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

Abstract

Background: Respiratory variations in the inferior vena cava diameter (ΔIVCD) have been studied extensively with respect to their value in predicting fluid responsiveness, but the results are conflicting. The aim of this meta-analysis was to explore the value of ΔIVCD for predicting fluid responsiveness in patients with circulatory shock receiving mechanical ventilation. Methods: PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched up to June 2017. The diagnostic OR (DOR), sensitivity, and specificity were calculated. The summary ROC curve was estimated, and the area under the ROC curve (AUROC) was calculated. Results: Overall, 603 patients were included in this review, 324 (53.7%) of whom were fluid-responsive. The cutoff values of ΔIVCD varied across studies, ranging from 8% to 21%. Heterogeneity between studies was assessed with an overall Q=0.069, I 2=0%, and P=0.483. The pooled sensitivity and specificity for the overall population were 0.69 (95% CI, 0.51-0.83) and 0.80 (95% CI, 0.66-0.89), respectively. The DOR was 9.28 (95% CI, 2.33-36.98). AUROCs were reported in five studies. Overall, the pooled AUROC was 0.82 (95% CI, 0.79-0.85). Conclusions: The findings of this study suggest that the ΔIVCD performed moderately well in predicting fluid responsiveness in patients with circulatory shock receiving mechanical ventilation.