Superior vena cava collapsibility index as a predictor of fluid responsiveness: a systematic review with meta-analysis.

IF 1.6 Q2 ANESTHESIOLOGY
Tomasz Królicki, Maciej Molsa, Andrzej Tukiendorf, Ryszard Gawda, Tomasz Czarnik
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Abstract

Introduction: 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.

Material and methods: 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.

Results: 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.

Conclusions: 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.

上腔静脉塌陷指数作为输液反应性的预测指标:系统综述与荟萃分析。
简介: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。目前报告其诊断性能的研究很少:采用 PRISMA 方法,在 Medline 和 EMBASE 数据库中进行了系统检索。研究纳入了将 SVC-CI 作为通气成人患者 FR 标记的前瞻性研究。利用双变量随机效应模型生成了接收者操作特征曲线(SROC)。计算了 ROC 曲线下面积(AUC)、曲线工作点的灵敏度和特异性:我们纳入了八项研究,共有 857 名患者,在扩容试验前共对其进行了 1083 次 SVC-CI 评估。在 609 例(56.23%)试验病例中存在 FR。SROC 曲线显示,该检验的工作点灵敏度和特异度分别为 80.8%(95% CI:66.3-90%)和 81.4%(95% CI:76.4-85.5%)。模型的 AUC 等于 0.848(95% CI:0.824-0.863),P < 0.001。没有发现明显的研究间异质性(I 2 = 0%)。亚组分析显示,呼气末正压(PEEP)水平较高(> 5 cm H 2 O)的患者的 SVC-CI 敏感性明显较低(χ 2 = 7.753,df = 2,P = 0.0207)。研究环境和扩容干预类型对测试结果没有明显影响:结论:SVC-CI 是重症监护室和手术室机械通气患者 FR 的可靠预测指标。PEEP 水平超过 5 cm H 2 O 可能会影响测试的灵敏度。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.00
自引率
5.90%
发文量
48
审稿时长
25 weeks
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