Division of Pediatric Critical Care, Department of Pediatrics, University of Campinas, Campinas, São Paulo, Brazil; and
Division of Pediatric Critical Care, Department of Pediatrics, University of Campinas, Campinas, São Paulo, Brazil; and.
Pediatrics. 2018 Nov;142(5). doi: 10.1542/peds.2018-1719.
: media-1vid110.1542/5828324804001PEDS-VA_2018-1719 CONTEXT: Central venous catheterization is routinely required in patients who are critically ill, and it carries an associated morbidity. In pediatric patients, the procedures can be difficult and challenging, predominantly because of their anatomic characteristics.
To determine whether ultrasound-guided techniques are associated with a reduced incidence of failures and complications when compared with the anatomic landmark technique.
We conducted a systematic search of PubMed and Embase.
We included randomized controlled trials and nonrandomized studies in which researchers compare ultrasound guidance with the anatomic landmark technique in children who underwent central venous catheterization.
Study characteristics, sample sizes, participant characteristics, settings, descriptions of the ultrasound technique, puncture sites, and outcomes were analyzed. Pooled analyses were performed by using random-effects models.
A total of 23 studies (3995 procedures) were included. Meta-analysis revealed that ultrasound guidance significantly reduced the risk of cannulation failure (odds ratio = 0.27; 95% confidence interval: 0.17-0.43), with significant heterogeneity seen among the studies. Ultrasound guidance also significantly reduced the incidence of arterial punctures (odds ratio = 0.34; 95% confidence interval: 0.21-0.55), without significant heterogeneity seen among the studies. Similar results were observed for femoral and internal jugular veins.
Potential publication bias for cannulation failure and arterial puncture was detected among the studies. However, no publication bias was observed when analyzing only the subgroup of randomized clinical trials.
Ultrasound-guided techniques are associated with a reduced incidence of failures and inadvertent arterial punctures in pediatric central venous catheterization when compared with the anatomic landmark technique.
与解剖标志技术相比，确定超声引导技术是否与降低失败率和并发症发生率相关。
我们对 PubMed 和 Embase 进行了系统检索。
我们纳入了比较儿童中心静脉置管中超声引导与解剖标志技术的随机对照试验和非随机研究。
分析了研究特征、样本量、参与者特征、设置、超声技术描述、穿刺部位和结局。采用随机效应模型进行汇总分析。
共纳入 23 项研究（3995 例操作）。Meta 分析显示，超声引导显著降低了置管失败的风险（优势比=0.27；95%置信区间：0.17-0.43），但研究间存在显著异质性。超声引导还显著降低了动脉穿刺的发生率（优势比=0.34；95%置信区间：0.21-0.55），研究间无显著异质性。股静脉和颈内静脉也观察到了类似的结果。
研究中检测到置管失败和动脉穿刺的潜在发表偏倚。然而，当仅分析随机临床试验的亚组时，未观察到发表偏倚。
与解剖标志技术相比，超声引导技术在儿科中心静脉置管中与降低失败率和意外动脉穿刺相关。
