To determine the predictive value of the end-expiratory occlusion test (EEOT) in fluid responsiveness evaluation by performing a systematic review and meta-analysis of studies.

Databases including PubMed, Embase and Cochrane Database were searched for relevant clinical trials before October 2017. Two independent investigators extracted data and study characteristics. Bivariate mixed-effects regression model was used to estimate the pooled sensitivity, specificity, positive and negative likelihood ratio and diagnostic odds ratio with 95% CIs. The SROC curve and Fagan graphs were produced, and the area under the curve was also calculated. Meanwhile, we calculated relative diagnostic odds ratio (RDOR) to compare diagnostic value of EEOT and PPV.

Seven studies (260 adult patients, 270 fluid challenges) were included. Fluid challenge test was used as standard reference in all studies. For the EEOT-induced changes in CO or its surrogate, the pooled sensitivity was 0.93 (95%CI: 0.86-0.96) and the pooled specificity was 0.90 (95%CI: 0.81-0.95). The area under the ROC curve was 0.97 (95%CI: 0.95-0.98). Four studies which compared EEOT and PPV at the same time, the RDOR was 3.13 (P=0.24).

EEOT-induced changes in CO or its surrogate can very reliably predict the response of CO to volume expansion in adult patients. There is no significant difference between the diagnostic value of EEOT and PPV.

End-expiratory occlusion test; Pulse pressure variation; Fluid challenge test; Fluid responsiveness; Meta-analysis