Accuracy of Ultrasonographic Measurements of Inferior Vena Cava to Determine Fluid Responsiveness: A Systematic Review and Meta-Analysis

Objective: Fluid responsiveness is the ability to increase the cardiac output in response to a fluid challenge. Only about 50% of patients receiving fluid resuscitation for acute circulatory failure increase their stroke volume, but the other 50% may worsen their outcome. Therefore, predicting fluid responsiveness is needed. In this purpose, in recent years, the assessment of the inferior vena cava (IVC) through ultrasound (US) has become very popular. The aim of our work was to systematically review all the previously published studies assessing the accuracy of the diameter of IVC or its respiratory variations measured through US in predicting fluid responsiveness. Data Sources: We searched in the MEDLINE (PubMed), Embase, Web of Science databases for all relevant articles from inception to September 2017. Study Selection: Included articles specifically addressed the accuracy of IVC diameter or its respiratory variations assessed by US in predicting the fluid responsiveness in critically ill ventilated or not, adult or pediatric patients. Data Extraction: We included 26 studies that investigated the role of the caval index (IVC collapsibility or distensibility) and 5 studies on IVC diameter. Data Synthesis: We conducted a meta-analysis for caval index with 20 studies: The pooled area under the curve, logarithmic diagnostic odds ratio, sensitivity, and specificity were 0.71 (95% confidence interval [CI]: 0.46-0.83), 2.02 (95% CI: 1.29-2.89), 0.71 (95% CI: 0.62-0.80), and 0.75 (95% CI: 0.64-0.85), respectively. Conclusion: An extreme heterogeneity of included studies was highlighted. Ultrasound evaluation of the diameter of the IVC and its respiratory variations does not seem to be a reliable method to predict fluid responsiveness.

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Ultrasonographic Measurement of the Respiratory Variation in the Inferior Vena Cava Diameter Is Predictive of Fluid Responsiveness in Critically Ill Patients: Systematic Review and Meta-analysis

Ultrasound in Medicine & Biology ◽

10.1016/j.ultrasmedbio.2013.12.010 ◽

2014 ◽

Vol 40 (5) ◽

pp. 845-853 ◽

Cited By ~ 117

Author(s):

Zhongheng Zhang ◽

Xiao Xu ◽

Sheng Ye ◽

Lei Xu

Keyword(s):

Systematic Review ◽

Inferior Vena Cava ◽

Critically Ill ◽

Fluid Responsiveness ◽

Critically Ill Patients ◽

Inferior Vena ◽

Meta Analysis ◽

Vena Cava ◽

Respiratory Variation ◽

Inferior Vena Cava Diameter

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Plethysmographic variability index as a tool to assess fluid responsiveness in critically ill patients: a correlation study with inferior vena cava distensibility index

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20195535 ◽

2019 ◽

Vol 7 (12) ◽

pp. 4663

Author(s):

Parvinder Singh Bedi ◽

Bhavna Pahwa ◽

Bhavna Hooda ◽

Deepak Dwivedi

Keyword(s):

Inferior Vena Cava ◽

Critically Ill ◽

Fluid Responsiveness ◽

Critically Ill Patients ◽

Inferior Vena ◽

Vena Cava ◽

Fluid Challenge ◽

Time Points ◽

Variability Index ◽

Plethysmographic Variability Index

Background: In critically ill patients in the intensive care unit (ICU), early aggressive fluid replacement is the cornerstone of resuscitation. Traditionally employed static measures of fluid responsiveness have a poor predictive value. It is therefore imperative to employ dynamic measures of fluid responsiveness that take into account the heart lung interactions in the mechanically ventilated patients. The main objective of this study was to evaluate the reliability of one such non-invasive dynamic index: Plethysmographic variability index (PVI) compared to the widely employed Inferior vena cava distensibility index (dIVC).Methods: Seventy-six adult patients admitted at a tertiary care mixed ICU, who developed hypotension (MAP<65mmHg), were included in the study. PVI was recorded using the MASIMO-7 monitor and dIVC measurements done using Terason ultrasound. Based on the dIVC measurement threshold of 18%, the patients were classified into volume responders and non-responders. The hemodynamic, PVI and dIVC measurements were recorded at pre specified time points following a fluid challenge of 20 ml/kg crystalloid infusion.Results: Baseline PVI values were significantly higher in the responders (22.3±8.2) compared to non-responders (10.1±2.9) (p<0.001) and showed a declining trend at all time points in the responders. Similar declining trend was observed in the dIVC measurements. Overall, the Pearson correlation graph showed strong correlation between dIVC and PVI values at all time points (r=0.678, p=0.001). The ROC curve between the dIVC and PVI values revealed that Baseline PVI (Pre PVI) >15.5% discriminated between responders and non-responders with a 90.2% sensitivity and 75% specificity with an AUC of 0.84 (0.72-0.96) (p<0.001).Conclusions: There is good correlation between PVI values and measured dIVC values at baseline and following a fluid challenge. Thus, PVI may be an acceptable, real time, continuous, surrogate measure of fluid responsiveness in critically ill patients.

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Does respiratory variation in inferior vena cava diameter predict fluid responsiveness in adult patients? A systematic review and meta-analysis of diagnostic accuracy studies

Hong Kong Journal of Emergency Medicine ◽

10.1177/10249079211029781 ◽

2021 ◽

pp. 102490792110297

Author(s):

Ebru Unal Akoglu ◽

Haldun Akoglu

Keyword(s):

Inferior Vena Cava ◽

Diagnostic Accuracy ◽

Fluid Responsiveness ◽

Inferior Vena ◽

Meta Analysis ◽

Vena Cava ◽

Adult Patients ◽

Diagnostic Utility ◽

Respiratory Variation ◽

Inferior Vena Cava Diameter

Objectives: To systematically review the diagnostic utility of the respiratory variation of the inferior vena cava diameter measured using ultrasonography for predicting fluid responsiveness in adult patients and compare the three commonly used equations, inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability. Methods: We searched PubMed, Scopus, Web of Science and Cochrane library, and included studies investigating the diagnostic accuracy of the respiratory variation of the inferior vena cava measured using ultrasonography compared to a reference standard for measuring cardiac output after a fluid challenge for fluid responsiveness, and stratified participants as fluid responsive or not. We included studies conducted in the emergency department or intensive care unit. We excluded studies on paediatric, prehospital, cancer, pregnant, dialysis patients or healthy volunteers. Results: We retrieved 270 records and excluded 171 because of irrelevance, patient population or publication type. We screened the abstracts of 99 studies and then the full texts of 42 studies. Overall, 21 studies with 1321 patients were included, of whom 689 (52%) were fluid responsive. The mean threshold value for positive inferior vena cava distensibility, inferior vena cava collapsibility and inferior vena cava variability was 17%, 35% and 12%, respectively. The heterogeneity between studies was high. Bivariate diagnostic random-effects meta-analysis was used to calculate the summary receiver operating characteristics curves. The overall accuracy, sensitivity and specificity of respiratory variation of the inferior vena cava diameter were 0.85, 0.72 and 0.81, respectively. The accuracy of inferior vena cava distensibility and inferior vena cava collapsibility was similar. The diagnostic utility of respiratory variation of the inferior vena cava diameter was lower but not statistically significant in mechanically ventilated patients compared with spontaneous breathing for predicting fluid responsiveness. Conclusion: The respiratory variation of the inferior vena cava diameter has moderate diagnostic utility for predicting fluid responsiveness independent of the equation used.

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