Department of Rehabilitation Sciences, Research Group for Rehabilitation in Internal Disorders, KU Leuven, 3000, Leuven, Belgium.
Department of Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium.
Crit Care. 2024 Mar 7;28(1):70. doi: 10.1186/s13054-024-04823-4.
Several bedside assessments are used to evaluate respiratory muscle function and to predict weaning from mechanical ventilation in patients on the intensive care unit. It remains unclear which assessments perform best in predicting weaning success. The primary aim of this systematic review and meta-analysis was to summarize and compare the accuracy of the following assessments to predict weaning success: maximal inspiratory (PImax) and expiratory pressures, diaphragm thickening fraction and excursion (DTF and DE), end-expiratory (Tdi) and end-inspiratory (Tdi) diaphragm thickness, airway occlusion pressure (P0.1), electrical activity of respiratory muscles, and volitional and non-volitional assessments of transdiaphragmatic and airway opening pressures.
Medline (via Pubmed), EMBASE, Web of Science, Cochrane Library and CINAHL were comprehensively searched from inception to 04/05/2023. Studies including adult mechanically ventilated patients reporting data on predictive accuracy were included. Hierarchical summary receiver operating characteristic (HSROC) models were used to estimate the SROC curves of each assessment method. Meta-regression was used to compare SROC curves. Sensitivity analyses were conducted by excluding studies with high risk of bias, as assessed with QUADAS-2. Direct comparisons were performed using studies comparing each pair of assessments within the same sample of patients.
Ninety-four studies were identified of which 88 studies (n = 6296) reporting on either PImax, DTF, DE, Tdi, Tdi and P0.1 were included in the meta-analyses. The sensitivity to predict weaning success was 63% (95% CI 47-77%) for PImax, 75% (95% CI 67-82%) for DE, 77% (95% CI 61-87%) for DTF, 74% (95% CI 40-93%) for P0.1, 69% (95% CI 13-97%) for Tdi, 37% (95% CI 13-70%) for Tdi, at fixed 80% specificity. Accuracy of DE and DTF to predict weaning success was significantly higher when compared to PImax (p = 0.04 and p < 0.01, respectively). Sensitivity and direct comparisons analyses showed that the accuracy of DTF to predict weaning success was significantly higher when compared to DE (p < 0.01).
DTF and DE are superior to PImax and DTF seems to have the highest accuracy among all included respiratory muscle assessments for predicting weaning success. Further studies aiming at identifying the optimal threshold of DTF to predict weaning success are warranted.
PROSPERO CRD42020209295, October 15, 2020.
有几种床边评估用于评估呼吸肌功能，并预测重症监护病房机械通气患者的脱机。目前尚不清楚哪种评估方法对预测脱机成功率最有效。本系统评价和荟萃分析的主要目的是总结和比较以下评估方法预测脱机成功率的准确性：最大吸气（PImax）和呼气压力、膈肌增厚分数和移动度（DTF 和 DE）、呼气末（Tdi）和吸气末（Tdi）膈肌厚度、气道阻断压（P0.1）、呼吸肌电活动以及跨膈和气道开口压力的自主和非自主评估。
从建库到 2023 年 4 月 5 日，全面检索了 Medline（通过 Pubmed）、EMBASE、Web of Science、Cochrane 图书馆和 CINAHL 数据库。纳入了包括机械通气的成年患者在内的报告预测准确性数据的研究。使用分层汇总受试者工作特征（HSROC）模型估计每种评估方法的 SROC 曲线。使用元回归比较 SROC 曲线。通过排除使用 QUADAS-2 评估具有高偏倚风险的研究，进行敏感性分析。直接比较是通过在同一患者样本中比较每对评估方法来进行的。
共确定了 94 项研究，其中 88 项研究（n=6296）报告了 PImax、DTF、DE、Tdi、Tdi 和 P0.1，这些研究被纳入荟萃分析。预测脱机成功率的敏感性为 63%（95%CI 47-77%），PImax 为 75%（95%CI 67-82%），DE 为 77%（95%CI 61-87%），DTF 为 77%（95%CI 61-87%））为 74%（95%CI 40-93%），P0.1 为 69%（95%CI 13-97%），Tdi 为 37%（95%CI 13-70%），特异性为 80%。与 PImax 相比，DE 和 DTF 预测脱机成功率的准确性显著更高（p=0.04 和 p<0.01）。敏感性和直接比较分析表明，DTF 预测脱机成功率的准确性明显高于 DE（p<0.01）。
DTF 和 DE 优于 PImax，而 DTF 似乎在所有纳入的呼吸肌评估中具有预测脱机成功率的最高准确性。有必要进一步研究确定 DTF 预测脱机成功率的最佳阈值。
PROSPERO CRD42020209295，2020 年 10 月 15 日。
