Prediction of fluid responsiveness with the use of echography of the inferior vena cava in spontaneously breathing patients with sepsis: a systematic review

Background
Sepsis is still a leading cause of death in western countries, most septic patients are first admitted to the Emergency Department and have a mortality rate as high as 60%. It is important to treat these patients swiftly and accurately. One major objective of care is optimal fluid resuscitation. Currently, a variety of different tools can be used to measure a patients volume status, which all have major disadvantages. A promising new method is measuring the vena cava inferior collapsibility index with using ultrasonography to evaluate the patients response to the given fluid therapy. This review focuses on the diagnostic accuracy in predicting fluid responsiveness with the use of echography of the vena cava inferior in spontaneously breathing patients with sepsis.
Methods
We conducted a systematic literature search of English language articles published on spontaneously breathing patients admitted to the hospital with sepsis, severe sepsis or septic shock. The selection of articles was done in a two stepped model. The quality of the included articles was assessed using the Quality Assessment Tool for Diagnostic Accuracy Studies (QUADAS-2) tool.
Results
Our search yielded 380 unique studies and we included six of these in our final review. The risk of bias and the concerns of applicability were mostly low, but some of the domains were very badly described, which resulted in a lot of unclear data. All articles have proven that measuring the collapsibility of the IVC has shown to be an accurate diagnostic tool to predict fluid responsiveness in patients with sepsis.
Conclusion
The measurement of the collapsibility of the inferior vena cava to predict fluid responsiveness is shown to be a good predictor of the volume state in patients with sepsis, severe sepsis or septic shock compared to conventional methods of measuring this.