scholarly journals Value of variation index of inferior vena cava diameter in predicting fluid responsiveness in patients with circulatory shock receiving mechanical ventilation: a systematic review and meta-analysis

Critical Care ◽  
2018 ◽  
Vol 22 (1) ◽  
Author(s):  
Haijun Huang ◽  
Qinkang Shen ◽  
Yafen Liu ◽  
Hua Xu ◽  
Yixin Fang
Keyword(s):  
Systematic Review ◽  
Mechanical Ventilation ◽  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Meta Analysis ◽  
Vena Cava ◽  
Circulatory Shock ◽  
Variation Index ◽  
Inferior Vena Cava Diameter

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

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.

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

2018 ◽  
Vol 35 (4) ◽  
pp. 354-363 ◽  
Author(s):  
Daniele Orso ◽  
Irene Paoli ◽  
Tommaso Piani ◽  
Francesco L. Cilenti ◽  
Lorenzo Cristiani ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Inferior Vena ◽  
Data Extraction ◽  
Meta Analysis ◽  
Vena Cava ◽  
Fluid Challenge ◽  
Area Under The Curve ◽  
Ultrasound Evaluation ◽  
Caval Index

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.

Systematic Review and Meta-Analysis of Ligation vs Repair of Inferior Vena Cava (IVC) Injuries

2019 ◽  
Vol 229 (4) ◽  
pp. e242-e243
Author(s):  
Saskya Byerly ◽  
Leonardo Tamariz ◽  
Eugenia Lee ◽  
Joshua Parreco ◽  
Christopher D. Barrett ◽  
...  
Keyword(s):  
Systematic Review ◽  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Meta Analysis ◽  
Vena Cava

scholarly journals Measurement site of inferior vena cava diameter affects the accuracy with which fluid responsiveness can be predicted in spontaneously breathing patients: a post hoc analysis of two prospective cohorts

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Morgan Caplan ◽  
Arthur Durand ◽  
Perrine Bortolotti ◽  
Delphine Colling ◽  
Julien Goutay ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Fluid Responsiveness ◽  
Volume Expansion ◽  
Inferior Vena ◽  
Vena Cava ◽  
Predict Fluid Responsiveness ◽  
Measurement Site ◽  
Inferior Vena Cava Diameter ◽  
The Right ◽  
Spontaneously Breathing

Abstract Background The collapsibility index of the inferior vena cava (cIVC) has potential for predicting fluid responsiveness in spontaneously breathing patients, but a standardized approach for measuring the inferior vena cava diameter has yet to be established. The aim was to test the accuracy of different measurement sites of inferior vena cava diameter to predict fluid responsiveness in spontaneously breathing patients with sepsis-related circulatory failure and examine the influence of a standardized breathing manoeuvre. Results Among the 81 patients included in the study, the median Simplified Acute Physiologic Score II was 34 (24; 42). Sepsis was of pulmonary origin in 49 patients (60%). Median volume expansion during the 24 h prior to study inclusion was 1000 mL (0; 2000). Patients were not severely ill: none were intubated, only 20% were on vasopressors, and all were apparently able to perform a standardized breathing exercise. Forty-one (51%) patients were responders to volume expansion (i.e. a ≥ 10% stroke volume index increase). The cIVC was calculated during non-standardized (cIVC-ns) and standardized breathing (cIVC-st) conditions. The accuracy with which both cIVC-ns and cIVC-st predicted fluid responsiveness differed significantly by measurement site (interaction p < 0.001 and < 0.0001, respectively). Measuring inferior vena cava diameters 4 cm caudal to the right atrium predicted fluid responsiveness with the best accuracy. At this site, a standardized breathing manoeuvre also significantly improved predictive power: areas under ROC curves [mean and (95% CI)] for cIVC-ns = 0.85 [0.78–0.94] versus cIVC-st = 0.98 [0.97–1.0], p < 0.001. When cIVC-ns is superior or equal to 33%, fluid responsiveness is predicted with a sensitivity of 66% and a specificity of 92%. When cIVC-st is superior or equal to 44%, fluid responsiveness is predicted with a sensitivity of 93% and a specificity of 98%. Conclusion The accuracy with which cIVC measurements predict fluid responsiveness in spontaneously breathing patients depends on both the measurement site of inferior vena cava diameters and the breathing regime. Measuring inferior vena cava diameters during a standardized inhalation manoeuvre at 4 cm caudal to the right atrium seems to be the method by which to obtain cIVC measurements best-able to predict patients’ response to volume expansion.

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