Fluid responsiveness assessment using inferior vena cava collapsibility among spontaneously breathing patients: Systematic review and meta-analysis

To synthesize the evidence about diagnostic accuracy of inferior vena cava collapsibility (IVCc) in prediction of fluid responsiveness among spontaneously breathing patients. Systematic review of diagnostic accuracy studies. Intensive care units or emergency departments. spontaneously breathing patients with indication for fluid bolus administration. A search was conducted in MEDLINE and EMBASE. We included studies assessing IVCc accuracy for fluid responsiveness assessment with a standard method for cardiac output measure as index test. General information (year, setting, cutoffs, standard method), sensitivity, specificity, and area under the receiving operator characteristics curve (AUROC). Risk of bias was assessed with QUADAS 2 tool. We obtained the pooled sensitivity, specificity and summary ROC curve, with estimated confidence intervals from a bivariate model. We also calculated positive and negative likelihood ratios and developed a Fagon nomogram. Eight studies were included with 497 patients. Overall, the studies presented a high risk of bias. IVCc sensitivity was 63% (95% CI – 46–78%) and specificity 83% (95% CI – 76–87%). Despite moderate accuracy of IVCc (SROC 0.83, 95% CI – 0.80–0.86), post-test probability of being fluid responsive based on a 50% pre-test probability led to considerable misclassification. IVCc had moderate accuracy for fluid responsiveness assessment in spontaneously breathing patients and should not be used in isolation for this purpose. Sintetizar la evidencia sobre la precisión diagnóstica de la colapsabilidad de la vena cava inferior (cVCI) en la predicción de la respuesta a los líquidos en pacientes que respiran espontáneamente. Revisión sistemática de estudios de precisión diagnóstica. Unidades de cuidados intensivos o servicios de urgencias. Pacientes con respiración espontánea con indicación de administración de bolos de líquidos. Se realizó una búsqueda en MEDLINE y EMBASE. Se incluyeron los estudios que evaluaban la precisión de la cVCI con un método estándar para medir el gasto cardíaco como prueba índice. Información general (año, entorno, puntos de corte, método estándar), sensibilidad, especificidad y área bajo curva. El riesgo de sesgo se evaluó con la herramienta QUADAS2. Obtuvimos la sensibilidad combinada, la especificidad y la curva ROC resumida, con intervalos de confianza (IC) estimados a partir de un modelo bivariado. Se incluyeron 8 estudios con 497 pacientes. La sensibilidad de la cVCI fue del 63% (IC9