Predictive accuracy of changes in the inferior vena cava diameter for predicting fluid responsiveness in patients with sepsis: A systematic review and meta-analysis

Hao Zhang; Jingyuan Jiang; Min Dai; Yan Liang; Ningxiang Li; Yongli Gao

doi:10.1371/journal.pone.0310462

Peer Review History

Original SubmissionSeptember 4, 2024
4 Sep 2024 Author Response https://doi.org/10.1371/journal.pone.0310462.r001
10 Oct 2024 Decision Letter - Vincenzo Lionetti, Editor PONE-D-24-36864Accuracy of the inferior vena cava in predicting fluid responsiveness in patients with sepsis: a systematic review and meta-analysisPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ACADEMIC EDITOR: All issues of both reviewers are required. Please improve english grammar and style of the draft. Please submit your revised manuscript by Nov 24 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. 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For every excluded study, the table should list the reason(s) for exclusion. If any of the included studies are unpublished, include a link (URL) to the primary source or detailed information about how the content can be accessed. A table of all data extracted from the primary research sources for the systematic review and/or meta-analysis. The table must include the following information for each study: Name of data extractors and date of data extraction Confirmation that the study was eligible to be included in the review. All data extracted from each study for the reported systematic review and/or meta-analysis that would be needed to replicate your analyses. If data or supporting information were obtained from another source (e.g. correspondence with the author of the original research article), please provide the source of data and dates on which the data/information were obtained by your research group. If applicable for your analysis, a table showing the completed risk of bias and quality/certainty assessments for each study or outcome. Please ensure this is provided for each domain or parameter assessed. For example, if you used the Cochrane risk-of-bias tool for randomized trials, provide answers to each of the signalling questions for each study. If you used GRADE to assess certainty of evidence, provide judgements about each of the quality of evidence factor. This should be provided for each outcome. An explanation of how missing data were handled. This information can be included in the main text, supplementary information, or relevant data repository. Please note that providing these underlying data is a requirement for publication in this journal, and if these data are not provided your manuscript might be rejected. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Partly ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Dear authors Appreciated for this effort of reviewing literature related to IVC diameter changes and its relation to fluid responsiveness prediction. Your efforts are well done. I just suggest to give more elaboration on the different observation of outcome effect between dIVC and cIVC from physiological point. Additionally did you ascertain that vasopressors were not manipulated during fluid challenge in included studies as this might affect the standard reference of CI or CO. Thanks Reviewer #2: Revisions to improve usefulness: 1. Provide a more detailed discussion of the clinical implications of the different ΔIVC, dIVC, and cIVC thresholds used across studies. What guidance can be given to clinicians on choosing appropriate cutoffs? 2. Expand the analysis and discussion of potential sources of bias in the included studies, particularly related to patient selection and index test conduct. 3. Include a more thorough explanation of the observed heterogeneity between studies and its implications for interpreting the pooled results. 4. Provide clearer guidance on how clinicians should integrate these IVC measurements with other clinical parameters when assessing fluid responsiveness. 5. Discuss any limitations in the generalizability of these findings to different sepsis patient populations or clinical settings. 6. Consider including a proposed algorithm or decision tree for using IVC measurements in clinical practice based on the synthesis of evidence from this review. Introduction: The introduction provides a good overview of the clinical importance of fluid management in sepsis and the potential role of IVC measurements. However, it could be strengthened by: ・Providing more context on current guidelines for fluid management in sepsis and their limitations. ・Clarifying the specific advantages of IVC measurements over other methods of assessing fluid responsiveness. Methods: The methods section is generally well-described, but could be improved by: ・Providing more detail on the search strategy, including full search terms for each database. ・Clarifying the criteria used for assessing study quality and how this information was incorporated into the analysis. ・Explaining how discrepancies in data extraction or quality assessment between reviewers were resolved. Results: The results are comprehensively presented, but some aspects could be clarified: ・The rationale for the chosen subgroup analyses could be more explicitly stated. ・More detail on the results of the quality assessment for individual studies would be helpful. ・A more in-depth exploration of the sources of heterogeneity would strengthen the analysis. Discussion: The discussion provides a good overview of the findings, but could be enhanced by: ・A more critical analysis of the limitations of the included studies and how these might impact the overall conclusions. ・More detailed discussion of the clinical implications of the different thresholds used across studies. ・Clearer guidance on how clinicians should integrate these IVC measurements with other clinical parameters when assessing fluid responsiveness. ・A more thorough comparison of these findings with other methods of assessing fluid responsiveness in sepsis. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Fadi Aljamaan Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . 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Revision 1
27 Nov 2024 Author Response Dear Reviewers, Happy Thanksgiving Day! Thank you for your thorough review and constructive suggestions regarding our manuscript. We have revised the manuscript in accordance with your comments and have marked all amendments in the revised document. In addition to our point-by-point responses to the reviewers’ comments, we have also made every effort to meet the required editorial standards, ensuring that all changes are easily identifiable. We hope that our revised manuscript fulfills your requirements. If any further action is needed, please do not hesitate to let us know. We look forward to your feedback. 1. Please improve english grammar and style of the draft Response: Considering the academic editor’s suggestion, we have engaged a native English speaker to thoroughly revise our language, ensuring the fluency, accuracy, and consistency of our writing. We believe these changes will greatly enhance the quality of our manuscript. 2. Data Availability Statement Response: Considering the Reviewer’s suggestion, we have corrected it, and it has been changed to “All data are in the manuscript and/or supporting information files”. Please see the Data Availability Statement in the attachment of Supplementary Material. 3. Literature search section Response: Considering the Reviewer’s suggestion, we uploaded the files in Excel format of Supplementary information. 4. Suggest to Give more elaboration on the different observation of outcome effect between dIVC and cIVC from physiological point. Response: Considering the Reviewer’s suggestion, we modified the Introduction and Discussion accordingly and added the following references. As detailed in the Introduction, page 6, lines 100 -103, see Discussion section, page 14, line 278-287. 5. The reviewer raises an important point that vasopressors were not manipulated during fluid challenge in included studies as this might affect the standard reference of CI or CO? Response: Considering the Reviewer’s suggestion, all members of the research team read all the literatures. We reviewed the full text and found that four literatures did not explicitly mention the use of vasopressors, two literatures excluded patients who were using vasopressors, and the remaining literatures all acknowledged the use of vasopressors during the study period. Subgroup analysis was not feasible due to the limited number of relevant studies. However, this issue is addressed in the Discussion and Limitations sections. Moreover, the details of the literature have been incorporated into Table1 Main characteristics of the eligible studies by the author. 6. Providing more context on current guidelines for fluid management in sepsis and their limitations. Response: Considering the Reviewer’s suggestion, we modified the Introduction accordingly. As detailed in the Introduction, page 4, lines 57 -64. 7. Clarifying the specific advantages of IVC measurements over other methods of assessing fluid responsiveness. Response: Considering the Reviewer’s suggestion, we modified the Introduction accordingly. As detailed in the Introduction, page 5, lines 74-78, 82-85. 8. Providing more detail on the search strategy, including full search terms for each database. Response: Thank you for the comment. We provided a complete search strategy for the PubMed database which showed in Fig 1. We now have elaborated the search strategy in Word format giving the details of Electronic search strategy. 9. Clarifying the criteria used for assessing study quality and how this information was incorporated into the analysis. Response: Considering the Reviewer’s suggestion, we used the QUADAS 2 tool as a guide to direct our judgments as to the quality of the included studies. ZH scored and recorded for all references using the QUADAS-2 tool, and then DM reviewed the results. More detailed descriptions in the supplementary Excel file were also provided. 10. Explaining how discrepancies in data extraction or quality assessment between reviewers were resolved. Response: Considering the Reviewer’s suggestion, we modified the Materials and Methods accordingly. In case of disagreement between two researchers in the literature screening or data extraction process, the decision was submitted to the third researcher (GYL). As detailed in the Study selection, page 8, lines 142-144. 11. The rationale for the chosen subgroup analyses could be more explicitly stated. Response: Considering the Reviewer’s suggestion, we modified the Subgroup analysis accordingly. As detailed in the Subgroup analysis, page 11, lines 210-213. 12. More detail on the results of the quality assessment for individual studies would be helpful. Response: Considering the Reviewer’s suggestion, we used the QUADAS 2 tool as a guide to direct our judgments as to the quality of the included studies. More detailed descriptions in the supplementary Excel file were also provided. 13. A more in-depth exploration of the sources of heterogeneity would strengthen the analysis. Response: Considering the Reviewer’s suggestion, we modified the Discussion accordingly. see Discussion section, page 12,14-16. 14. More detailed discussion of the clinical implications of the different thresholds used across studies. Response: Considering the Reviewer’s suggestion, we modified the Discussion accordingly. see Discussion section, page 16, lines 333-340. 15. Clearer guidance on how clinicians should integrate these IVC measurements with other clinical parameters when assessing fluid responsiveness. Response: Considering the Reviewer’s suggestion, we modified the Discussion accordingly. see Discussion section, page 14, lines 279-288. 16. A more thorough comparison of these findings with other methods of assessing fluid responsiveness in sepsis. Response: Considering the Reviewer’s suggestion, we modified the Discussion accordingly. see Discussion section, page 12,14-16. Attachments Attachment Submitted filename: Response to Reviewers.docx https://doi.org/10.1371/journal.pone.0310462.r003
17 Dec 2024 Decision Letter - Vincenzo Lionetti, Editor PONE-D-24-36864R1Predictive accuracy of changes in the inferior vena cava diameter for predicting fluid responsiveness in patients with sepsis: A systematic review and meta-analysisPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: Despite some improvement, the revised form requires further clarification in accord with Reviewer's suggestions/>============================== Please submit your revised manuscript by Jan 31 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Vincenzo Lionetti, M.D., PhD Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #1: All comments have been addressed Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: No ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: No ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: Appreciated for the excellent work. It is still as you mentioned in the limitations that pattern and type of breathing affect the change of dIVC and its predictivity even though you could not find statistical significance with PEEP and VT, but for sure many other non recorded variable may play role. Reviewer #2: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Aljamaan, Fadi S Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0310462.r004
Revision 2
29 Dec 2024 Author Response Dear Reviewers, Thank you for your thorough review and constructive suggestions regarding our manuscript. We have revised the manuscript in accordance with your comments and have marked all amendments in the revised document. In addition to our point-by-point responses to the reviewers’ comments, we have also made every effort to meet the required editorial standards, ensuring that all changes are easily identifiable. We hope that our revised manuscript fulfills your requirements. If any further action is needed, please do not hesitate to let us know. We look forward to your feedback. 1. It is still as you mentioned in the limitations that pattern and type of breathing affect the change of dIVC and its predictivity even though you could not find statistical significance with PEEP and VT, but for sure many other non recorded variable may play role. Response Reviewer #1: Considering the Reviewer’s suggestion, we have expounded more detail in the discussion section, page 13, line 252-255. Based on past research findings, we suggest that this outcome could be attributed to physiological differences between adults and children. They included several studies of pediatric patients, whereas we excluded these studies. 2. Is the manuscript presented in an intelligible fashion and written in standard English? Response Reviewer #2: Considering the Reviewer’s suggestion, we have engaged a native English speaker to thoroughly revise our language, ensuring the fluency, accuracy, and consistency of our writing. We believe these changes will greatly enhance the quality of our manuscript. 3. Has the statistical analysis been performed appropriately and rigorously? Response Reviewer #2: This systematic review and meta-analysis was carried out was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis of Diagnostic Test Accuracy (PRISMA-DTA) statement. Based on the given guidelines, we employed the statistical analysis software provided by the instructions to obtain the data results. 4. Have the authors made all data underlying the findings in their manuscript fully available? Response Reviewer #2: Considering the Reviewer’s suggestion, All of our data, which is open and transparent, has been uploaded to the attachment in Excel tables. Attachments Attachment Submitted filename: Response to Reviewers-3.docx https://doi.org/10.1371/journal.pone.0310462.r005
7 Jan 2025 Decision Letter - Vincenzo Lionetti, Editor PONE-D-24-36864R2Predictive accuracy of changes in the inferior vena cava diameter for predicting fluid responsiveness in patients with sepsis: A systematic review and meta-analysisPLOS ONE Dear Dr. Zhang, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. ============================== ACADEMIC EDITOR: The authors are encouraged to reply to all comments by one reviewer. ============================== Please submit your revised manuscript by Feb 21 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Vincenzo Lionetti, M.D., PhD Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: (No Response) ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: No ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: This systematic review and meta-analysis examines the predictive accuracy of inferior vena cava (IVC) measurements for fluid responsiveness in septic patients. The study analyzed 21 papers (1,207 patients), evaluating three key parameters: overall IVC diameter changes (∆IVC), IVC distensibility (dIVC) in mechanically ventilated patients, and IVC collapsibility (cIVC) in spontaneously breathing patients. The results demonstrated good diagnostic accuracy across all measures, with particularly strong performance of cIVC in spontaneously breathing patients. However, there are some concerns needing revision. Methodology: 1. The selection criteria differentiating mechanically ventilated from spontaneously breathing patients needs clearer exposition 2. The heterogeneity in ventilator parameters across studies requires more detailed analysis 3. The rationale for subgroup analysis thresholds should be better justified Results Presentation: 1. Forest plots and funnel plots should be integrated into the main text rather than supplementary materials for better readability 2. The discussion of varying thresholds across studies needs expansion 3. The implications of different fluid challenge protocols require more detailed analysis 4. The meta-regression results need clearer presentation, particularly regarding the clinical significance of findings Discussion: 1. The limitations section should be expanded to address: - Heterogeneity in study protocols - Variations in measurement techniques - Impact of different patient populations 2. Clinical implementation challenges need more thorough discussion 3. Specific recommendations for standardizing measurement techniques should be included 4. The implications of different ventilator settings need more detailed analysis ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #2: No ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0310462.r006
Revision 3
23 Feb 2025 Author Response Dear Editors, Thank you for your thorough review and constructive suggestions regarding our manuscript. We sincerely appreciate the time and effort you dedicated to reviewing and providing feedback. In particular, we highly value the constructive suggestions you made, which were carefully discussed within our team. We fully agree with your recommendations and have made detailed revisions accordingly. These improvements will help enhance the manuscript’s quality and ensure it meets the standards for publication. Once again, thank you for your valuable input, which has greatly contributed to this research. We look forward to your feedback. Below are our point-by-point responses to your comments: Methodology: 1. The selection criteria differentiating mechanically ventilated from spontaneously breathing patients needs clearer exposition. Response academic editor: Thank you once again for your constructive feedback. We greatly appreciate and value your insights. In response, we have revised and enhanced the Methodology section. Your valuable input has improved the completeness of the description. The manuscript has been amended to state: “The inclusion criteria included studies published in Chinese and English that focused on patients with sepsis or septic shock. The research subjects in the original literature should identify whether they are mechanically ventilated or spontaneously breathing patients. Mechanically ventilated patients should collect ventilator parameters.” 2. The heterogeneity in ventilator parameters across studies requires more detailed analysis Response academic editor: Thank you for your valuable suggestion. In response, we have revised the Methodology section accordingly. And it has been changed to “For the subgroup analysis, we first compared mechanically ventilated and nonmechanically ventilated individuals. We analyzed various ventilator parameters including TV, PEEP, and threshold, which are mechanically ventilated.” 3. The rationale for subgroup analysis thresholds should be better justified Response academic editor: Thank you for your helpful suggestion. In response, we have revised the Methodology section accordingly. The manuscript has been amended to state: “Currently, there is no evidence that a single evaluation parameter or index can be utilized as an endpoint on its own to direct fluid resuscitation in sepsis patients. Our subgroup analysis is based on previous systematic review results, basic ventilator parameters (TV=6-8mL/kg, PEEP=5 cmH2O), and dose selection for fluid resuscitation. Each enrolled patient with septic shock was categorized into the low-volume (200ml), medium-volume (7 mL/kg fluid), or high-volume (above 500 mL) fluid group according to the infusion volume. We conducted subgroup analyses based on TV, PEEP, infusion volume, and diagnostic threshold.” Results Presentation: 1. Forest plots and funnel plots should be integrated into the main text rather than supplementary materials for better readability Response academic editor: Thank you for your insightful comment and helpful suggestions. In response, we have revised the forest plots and funnel plots accordingly. 2. The discussion of varying thresholds across studies needs expansion? Response academic editor: Thank you for your insightful comment and helpful suggestions. In response, we have revised the Results and Discussion section accordingly. 3. The implications of different fluid challenge protocols require more detailed analysis. Response academic editor: Thank you for your insightful suggestion. In response, we have revised the Results and Discussion section accordingly. 4. The meta-regression results need clearer presentation, particularly regarding the clinical significance of findings. Response academic editor: Thank you for your helpful suggestion. In response, we have revised the Results and Discussion section accordingly. Discussion Presentation: 1. The limitations section should be expanded to address: Heterogeneity in study protocols, Variations in measurement techniques, Impact of different patient populations. Response academic editor: Thank you for your helpful suggestion. In response, we have revised the Limitations section accordingly. “First, heterogeneity in measurement protocols primarily arises from differences between mechanically ventilated and non-ventilated patient cohorts. Second, critically ill patients demonstrate significant heterogeneity that those with heart failure, kidney disease, or other comorbidities may exhibit marked variations in fluid resuscitation efficacy. This necessitates the integration of dynamic parameters, such as ultrasound-guided assessments combined with pulse pressure variation (PPV) or fluid challenge tests, when evaluating fluid resuscitation in septic patients. Additionally, blood lactate levels should be combined to comprehensively assess resuscitation outcomes.” 2. Clinical implementation challenges need more thorough discussion. Response academic editor: Thank you for your thoughtful suggestion. In response, we have revised the Discussion section accordingly. 3. Specific recommendations for standardizing measurement techniques should be included. Response academic editor: Thank you for your suggestion. In response, we have revised the Discussion section accordingly. 4. The implications of different ventilator settings need more detailed analysis. Response academic editor: Thank you for your suggestion. In response, we have revised the Discussion section accordingly. Attachments Attachment Submitted filename: Response_to_Reviewers_auresp_3.docx https://doi.org/10.1371/journal.pone.0310462.r007
17 Mar 2025 Decision Letter - Vincenzo Lionetti, Editor Predictive accuracy of changes in the inferior vena cava diameter for predicting fluid responsiveness in patients with sepsis: A systematic review and meta-analysis PONE-D-24-36864R3 Dear Dr. Zhang, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. 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If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #2: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #2: After reviewing the revised manuscript, I find that the authors have addressed the major concerns raised in the previous review. The improvements to the methodology, results presentation, and discussion sections have significantly enhanced the quality and clarity of the manuscript. ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #2: No ******** https://doi.org/10.1371/journal.pone.0310462.r008
Formally Accepted
Acceptance Letter - Vincenzo Lionetti, Editor PONE-D-24-36864R3 PLOS ONE Dear Dr. Zhang, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Vincenzo Lionetti Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0310462.r009

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