Llamas-Álvarez Ana M, Tenza-Lozano Eva M, Latour-Pérez Jaime
Intensive Care Unit, Elche General University Hospital, Elche, Spain.
Intensive Care Unit, Elche General University Hospital, Elche, Spain.
Chest. 2017 Dec;152(6):1140-1150. doi: 10.1016/j.chest.2017.08.028. Epub 2017 Aug 31.
Deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging, and traditional weaning predictor tools are not very accurate. The aim of this systematic review and meta-analysis was to assess the accuracy of lung and diaphragm ultrasound for predicting weaning outcomes in critically ill adults.
MEDLINE, the Cochrane Library, Web of Science, Scopus, LILACS, Teseo, Tesis Doctorales en Red, and OpenGrey were searched, and the bibliographies of relevant studies were reviewed. Two researchers independently selected studies that met the inclusion criteria and assessed study quality in accordance with the Quality Assessment of Diagnostic Accuracy Studies-2 tool. The summary receiver-operating characteristic curve and pooled diagnostic OR (DOR) were estimated by using a bivariate random effects analysis. Sources of heterogeneity were explored by using predefined subgroup analyses and bivariate meta-regression.
Nineteen studies involving 1,071 people were included in the study. For diaphragm thickening fraction, the area under the summary receiver-operating characteristic curve was 0.87, and DOR was 21 (95% CI, 11-40). Regarding diaphragmatic excursion, pooled sensitivity was 75% (95% CI, 65-85); pooled specificity, 75% (95% CI, 60-85); and DOR, 10 (95% CI, 4-24). For lung ultrasound, the area under the summary receiver-operating characteristic curve was 0.77, and DOR was 38 (95% CI, 7-198). Based on bivariate meta-regression analysis, a significantly higher specificity for diaphragm thickening fraction and higher sensitivity for diaphragmatic excursion was detected in studies with applicability concerns.
Lung and diaphragm ultrasound can help predict weaning outcome, but its accuracy may vary depending on the patient subpopulation.
确定机械通气患者的最佳拔管时机具有挑战性，传统的撤机预测工具并不十分准确。本系统评价和荟萃分析的目的是评估肺和膈肌超声预测危重症成年患者撤机结局的准确性。
检索了MEDLINE、Cochrane图书馆、科学引文索引、Scopus、拉丁美洲和加勒比地区卫生科学数据库、Teseo、博士论文网络和OpenGrey，并查阅了相关研究的参考文献。两名研究人员独立选择符合纳入标准的研究，并根据诊断准确性研究质量评估-2工具评估研究质量。采用双变量随机效应分析估计汇总受试者工作特征曲线和合并诊断比值比（DOR）。通过预定义的亚组分析和双变量meta回归探索异质性来源。
该研究纳入了19项涉及1071人的研究。对于膈肌增厚分数，汇总受试者工作特征曲线下面积为0.87，DOR为21（95%CI，11-40）。关于膈肌移动度，合并敏感性为75%（95%CI，65-85）；合并特异性为75%（95%CI，60-85）；DOR为10（95%CI，4-24）。对于肺部超声，汇总受试者工作特征曲线下面积为0.77，DOR为38（95%CI，7-198）。基于双变量meta回归分析，在存在适用性问题的研究中，检测到膈肌增厚分数的特异性显著更高，膈肌移动度的敏感性更高。
肺和膈肌超声有助于预测撤机结局，但其准确性可能因患者亚组而异。
