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Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness

A systematic review and meta-analysis

Das, Saurabh K.; Choupoo, Nang S.; Pradhan, Debasis; Saikia, Priyam; Monnet, Xavier

European Journal of Anaesthesiology (EJA): November 2018 - Volume 35 - Issue 11 - p 831–839
doi: 10.1097/EJA.0000000000000841
Monitoring

BACKGROUND The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear.

OBJECTIVES To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration.

DESIGN Systematic review and meta-analysis.

DATA SOURCE We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017.

ELIGIBILITY CRITERIA Case–control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria.

RESULT A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76).

CONCLUSION Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status.

IDENTIFIER CRD 42017068028.

From the Department of Critical Care, Artemis Hospital, Gurgaram, Haryana (SKD), Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Education and Research, Dr Ram Monohar Lohia Hospital, New Delhi, Delhi (NSC), Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya (DP), Department of Anaesthesiology and Critical Care, Guwahati Medical College, Guwahati, Assam, India (PS) and AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de Réanimation Médicale, Paris, France (XM)

Correspondence to Dr Saurabh K. Das, Department of Critical Care, Artemis Hospital, Gurgaram, Haryana, India E-mail: drsauravdas1977@gmail.com

Published online 13 June 2018

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© 2018 European Society of Anaesthesiology