From the Department of Anesthesiology, Perioperative Medicine and Pain Management, University of Miami Miller School of Medicine, Jackson Memorial Hospital, Miami, Florida.
Department of Health Informatics, The Louis Calder Memorial Library, University of Miami Miller School of Medicine, Miami, Florida.
Anesth Analg. 2021 Oct 1;133(4):852-859. doi: 10.1213/ANE.0000000000005336.
Focused cardiac ultrasound (FoCUS) has become a valuable tool to assess unexplained hypotension in critically ill patients. Due to increasing availability of transthoracic echocardiography (TTE) equipment in the operating room, there is a widespread interest in its usefulness for intraoperative diagnosis of hypotension as an alternative to transesophageal echocardiography (TEE). The objective of this systematic review is to evaluate the utility of intraoperative FoCUS to assess patients experiencing unexplained hypotension while undergoing noncardiac surgery. We performed a systematic literature search of multiple publication databases for studies that evaluated the utility of intraoperative FoCUS for assessment and management of unexplained hypotension in patients undergoing noncardiac surgery, including retro- and prospective clinical studies. A summary of the study findings, study quality, and assessment of level of evidence is presented. We identified 2227 unique articles from the literature search, of which 27 were potentially relevant, and 9 were included in this review. The number of patients pooled from these studies was 255, of whom 228 had intraoperative diagnoses with the aid of intraoperative FoCUS. The level of evidence of all studies included was very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) guidelines. This systematic review has demonstrated that FoCUS may be a useful, noninvasive method to differentiate causes of intraoperative hypotension and guide correcting interventions, although the quality of evidence is very low. Further prospective high-quality studies are needed to investigate whether intraoperative FoCUS has a diagnostic utility that is associated with improved outcomes.
聚焦式心脏超声（FoCUS）已成为评估危重症患者不明原因低血压的一种有价值的工具。由于经胸超声心动图（TTE）设备在手术室中的可用性不断增加，人们对其在术中诊断低血压方面的有用性产生了广泛的兴趣，将其作为经食管超声心动图（TEE）的替代方法。本系统评价的目的是评估术中 FoCUS 在评估和处理非心脏手术患者不明原因低血压中的效用。我们对多个出版数据库进行了系统文献检索，以评估术中 FoCUS 在评估和处理非心脏手术患者不明原因低血压中的效用，包括回顾性和前瞻性临床研究。本文介绍了研究结果的总结、研究质量和证据水平的评估。我们从文献检索中确定了 2227 篇独特的文章，其中 27 篇可能相关，9 篇被纳入本综述。从这些研究中汇总的患者人数为 255 名，其中 228 名在术中 FoCUS 的帮助下做出了术中诊断。根据推荐评估、制定和评估（GRADE）指南，所有纳入研究的证据水平均非常低。本系统评价表明，FoCUS 可能是一种有用的、非侵入性的方法，可以区分术中低血压的原因，并指导纠正干预措施，尽管证据质量非常低。需要进一步进行前瞻性高质量研究，以调查术中 FoCUS 是否具有与改善结局相关的诊断效用。
