Variation in central venous oxygen saturation to evaluate fluid responsiveness: a systematic review and meta-analysis

Background Since oxygen content and oxygen consumption typically remain unchanged within a short period, variation in central venous oxygen saturation (?ScvO(2)) during fluid challenge can theoretically track the changes in cardiac output (CO). We conducted this meta-analysis to systematically assess the diagnostic performance of ?ScvO(2) during a fluid challenge for fluid responsiveness in mechanically ventilated patients receiving volume expansion.Methods Electronic databases were systematically searched to identify relevant studies published before October 24, 2022. As the cutoff value of ?ScvO(2) was expected to vary across the included studies, we estimated the area under the hierarchical summary receiver operating characteristic curve (AUHSROC) as the primary measure of diagnostic accuracy. The optimal threshold of ?ScvO(2) and the corresponding 95% confidential interval (CI) were also estimated.Results This meta-analysis included 5 observational studies comprising 240 participants, of whom 133 (55%) were fluid responders. Overall, the ?ScvO(2) during the fluid challenge exhibited excellent performance for defining fluid responsiveness in mechanically ventilated patients receiving volume expansion, with an AUHSROC of 0.86 (95% CI 0.83-0.89), a pooled sensitivity of 0.78 (95% CI 0.69-0.85), a pooled specificity of 0.84 (95% CI 0.72-0.91), and a pooled diagnostic odds ratio of 17.7 (95% CI 5.9-53.2). The distribution of the cutoff values was nearly conically symmetrical and concentered between 3 and 5%; the mean and median cutoff values were 4% (95% CI 3-5%) and 4% (95% CI not estimable), respectively.Conclusion sIn mechanically ventilated patients receiving volume expansion, the Delta ScvO2 during the fluid challenge is a reliable indicator of fluid responsiveness.

Automated summary

This meta-analysis found that the variation in central venous oxygen saturation (?ScvO(2)) can reliably indicate fluid responsiveness in mechanically ventilated patients receiving volume expansion. The study concluded that ?ScvO(2) performs well in defining fluid responsiveness in this patient population.