Table 1.
Major published studies regarding the use of IVC respiratory variation to predict fluid responsiveness in adult ICU patients with acute circulatory failure
| N | Type of ICU, shock, and ventilation | Exclusion criteria | Respondent definition | Discriminatory value | S/E PPV/NPV AUC* | |
|---|---|---|---|---|---|---|
| Ventilated patients | ||||||
| Feissel et al.(24) | 23 | M, septic shock, TV 8 - 10mL/kg | Hypoxemia with risk of death, right ventricular failure† | Δ ≥ 15% CO after fluids (8mL/kg hydroxyethylamide 6% for 20 minutes) | ΔdVCI > 12% | NPV 92%, PPV 93% |
| Barbier et al.(25) | 39 | MC, septic shock, TV 8.5mL/kg | Impossible to perform EchoTT | Δ ≥ 15% CI after fluids (7mL/kg of modified fluid gelatin 4% for 30 minutes) | ΔdVCI > 18% | S and E 90% (ASC 0,91; 0,84 - 0,98) |
| Charbonneau et al.(30) | 44 | MC, septic shock, TV 8 -10mL/kg | Hypoxemia with risk of death, right ventricular failure†, respiratory effort, arrhythmia, impossible to perform EchoTT | Δ ≥ 15% CI after fluids (7mL/kg of hydroxyethylamide 6% in 15 minutes) | ΔdVCI > 21% | S 38%, E 61% (AUC 0.43; 0.25 - 0.61) |
| Theerawit et al.(31) | 29 | M, septic shock, TV 8mL/kg | Arrhythmia, ascites, severe valvulopathy or intracardiac shunt, contraindication to sedatives/anesthetics | Δ ≥ 15% CO§ after fluids (1 L 0.9% NaCl for 1 hour or 0.5L hydroxyethylamide 130/0.46% or 5% human albumin for 30 minutes) | ΔdVCI > 10% | S 75%, E 77% (AUC 0.69; 0.48 - 0.9) |
| Vignon et al.(32) | 540 | MC, shock of any cause, TV < 8mL/kg in 66% | Pregnancy, amputation, or severe ischemia in lower limbs, contraindication for TEE or LLEM¶ | Δ ≥ 10% LVOT-VTI 1 minute after LLEM | ΔdVCI ≥ 8% | S 55%, E 70% (AUC 0.64) |
| Nonventilated patients | ||||||
| Airapetian et al.(9) | 59 | MC, shock of any cause | Signs of bleeding, arrhythmia, compression stockings, contraindication to LLEM¶, immediate need of volume | Δ ≥ 10% CO after 0.5L of saline solution for 15 minutes | ΔcVCI > 42% | S 31%, E 97% NPV 59%, PPV 90% (ASC 0,62; 0,49 - 0,74) |
| Muller et al.(27) | 40 | UN, septic, hemorrhagic, hypovolemic shock | Pulmonary edema, right ventricular failure or high RA pressure† | Δ ≥ 15% LVOT-VTI after 0.5L hydroxyethylamide 130/0.46% for 15 minutes | ΔcVCI > 40% | S 70%, E 80% (ASC 0,77; 0,60 - 0,88) |
With 95% confidence interval when reported in the literature;
documented by transthoracic echocardiography;
cardiac output was obtained from FloTrac/Vigileo (third generation), which is not the gold standard for assessing CO;
for example, elevated intracranial pressure, cardiac tamponade, and acute aortic dissection;
ICU - intensive care unit; S - sensitivity; E - specificity; PPV - positive predictive value; NPV - negative predictive value; AUC - area under the curve; M - medical; TV - tidal volume; CO - cardiac output; dVCI - distensibility index of the IVC; MC - medical-surgical; EchoTT - transthoracic echocardiography; TEE - transesophageal echocardiography; CI - cardiac index; NaCl - sodium chloride; LLEM - lower limb elevation maneuver; LVOT-VTI - time-velocity integral of the left ventricular outflow tract; cVCI - collapsibility index of the IVC; UN - unspecified; RA - right atrium.