Related Experiment Video
Updated: Aug 24, 2025
Image Acquisition Method for the Sonographic Assessment of the Inferior Vena Cava
Published on: January 13, 2023
Fluid responsiveness assessment using inferior vena cava collapsibility among spontaneously breathing patients:
L C M Cardozo Júnior1, G S D Lemos2, B A M P Besen3
1Medical ICU, Disciplina de Emergências Clínicas, Departamento de Clínica Médica, Hospital das Clínicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brazil.
Objective:
To synthesize the evidence about diagnostic accuracy of inferior vena cava collapsibility (IVCc) in prediction of fluid responsiveness among spontaneously breathing patients.
Design:
Systematic review of diagnostic accuracy studies.
Setting:
Intensive care units or emergency departments.
Patients And Participants:
spontaneously breathing patients with indication for fluid bolus administration.
Interventions:
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.
Main Variables Of Interest:
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.
Results:
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.
Conclusions:
IVCc had moderate accuracy for fluid responsiveness assessment in spontaneously breathing patients and should not be used in isolation for this purpose.
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