Sigaut Stephanie, Skhiri Alia, Stany Ida, Golmar Jonathan, Nivoche Yves, Constant Isabelle, Murat Isabelle, Dahmani Souhayl
Robert Debre University Hospital, Paris, France.
Paediatr Anaesth. 2009 Dec;19(12):1199-206. doi: 10.1111/j.1460-9592.2009.03171.x. Epub 2009 Oct 23.
Central venous catheter placement is technically difficult in pediatric population especially in the younger patients. Ultrasound prelocation and/or guidance (UPG) of internal jugular vein (IJV) access has been shown to decrease failure rate and complications related to this invasive procedure. The goal of the present study was to perform a systematic review of the advantages of UPG over anatomical landmarks (AL) during IJV access in children and infants.
A comprehensive literature search was conducted to identify clinical trials that focused on the comparison of UPG to AL techniques during IJV access in children and infants. Two reviewers independently assessed each study to meet inclusion criteria and extracted data. Data from each trial were combined to calculate the pooled odds ratio (OR) or the mean differences (MD), and their 95% confidence intervals [CI 95%]. I(2) statistics were used to assess statistics heterogeneity and to guide the use of fixed or random effect for computation of overall effects. Subgroup analysis was used to clarify the effects of the techniques used (prelocation or guidance) or the experience of practitioners.
Literature found five articles. Most of the patients were cardiac surgery patients. In comparison with AL, UPG had no effect on IJV access failure rate (OR = 0.28 [0.05, 1.47], I(2) = 75%, P = 0.003), the rate of carotid artery puncture (OR = 0.32 [0.06, 1.62], I(2) = 68%, P = 0.01), haematoma, haemothorax, or pneumothorax occurrence (OR = 0.40 [0.14, 1.13], I(2) = 17%, P = 0.30, OR = 0.72, OR = 0.81 [0.18, 3.73], I(2) = 0%, P = 0.94, respectively) and time to IJV access and haemothorax/pneumothorax occurrence. Subgroup analysis found an efficacy of ultrasound when used by novice operators or during intraoperative use.
This current meta-analysis does not found the utility of ultrasound during IJV access in children and infants in increasing the success rate and in decreasing complications.
在儿科人群中，尤其是年龄较小的患者，中心静脉导管置入术在技术上具有挑战性。已证明超声预定位和/或引导（UPG）颈内静脉（IJV）穿刺可降低该侵入性操作的失败率和并发症。本研究的目的是系统评价在儿童和婴儿IJV穿刺过程中，UPG相对于解剖标志（AL）的优势。
进行全面的文献检索，以确定关注儿童和婴儿IJV穿刺过程中UPG与AL技术比较的临床试验。两名研究者独立评估每项研究是否符合纳入标准并提取数据。合并每项试验的数据以计算合并比值比（OR）或平均差（MD）及其95%置信区间[CI 95%]。I²统计量用于评估统计异质性，并指导使用固定效应或随机效应计算总体效应。亚组分析用于阐明所用技术（预定位或引导）或从业者经验的影响。
文献检索找到五篇文章。大多数患者为心脏手术患者。与AL相比，UPG对IJV穿刺失败率（OR = 0.28 [0.05, 1.47]，I² = 75%，P = 0.003）、颈动脉穿刺率（OR = 0.32 [0.06, 1.62]，I² = 68%，P = 0.01）、血肿、血胸或气胸发生率（OR分别为0.40 [0.14, 1.13]，I² = 17%，P = 0.3；OR = 0.72；OR = 0.81 [0.18, 3.73]，I² = 0%，P = 0.94）以及IJV穿刺时间和血胸/气胸发生率均无影响。亚组分析发现，新手操作者使用超声或术中使用超声有效。
当前的荟萃分析未发现超声在儿童和婴儿IJV穿刺过程中提高成功率和降低并发症方面的效用。
