Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland.
Institute of Health Sciences, University of Opole, Poland.
Anaesthesiol Intensive Ther. 2024;56(3):169-176. doi: 10.5114/ait.2024.142797.
The superior vena cava collapsibility index (SVC-CI) is a potential marker of fluid responsiveness (FR) in mechanically ventilated patients. Few studies reporting its diagnostic performance are currently available.
A systematic search, using the PRISMA approach, was performed using the Medline and EMBASE databases. Prospective studies evaluating the SVC-CI as a marker of FR in ventilated adult patients were included. A bivariate random-effect model was utilised to generate the summary receiver operating characteristic (SROC) curve. The area under the ROC curve (AUC), the sensitivity and specificity of the curve operating point were calculated.
We included eight studies with a total of 857 patients, in whom SVC-CI was evaluated a total of 1083 times prior to the volume expansion trial. In 609 (56.23%) trial cases FR was present. The SROC curve demonstrated that the test's operating point has a sensitivity and specificity of 80.8% (95% CI: 66.3-90%) and 81.4% (95% CI: 76.4-85.5%), respectively. The model's AUC was equal to 0.848 (95% CI: 0.824-0.863) with P < 0.001. No significant inter-study heterogeneity was found (I 2 = 0%). A subgroup analysis revealed a significantly lower sensitivity of SVC-CI in patients with higher levels of positive end-expiratory pressure (PEEP) (> 5 cm H 2 O) (χ 2 = 7.753, df = 2, P = 0.0207). The study setting and type of intervention for volume expansion did not significantly change the performance of the test.
SVC-CI is a reliable predictor of FR for mechanically ventilated patients in intensive care units and operating rooms. A PEEP level exceeding 5 cm H 2 O may impair the sensitivity of the test.
上腔静脉塌陷指数（SVC-CI）是机械通气患者液体反应性（FR）的潜在标志物。目前，已有少量报告其诊断性能的研究。
采用 PRISMA 方法，对 Medline 和 EMBASE 数据库进行系统检索。纳入评估 SVC-CI 作为机械通气成人患者 FR 标志物的前瞻性研究。使用双变量随机效应模型生成汇总受试者工作特征（SROC）曲线。计算曲线工作点的曲线下面积（AUC）、敏感度和特异度。
我们纳入了 8 项共 857 例患者的研究，其中共对 1083 次 SVC-CI 进行了评估，这些患者均进行了容量扩张试验。在 609 例（56.23%）试验病例中存在 FR。SROC 曲线表明，该试验的工作点具有 80.8%（95%CI：66.3-90%）的敏感度和 81.4%（95%CI：76.4-85.5%）的特异性。模型的 AUC 等于 0.848（95%CI：0.824-0.863），P<0.001。未发现显著的异质性（I 2=0%）。亚组分析显示，在 PEEP 水平较高（>5cmH 2 O）的患者中，SVC-CI 的敏感度显著降低（χ 2=7.753，df=2，P=0.0207）。容量扩张的研究环境和干预类型并未显著改变试验的性能。
SVC-CI 是重症监护病房和手术室机械通气患者 FR 的可靠预测指标。PEEP 水平超过 5cmH 2 O 可能会降低试验的敏感度。
