Does Respiratory Variation in Inferior Vena Cava Diameter Predict Fluid Responsiveness in Mechanically Ventilated Patients? A Systematic Review and Meta-analysis

Anesth Analg. 2018 Nov;127(5):1157-1164. doi: 10.1213/ANE.0000000000003459.


Background: We performed a systematic review and meta-analysis of studies investigating the diagnostic accuracy of respiratory variation in inferior vena cava diameter (ΔIVC) for predicting fluid responsiveness in patients receiving mechanical ventilation.

Methods: MEDLINE, EMBASE, the Cochrane Library, and Web of Science were screened from inception to February 2017. The meta-analysis assessed the pooled sensitivity, specificity, diagnostic odds ratio, and area under the receiver operating characteristic curve. In addition, heterogeneity and subgroup analyses were performed.

Results: A total of 12 studies involving 753 patients were included. Significant heterogeneity existed among the studies, and meta-regression indicated that ventilator settings were the main sources of heterogeneity. Subgroup analysis indicated that ΔIVC exhibited better diagnostic performance in the group of patients ventilated with tidal volume (TV) ≥8 mL/kg and positive end-expiratory pressure (PEEP) ≤5 cm H2O than in the group ventilated with TV <8 mL/kg or PEEP >5 cm H2O, as demonstrated by higher sensitivity (0.80 vs 0.66; P = .02), specificity (0.94 vs 0.68; P < .001), diagnostic odds ratio (68 vs 4; P < .001), and area under the receiver operating characteristic curve (0.88 vs 0.70; P < .001). The best ΔIVC threshold for predicting fluid responsiveness was 16% ± 2% in the group of TV ≥8 mL/kg and PEEP ≤5 cm H2O, whereas in the group of TV <8 mL/kg or PEEP >5 cm H2O, this threshold was 14% ± 5%.

Conclusions: ΔIVC shows limited ability for predicting fluid responsiveness in distinct ventilator settings. In patients with TV ≥8 mL/kg and PEEP ≤5 cm H2O, ΔIVC was an accurate predictor of fluid responsiveness, while in patients with TV <8 mL/kg or PEEP >5 cm H2O, ΔIVC was a poor predictor. Thus, intensivists must be cautious when using ΔIVC.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Clinical Decision-Making
  • Fluid Therapy* / adverse effects
  • Humans
  • Lung / physiopathology*
  • Patient Selection
  • Predictive Value of Tests
  • Respiration*
  • Respiration, Artificial* / adverse effects
  • Risk Assessment
  • Risk Factors
  • Treatment Outcome
  • Ultrasonography*
  • Vena Cava, Inferior / diagnostic imaging*