下腔静脉呼吸变异度对液体无反应性的诊断准确性：系统评价和荟萃分析。

Diagnostic accuracy of inferior vena caval respiratory variation in detecting fluid unresponsiveness: A systematic review and meta-analysis.

机构信息

From the Department of Critical Care, Artemis Hospital, Gurgaram, Haryana (SKD), Department of Anaesthesiology and Critical Care, Post Graduate Institute of Medical Education and Research, Dr Ram Monohar Lohia Hospital, New Delhi, Delhi (NSC), Department of Anaesthesiology and Critical Care, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya (DP), Department of Anaesthesiology and Critical Care, Guwahati Medical College, Guwahati, Assam, India (PS) and AP-HP, Hôpitaux Universitaires Paris-Sud, Hôpital de Bicêtre, Service de Réanimation Médicale, Paris, France (XM).

出版信息

Eur J Anaesthesiol. 2018 Nov;35(11):831-839. doi: 10.1097/EJA.0000000000000841.

DOI:10.1097/EJA.0000000000000841

PMID:29901465

Abstract

BACKGROUND

The accuracy of respiratory variation of the inferior vena cava (rvIVC) in predicting fluid responsiveness, particularly in spontaneously breathing patients is unclear.

OBJECTIVES

To consider the evidence to support the accuracy of rvIVC in identifying patients who are unlikely to benefit from fluid administration.

DESIGN

Systematic review and meta-analysis.

DATA SOURCE

We searched MEDLINE, EMBASE, Cochrane Library, KoreaMed, LILCAS and WHO Clinical Trial Registry from inception to June 2017.

ELIGIBILITY CRITERIA

Case-control or cohort studies that evaluated the accuracy of rvIVC in living adult humans were included. A study was included in the meta-analysis if data enabling construction of 2 × 2 tables were reported, calculated or could be obtained from authors and met the above cited criteria.

RESULT

A total of 23 studies including 1574 patients were included in qualitative analysis. The meta-analysis involved 20 studies and 761 patients. Pooled sensitivity and specificity of rvIVC in 330 spontaneously breathing patients were 0.80 [95% confidence interval (CI) 0.68 to 0.89] and 0.79 (95% CI 0.60 to 0.90). Pooled sensitivity and specificity of rvIVC in 431 mechanically ventilated patients were 0.79 (95% CI 0.67 to 0.86) and 0.70 (95% CI 0.63 to 0.76).

CONCLUSION

Decreased inferior vena caval respiratory variation is moderately accurate in predicting fluid unresponsiveness both in spontaneous and mechanically ventilated patients. The findings of this review should be used in the appropriate clinical context and in conjunction with other clinical assessments of fluid status.

IDENTIFIER

CRD 42017068028.

摘要

背景

下腔静脉呼吸变异度（rvIVC）预测液体反应性的准确性，尤其是在自主呼吸患者中，尚不清楚。

目的

评估 rvIVC 识别不太可能从液体治疗中获益的患者的准确性。

设计

系统评价和荟萃分析。

数据来源

我们检索了 MEDLINE、EMBASE、 Cochrane 图书馆、韩国医学文献分析系统、LILACS 和世界卫生组织临床试验注册平台，检索时间从建库至 2017 年 6 月。

入选标准

评估 rvIVC 在成年活体内准确性的病例对照或队列研究。meta 分析纳入的研究为提供了可用于构建 2×2 表格的数据、计算数据或可以从作者处获得数据且符合上述标准的研究。

结果

共纳入 23 项研究，包含 1574 例患者，进行定性分析。meta 分析共纳入 20 项研究，包含 761 例患者。330 例自主呼吸患者中 rvIVC 的汇总敏感性和特异性为 0.80（95%可信区间 0.68 至 0.89）和 0.79（95%可信区间 0.60 至 0.90）。431 例机械通气患者中 rvIVC 的汇总敏感性和特异性为 0.79（95%可信区间 0.67 至 0.86）和 0.70（95%可信区间 0.63 至 0.76）。