TY - JOUR T1 - Fluid responsiveness assessment using inferior vena cava collapsibility among spontaneously breathing patients: Systematic review and meta-analysis JO - Medicina Intensiva T2 - AU - Cardozo Júnior,L.C.M. AU - Lemos,G.S.D. AU - Besen,B.A.M.P. SN - 02105691 M3 - 10.1016/j.medin.2021.12.015 DO - 10.1016/j.medin.2021.12.015 UR - https://medintensiva.org/es-fluid-responsiveness-assessment-using-inferior-articulo-S0210569122000092 AB - ObjectiveTo synthesize the evidence about diagnostic accuracy of inferior vena cava collapsibility (IVCc) in prediction of fluid responsiveness among spontaneously breathing patients. DesignSystematic review of diagnostic accuracy studies. SettingIntensive care units or emergency departments. Patients and participantsspontaneously breathing patients with indication for fluid bolus administration. InterventionsA 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. Main variables of interestGeneral 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. ResultsEight 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. ConclusionsIVCc had moderate accuracy for fluid responsiveness assessment in spontaneously breathing patients and should not be used in isolation for this purpose. ER -