysis ◽

End Tidal

Abstract Background: The variation of end-tidal carbon dioxide(ΔEtCO2) has have been extensively studied with respect to its value in predicting fluid responsiveness, but the results are conflicting. This meta-analysis aimed to explore the value of ΔEtCO2 for predicting fluid responsiveness during the passive leg raising(PLR) test in patients with mechanical ventilation. Methods: PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched up to November 2021. The diagnostic odds ratio (DOR), sensitivity, and specificity were calculated. The summary receiver operating characteristic curve was estimated, and the area under the curve (AUROC) was calculated. We performed meta-regression analysis for heterogeneity exploration and sensitivity analysis for the publication bias.Results: Overall, 298 patients were included in this review, of whom 149 (50%) were fluid responsive. The cutoff values of ΔEtCO2 varied across studies, ranging from 5% to 5.8% or absolute increase 2mmHg. Heterogeneity between studies was assessed with an overall Q = 4.098, I2 = 51%, and P = 0.064. The pooled sensitivity and specificity for the overall population were 0.79 (95% CI: 0.72–0.85) and 0.90 (95% CI: 0.77–0.96), respectively. The DOR was 35 (95% CI: 12–107) (Fig. 4). The pooled AUROC was 0.81 (95% CI: 0.77–0.84). On meta-regression analysis, the number of patients was sources of heterogeneity. The sensitivity analysis showed that the pooled DOR ranged from 21 to 140 and the pooled AUC ranged from 0.92 to 0.96 when one study was omitted.Conclusions: This study was the first meta-analysis to evaluate the diagnostic accuracy of ΔEtCO2 in predicting fluid responsiveness during PLR test in patients with mechanical ventilation. This study confirmed that the ΔEtCO2 performed well in predicting fluid responsiveness in patients with mechanical ventilation.

Download Full-text

Assessment of fluid responsiveness with end-tidal carbon dioxide using a simplified passive leg raising maneuver: a prospective observational study

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-016-0677-z ◽

2016 ◽

Vol 63 (9) ◽

pp. 1033-1041 ◽

Cited By ~ 11

Author(s):

Francis Toupin ◽

Ariane Clairoux ◽

Alain Deschamps ◽

Jean-Sébastien Lebon ◽

Yoan Lamarche ◽

...

Keyword(s):

Carbon Dioxide ◽

Observational Study ◽

Fluid Responsiveness ◽

Prospective Observational Study ◽

Passive Leg Raising ◽

End Tidal Carbon Dioxide ◽

End Tidal

Download Full-text

Assessment of fluid responsiveness with end-tidal carbon dioxide using a simplified passive leg-raising maneuver: a prospective observational study

Canadian Journal of Anesthesia/Journal canadien d anesthésie ◽

10.1007/s12630-017-0847-7 ◽

2017 ◽

Vol 64 (5) ◽

pp. 546-546 ◽

Cited By ~ 1

Author(s):

Michal Barak ◽

Eliot Yussim

Keyword(s):

Carbon Dioxide ◽

Observational Study ◽

Fluid Responsiveness ◽

Prospective Observational Study ◽

Passive Leg Raising ◽

End Tidal Carbon Dioxide ◽

End Tidal

Download Full-text

Magnitude of benefit of the addition of bevacizumab (BEVA) to first-line chemotherapy (CT) for advanced/metastatic colorectal cancer (MCRC): Meta-analysis of randomized clinical trials

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e15021 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e15021-e15021

Author(s):

V. Vaccaro ◽

F. Cuppone ◽

F. Loupakis ◽

M. Milella ◽

P. Carlini ◽

...

Keyword(s):

Sensitivity Analysis ◽

Clinical Trials ◽

Regression Analysis ◽

Phase Ii ◽

Randomized Clinical Trials ◽

Meta Analysis ◽

Phase Iii ◽

Phase Ii Trials ◽

Meta Regression ◽

Meta Regression Analysis

e15021 Background: The monoclonal antibody against vascular endothelial growth factor BEVA has recently demonstrated to improve survival for MRC patients (pts). Nevertheless, the magnitude of the provided benefit in the daily practice is still controversial. In order to quantify the benefit of adding BEVA to CT for MCRC, a literature-based meta-analysis was conducted. Methods: Survival Hazard Ratios (HR) were extracted from prospective, randomized clinical trials (RCTs, either phase II/III) reports. HR and event-based relative risks (RR) with 95% confidence intervals (CI) were derived through a random-effect model. Differences in primary (progression-free- and overall-survival, PFS/OS) and secondary outcomes (overall, partial and complete response rates, ORR/PR/CR) were explored. Absolute differences (AD) and the number of patients needed to treat (NNT) were calculated. Heterogeneity test and a meta-regression analysis with clinical predictors for outcomes were conducted as well. A sensitivity analysis according to the trial phase-design was accomplished. Results: Five trials (2,728 pts), 2 phase II (313 pts) and 3 phase III (2,415 pts), were gathered. No significant interaction was found in the sensitivity analysis between phase II and III, although a trend showed a better PFS results for BEVA in phase II trials (p=0.057). At the meta-regression analysis female gender and rectal primary site were significant predictors for PFS (p=0.003, p=0.005). Toxicity analysis is ongoing. Conclusions: Although concerns regarding costs and toxicities still exist, BEVA significantly improves the outcome of untreated MCRC pts. The absolute benefit provided into an unselected population for molecular features should be considered of paramount importance for advanced disease. [Table: see text] No significant financial relationships to disclose.

Download Full-text