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The following is a summary of “Clinical value of calibrated abdominal compression plus transthoracic echocardiography to predict fluid responsiveness in critically ill infants: a diagnostic accuracy study,” published in the May 2025 issue of BMC Pediatrics by Gotchac et al. 

Predicting fluid responsiveness had been difficult in infants, yet avoiding unnecessary volume expansion (VE) remained essential to prevent fluid overload.  

Researchers conducted a retrospective study to specify whether the stroke volume (SV) changes induced by a calibrated abdominal compression (ΔSV-AC) could predict fluid responsiveness in infants without cardiac disease.  

They evaluated diagnostic test accuracy in a single center setting within a general pediatric intensive care unit (PICU). Infants under 2 years with acute circulatory failure who required a 10 mL·kg^-1 crystalloid VE over 20 minutes, whether ventilated or not, were included. The SV was measured via transthoracic echocardiography at baseline, during a calibrated abdominal compression of 22 mmHg for 30 seconds, and after fluid administration. The area under the receiver operating characteristic curve (AUROC) of ΔSV-AC was determined to predict fluid responsiveness, defined as a 15% SV increase after VE.  

The results showed that 27 VE cases involving 21 patients were analyzed and 17 of these cases were administered to spontaneously breathing children. Fluid responsiveness was observed in 12 cases. The AUROC for ΔSV-AC was 0.93 (95% CI 0.82–1). The optimal threshold for ΔSV-AC was 9.5%. At this threshold, sensitivity was 92% (95% CI 62–100), specificity was 87% (95% CI 60–98), and the positive and negative predictive values were 85% (95% CI 60–95) and 93% (95% CI 66–99), respectively.  

Investigators concluded that echocardiographic evaluation of SV changes induced by calibrated abdominal compression effectively predicted fluid responsiveness in infants without cardiac disease in the PICU. 

Source: bmcpediatr.biomedcentral.com/articles/10.1186/s12887-025-05728-z