Gao Yang, Yin Hong, Wang Mei-Huan, Gao Yue-Hua
Department of Ultrasound, Shandong Provincial Maternal and Child Health Care Hospital, Jinan, China.
Department of Ultrasound, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China.
Front Pediatr. 2023 Sep 6;11:1211306. doi: 10.3389/fped.2023.1211306. eCollection 2023.
Although lung and diaphragm ultrasound are valuable tools for predicting weaning results in adults with MV, their relevance in children is debatable. The goal of this meta-analysis was to determine the predictive value of lung and diaphragm ultrasound in newborn weaning outcomes.
For eligible studies, the databases MEDLINE, Web of Science, Cochrane Library, PubMed, and Embase were thoroughly searched. The Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) method was used to evaluate the study's quality. Results were gathered for sensitivity, specificity, diagnostic odds ratio (DOR), and the area under the curve of summary receiver operating characteristic curves (AUSROC). To investigate the causes of heterogeneity, subgroup analyses and meta-regression were conducted.
A total of 11 studies were suitable for inclusion in the meta-analysis, which included 828 patients. The pooled sensitivity and specificity of lung ultrasound (LUS) were 0.88 (95%CI, 0.85-0.90) and 0.81 (95%CI, 0.75-0.87), respectively. The DOR for diaphragmatic excursion (DE) is 13.17 (95%CI, 5.65-30.71). The AUSROC for diaphragm thickening fraction (DTF) is 0.86 (95%CI, 0.82-0.89). The most sensitive and specific method is LUS. The DE and DTF were the key areas where study heterogeneity was evident.
Lung ultrasonography is an extremely accurate method for predicting weaning results in MV infants. DTF outperforms DE in terms of diaphragm ultrasound predictive power.
尽管肺部和膈肌超声是预测机械通气（MV）成年患者撤机结果的重要工具，但其在儿童中的相关性仍存在争议。本荟萃分析的目的是确定肺部和膈肌超声对新生儿撤机结局的预测价值。
对符合条件的研究，全面检索了MEDLINE、科学网、Cochrane图书馆、PubMed和Embase数据库。采用诊断准确性研究质量评估（QUADAS-2）方法评估研究质量。收集敏感性、特异性、诊断比值比（DOR）和总结性接收器操作特征曲线下面积（AUSROC）的结果。为研究异质性的原因，进行了亚组分析和Meta回归。
共有11项研究适合纳入荟萃分析，包括828例患者。肺部超声（LUS）的合并敏感性和特异性分别为0.88（95%CI，0.85-0.90）和0.81（95%CI，0.75-0.87）。膈肌移动度（DE）的DOR为13.17（95%CI，5.65-30.71）。膈肌增厚分数（DTF）的AUSROC为0.86（95%CI，0.82-0.89）。最敏感和特异的方法是LUS。DE和DTF是研究异质性明显的关键领域。
肺部超声是预测MV婴儿撤机结果的极其准确的方法。在膈肌超声预测能力方面，DTF优于DE。
