Back
 IJCM  Vol.9 No.10 , October 2018
Meta-Analysis of Ventilated versus Spontaneously Breathing Patients in Predicting Fluid Responsiveness by Inferior Vena Cava Variation
Abstract: Purpose: Respiratory variation in inferior vena cava (ΔIVC) has been extensively studied in predicting fluid responsiveness, but the results are conflicting. We performed a systemic review and meta-analysis of studies aiming at investigating the diagnostic accuracy of ΔIVC in predicting fluid responsiveness. Methods: MEDLINE, EMBASE, Cochrane Database and Web of Science were screened for relevant original and review articles from inception to July 2016. The meta-analysis determined the pooled sensitivity, specificity, diagnostic odds ratio (DOR) and area under the ROC curve (AUROC). In addition, subgroup analyses were performed in mechanically ventilated patients and spontaneously breathing patients. Results: A total of 20 studies involving 635 patients were included. Cutoff values of ΔIVC varied from 12% to 42%, the pooled sensitivity and specificity was 0.68 (0.62 - 0.75) and 0.80 (0.75 - 0.85), respectively. The DOR was 14.2 (6.0 - 33.6) and the AUROC was 0.86 (0.78 - 0.93). Subgroup analysis showed better diagnostic performance in patients on mechanical ventilation than in spontaneously breathing patients with higher sensitivity (0.75 vs. 0.56), specificity (0.82 vs. 0.78), DOR (22.9 vs. 7.9) and AUROC (0.90 vs. 0.80). The best threshold of ΔIVC in patients on mechanical ventilation was IVC distensibility index (ΔIVC ≥ 17% ± 4%), compared to IVC collapsibility index (ΔcIVC ≥ 33% ± 12%) in spontaneously breathing patients. Conclusion: ΔIVC is not an accurate predictor of fluid responsiveness in patients with acute circulatory failure. In patients on mechanical ventilation, the predicting ability of ΔIVC was moderate with acceptable sensitivity and specificity; in spontaneously breathing patients, the specificity remains acceptable but its sensitivity is poor.
Cite this paper: Si, X. , Cao, D. , Xu, H. and Guan, X. (2018) Meta-Analysis of Ventilated versus Spontaneously Breathing Patients in Predicting Fluid Responsiveness by Inferior Vena Cava Variation. International Journal of Clinical Medicine, 9, 760-777. doi: 10.4236/ijcm.2018.910063.
References

[1]   Lakhal, K., Ehrmann, S., Perrotin, D., Wolff, M. and Boulain, T. (2013) Fluid Challenge: Tracking Changes in Cardiac Output with Blood Pressure Monitoring (Invasive or Non-Invasive). Intensive Care Medicine, 39, 1953-1962.
https://doi.org/10.1007/s00134-013-3086-6

[2]   Marik, P.E., Monnet, X. and Teboul, J.L. (2011) Hemodynamic Parameters to Guide Fluid Therapy. Annals of Intensive Care, 1, 1.
https://doi.org/10.1186/2110-5820-1-1

[3]   Michard, F. and Teboul, J.L. (2002) Predicting Fluid Responsiveness in ICU Patients: A Critical Analysis of the Evidence. Chest, 121, 2000-2008.
https://doi.org/10.1378/chest.121.6.2000

[4]   Osman, D., Ridel, C., Ray, P., Monnet, X., Anguel, N., Richard, C. and Teboul, J.L. (2007) Cardiac Filling Pressures Are Not Appropriate to Predict Hemodynamic Response to Volume Challenge. Critical Care Medicine, 35, 64-68.
https://doi.org/10.1097/01.CCM.0000249851.94101.4F

[5]   Slama, M., Masson, H., Teboul, J.L., Arnout, M.L., Susic, D., Frohlich, E. and Andrejak, M. (2002) Respiratory Variations of Aortic VTI: A New Index of Hypovolemia and Fluid Responsiveness. American Journal of Physiology Heart and Circulatory Physiology, 283, H1729-1733.
https://doi.org/10.1152/ajpheart.00308.2002

[6]   Feissel, M., Michard, F., Mangin, I., Ruyer, O., Faller, J.P. and Teboul, J.L. (2001) Respiratory Changes in Aortic Blood Velocity as an Indicator of Fluid Responsiveness in Ventilated Patients with Septic Shock. Chest, 119, 867-873.
https://doi.org/10.1378/chest.119.3.867

[7]   Monnet, X., Bleibtreu, A., Ferre, A., Dres, M., Gharbi, R., Richard, C. and Teboul, J.L. (2012) Passive Leg-Raising and End-Expiratory Occlusion Tests Perform Better than Pulse Pressure Variation in Patients with Low Respiratory System Compliance. Critical Care Medicine, 40, 152-157.
https://doi.org/10.1097/CCM.0b013e31822f08d7

[8]   Matamis, D., Soilemezi, E., Tsagourias, M., Akoumianaki, E., Dimassi, S., Boroli, F., Richard, J.C. and Brochard, L. (2013) Sonographic Evaluation of the Diaphragm in Critically Ill Patients. Technique and Clinical Applications. Intensive Care Medicine, 39, 801-810.
https://doi.org/10.1007/s00134-013-2823-1

[9]   Zhang, Z., Xu, X., Ye, S. and Xu, L. (2014) 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, 40, 845-853.
https://doi.org/10.1016/j.ultrasmedbio.2013.12.010

[10]   Schardt, C., Adams, M.B., Owens, T., Keitz, S. and Fontelo, P. (2007) Utilization of the PICO Framework to Improve Searching PubMed for Clinical Questions. BMC Medical Informatics and Decision Making, 7, 16.
https://doi.org/10.1186/1472-6947-7-16

[11]   Whiting, P.F., Rutjes, A.W., Westwood, M.E., Mallett, S., Deeks, J.J., Reitsma, J.B., Leeflang, M.M., Sterne, J.A. and Bossuyt, P.M. (2011) QUADAS-2: A Revised Tool for the Quality Assessment of Diagnostic Accuracy Studies. Annals of Internal Medicine, 155, 529-536.
https://doi.org/10.7326/0003-4819-155-8-201110180-00009

[12]   Barbier, C., Loubieres, Y., Schmit, C., Hayon, J., Ricome, J.L., Jardin, F. and Vieillard-Baron, A. (2004) Respiratory Changes in Inferior Vena Cava Diameter Are Helpful in Predicting Fluid Responsiveness in Ventilated Septic Patients. Intensive Care Medicine, 30, 1740-1746.
https://doi.org/10.1007/s00134-004-2259-8

[13]   Feissel, M., Michard, F., Faller, J.P. and Teboul, J.L. (2004) The Respiratory Variation in Inferior Vena Cava Diameter as a Guide to Fluid Therapy. Intensive Care Medicine, 30, 1834-1837.
https://doi.org/10.1007/s00134-004-2233-5

[14]   Moretti, R. and Pizzi, B. (2010) Inferior Vena Cava Distensibility as a Predictor of Fluid Responsiveness in Patients with Subarachnoid Hemorrhage. Neurocritical Care, 13, 3-9. https://doi.org/10.1007/s12028-010-9356-z

[15]   Choi, D.Y., Kwak, H.J., Park, H.Y., Kim, Y.B., Choi, C.H. and Lee, J.Y. (2010) Respiratory Variation in Aortic Blood Flow Velocity as a Predictor of Fluid Responsiveness in Children after Repair of Ventricular Septal Defect. Pediatric Cardiology, 31, 1166-1170.
https://doi.org/10.1007/s00246-010-9776-8

[16]   Machare-Delgado, E., Decaro, M. and Marik, P.E. (2011) Inferior Vena Cava Variation Compared to Pulse Contour Analysis as Predictors of Fluid Responsiveness: A Prospective Cohort Study. Journal of Intensive Care Medicine, 26, 116-124.
https://doi.org/10.1177/0885066610384192

[17]   Corl, K., Napoli, A.M. and Gardiner, F. (2012) Bedside Sonographic Measurement of the Inferior Vena Cava Caval Index Is a Poor Predictor of Fluid Responsiveness in Emergency Department Patients. Emergency Medicine Australasia, 24, 534-539.
https://doi.org/10.1111/j.1742-6723.2012.01596.x

[18]   Muller, L., Bobbia, X., Toumi, M., Louart, G., Molinari, N., Ragonnet, B., Quintard, H., Leone, M., Zoric, L. and Lefrant, J.Y. (2012) Respiratory Variations of Inferior Vena Cava Diameter to Predict Fluid Responsiveness in Spontaneously Breathing Patients with Acute Circulatory Failure: Need for a Cautious Use. Critical Care, 16, R188.
https://doi.org/10.1186/cc11672

[19]   Brun, C., Zieleskiewicz, L., Textoris, J., Muller, L., Bellefleur, J.P., Antonini, F., Tourret, M., Ortega, D., Vellin, A., Lefrant, J.Y., Boubli, L., Bretelle, F., Martin, C. and Leone, M. (2013) Prediction of Fluid Responsiveness in Severe Preeclamptic Patients with Oliguria. Intensive Care Medicine, 39, 593-600.
https://doi.org/10.1007/s00134-012-2770-2

[20]   Byon, H.J., Lim, C.W., Lee, J.H., Park, Y.H., Kim, H.S., Kim, C.S. and Kim, J.T. (2013) Prediction of Fluid Responsiveness in Mechanically Ventilated Children Undergoing Neurosurgery. British Journal of Anaesthesia, 110, 586-591.
https://doi.org/10.1093/bja/aes467

[21]   Baker, A.K., Partridge, R.J., Litton, E. and Ho, K.M. (2013) Assessment of the Plethysmographic Variability Index as a Predictor of Fluid Responsiveness in Critically Ill Patients: A Pilot Study. Anaesthesia and Intensive Care, 41, 736-741.

[22]   Lanspa, M.J., Grissom, C.K., Hirshberg, E.L., Jones, J.P. and Brown, S.M. (2013) Applying Dynamic Parameters to Predict Hemodynamic Response to Volume Expansion in Spontaneously Breathing Patients with Septic Shock. Shock, 39, 155-160.
https://doi.org/10.1097/SHK.0b013e31827f1c6a

[23]   Charbonneau, H., Riu, B., Faron, M., Mari, A., Kurrek, M.M., Ruiz, J., Geeraerts, T., Fourcade, O., Genestal, M. and Silva, S. (2014) Predicting Preload Responsiveness Using Simultaneous Recordings of Inferior and Superior Vena Cavae Diameters. Critical Care, 18, 473.
https://doi.org/10.1186/s13054-014-0473-5

[24]   de Valk, S., Olgers, T.J., Holman, M., Ismael, F., Ligtenberg, J.J. and Ter Maaten, J.C. (2014) The Caval Index: An Adequate Non-Invasive Ultrasound Parameter to Predict Fluid Responsiveness in the Emergency Department? BMC Anesthesiology, 14, 114.
https://doi.org/10.1186/1471-2253-14-114

[25]   Sobczyk, D., Nycz, K. and Andruszkiewicz, P. (2015) Bedside Ultrasonographic Measurement of the Inferior Vena Cava Fails to Predict Fluid Responsiveness in the First 6 Hours after Cardiac Surgery: A Prospective Case Series Observational Study. Journal of Cardiothoracic and Vascular Anesthesia, 29, 663-669.
https://doi.org/10.1053/j.jvca.2014.08.015

[26]   Lujan Varas, J., Martinez Díaz, C., Blancas, R., Martinez Gonzalez, O., Llorente Ruiz, B., Molina Montero, R., Arenillas Juanas, C., Pardo, A., Alcázar Sánchez-Elvira, L. and Cambronero Galache, J.A. (2015) Inferior Vena Cava Distensibility Index Predicting Fluid Responsiveness in Ventilated Patients. Intensive Care Medicine Experimental, 3, A600.
https://doi.org/10.1186/2197-425X-3-S1-A600

[27]   Airapetian, N., Maizel, J., Alyamani, O., Mahjoub, Y., Lorne, E., Levrard, M., Ammenouche, N., Seydi, A., Tinturier, F., Lobjoie, E., Dupont, H. and Slama, M. (2015) Does Inferior Vena Cava Respiratory Variability Predict Fluid Responsiveness in Spontaneously Breathing Patients? Critical Care, 19, 400.
https://doi.org/10.1186/s13054-015-1100-9

[28]   Weber, T., Wagner, T., Neumann, K. and Deusch, E. (2015) Low Predictability of Three Different Noninvasive Methods to Determine Fluid Responsiveness in Critically Ill Children. Pediatric Critical Care Medicine, 16, e89-e94.
https://doi.org/10.1097/PCC.0000000000000364

[29]   Achar, S.K., Sagar, M.S., Shetty, R., Kini, G., Samanth, J., Nayak, C., Madhu, V. and Shetty, T. (2016) Respiratory Variation in Aortic Flow Peak Velocity and Inferior Vena Cava Distensibility as Indices of Fluid Responsiveness in Anaesthetised and Mechanically Ventilated Children. Indian Journal of Anaesthesia, 60, 121-126.
https://doi.org/10.4103/0019-5049.176285

[30]   Sobczyk, D., Nycz, K., Andruszkiewicz, P., Wierzbicki, K. and Stapor, M. (2016) Ultrasonographic Caval Indices Do Not Significantly Contribute to Predicting Fluid Responsiveness Immediately after Coronary Artery Bypass Grafting When Compared to Passive Leg Raising. Cardiovascular Ultrasound, 14, 23.
https://doi.org/10.1186/s12947-016-0065-4

[31]   de Oliveira, O.H., Freitas, F.G., Ladeira, R.T., Fischer, C.H., Bafi, A.T., Azevedo, L.C. and Machado, F.R. (2016) Comparison between Respiratory Changes in the Inferior Vena Cava Diameter and Pulse Pressure Variation to Predict Fluid Responsiveness in Postoperative Patients. Journal of Critical Care, 34, 46-49.
https://doi.org/10.1016/j.jcrc.2016.03.017

[32]   Cecconi, M., De Backer, D., Antonelli, M., Beale, R., Bakker, J., Hofer, C., Jaeschke, R., Mebazaa, A., Pinsky, M.R., Teboul, J.L., Vincent, J.L. and Rhodes, A. (2014) Consensus on Circulatory Shock and Hemodynamic Monitoring. Task Force of the European Society of Intensive Care Medicine. Intensive Care Medicine, 40, 1795-1815.
https://doi.org/10.1007/s00134-014-3525-z

[33]   Via, G., Tavazzi, G. and Price, S. (2016) Ten Situations Where Inferior Vena Cava Ultrasound May Fail to Accurately Predict Fluid Responsiveness: A Physiologically Based Point of View. Intensive Care Medicine, 42, 1164-1167.
https://doi.org/10.1007/s00134-016-4357-9

[34]   Jellinek, H., Krenn, H., Oczenski, W., Veit, F., Schwarz, S. and Fitzgerald, R.D. (2000) Influence of Positive Airway Pressure on the Pressure Gradient for Venous Return in Humans. Journal of Applied Physiology, 88, 926-932.
https://doi.org/10.1152/jappl.2000.88.3.926

[35]   Gignon, L., Roger, C., Bastide, S., Alonso, S., Zieleskiewicz, L., Quintard, H., Zoric, L., Bobbia, X., Raux, M., Leone, M., Lefrant, J.Y. and Muller, L. (2016) Influence of Diaphragmatic Motion on Inferior Vena Cava Diameter Respiratory Variations in Healthy Volunteers. Anesthesiology, 124, 1338-1346.
https://doi.org/10.1097/ALN.0000000000001096

[36]   Juhl-Olsen, P., Frederiksen, C.A. and Sloth, E. (2012) Ultrasound Assessment of Inferior Vena Cava Collapsibility Is Not a Valid Measure of Preload Changes during Triggered Positive Pressure Ventilation: A Controlled Cross-Over Study. Ultraschall in der Medizin, 33, 152-159.
https://doi.org/10.1055/s-0031-1281832

 
 
Top