Cardozo Júnior L C M, Lemos G S D, Besen B A M P
Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil; ICU, Hospital São Paulo, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP, Brazil.
Med Intensiva (Engl Ed). 2023 Feb;47(2):90-98. doi: 10.1016/j.medine.2021.12.018. Epub 2022 Oct 19.
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.
综合关于下腔静脉塌陷度（IVCc）在预测自主呼吸患者液体反应性方面诊断准确性的证据。
诊断准确性研究的系统评价。
重症监护病房或急诊科。
有液体冲击治疗指征的自主呼吸患者。
在MEDLINE和EMBASE中进行检索。我们纳入了以心输出量测量的标准方法作为指标测试来评估IVCc对液体反应性评估准确性的研究。
一般信息（年份、设置、截断值、标准方法）、敏感性、特异性以及受试者工作特征曲线下面积（AUROC）。使用QUADAS 2工具评估偏倚风险。我们通过双变量模型获得合并的敏感性、特异性和汇总ROC曲线以及估计的置信区间。我们还计算了阳性和阴性似然比，并绘制了Fagon列线图。
纳入8项研究，共497例患者。总体而言，这些研究存在较高的偏倚风险。IVCc的敏感性为63%（95%CI - 46 - 78%），特异性为83%（95%CI - 76 - 87%）。尽管IVCc的准确性中等（SROC 0.83，95%CI - 0.80 - 0.86），但基于50%的预测试概率，液体反应性的测试后概率导致了相当大的错误分类。
IVCc在评估自主呼吸患者液体反应性方面准确性中等，不应单独用于此目的。
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