Wu Chenxia, Hu Luoxia, Shen Qinkang, Xu Hua, Huang Haijun
Department of Emergency, The First Affiliated Hospital of Zhejiang ChineseMedical University, Zhejiang 310018, Hangzhou, China.
Heliyon. 2023 Jul 17;9(7):e18227. doi: 10.1016/j.heliyon.2023.e18227. eCollection 2023 Jul.
The predictive power of extubation failure diagnosed by decrease in central venous oxygen saturation (ΔScvO2) varies by studies. Here we summarized the diagnostic value of extubation failure tested by ΔScvO2.
A comprehensive online search was performed to select potentially eligible studies that evaluated the predictive power of extubation failure tested by ΔScvO2. A manual search was also performed to identify additional studies. Data were extracted to calculate the pooled sensitivity, specificity, positive likelihood ratio (LR), negative LR, diagnostic odds ratio (DOR), and area under the receiver operating characteristic curve (AUC) to evaluate the predictive power of extubation failure.
Overall, five studies including 353 patients were included in this review, of whom 105 (30%) were extubation failure. The cutoff values of ΔScvO2 varied across studies, ranging from 3.8% to 5.4%. Heterogeneity between studies was assessed with an overall = 0.007, = 0%, and = 0.498. The pooled sensitivity and specificity for the overall population were 0.83 (95% CI: 0.74-0.90) and 0.88 (95% CI: 0.83-0.92), respectively. The pooled positive LR and negative LR were 7.2 (95%CI: 4.6-11.2) and 0.19 (95%CI: 0.12-0.31), respectively. The DOR was 38 (95% CI: 17-86). Overall, the pooled AUROC was 0.92 (95% CI: 0.90-0.94).
The ΔScvO2 performed well in predicting extubation failure in adult mechanical ventilation patients. Further studies with a larger data set and well-designed models are required to confirm the diagnostic accuracy and utility of ScvO2 in predicting extubation outcomes in mechanical ventilation patients.
通过中心静脉血氧饱和度下降（ΔScvO2）诊断拔管失败的预测能力因研究而异。在此，我们总结了通过ΔScvO2检测拔管失败的诊断价值。
进行全面的在线搜索，以选择评估通过ΔScvO2检测拔管失败预测能力的潜在合格研究。还进行了手动搜索以识别其他研究。提取数据以计算合并敏感度、特异度、阳性似然比（LR）、阴性LR、诊断比值比（DOR）和受试者工作特征曲线下面积（AUC），以评估拔管失败的预测能力。
总体而言，本综述纳入了五项研究，共353例患者，其中105例（30%）为拔管失败。不同研究中ΔScvO2的截断值有所不同，范围为3.8%至5.4%。研究间的异质性评估结果为I² = 0.007，P = 0%，tau² = 0.498。总体人群的合并敏感度和特异度分别为0.83（95%CI：0.74 - 0.90）和0.88（95%CI：0.83 - 0.92）。合并阳性LR和阴性LR分别为7.2（95%CI：4.6 - 11.2）和0.19（95%CI：0.12 - 0.31）。DOR为38（95%CI：17 - 86）。总体而言，合并AUROC为0.92（95%CI：0.90 - 0.94）。
ΔScvO2在预测成人机械通气患者拔管失败方面表现良好。需要进一步开展具有更大数据集和精心设计模型的研究，以确认ScvO2在预测机械通气患者拔管结局方面诊断准确性和实用性。
