Iranpour Yashar, Zandifar Afrooz
Department of anesthesiology, Tehran University of Medical Science, Tehran.
Department of Radiology, Tehran University of Medical Science, Tehran.
Eur J Transl Myol. 2024 Sep 3;34(3):12642. doi: 10.4081/ejtm.2024.12642.
Diaphragmatic ultrasound, valued for its portability and safety, assesses both structural and functional aspects of the diaphragm. While some studies support its predictive value, others conflict. This meta-analysis aims to clarify diaphragmatic ultrasound's role in predicting successful liberation from mechanical ventilation in intensive care settings. A systematic search was performed on Web of Science, Scopus, and PubMed up to March, 2024. The search strategy included a combination of relevant medical subject heading (MeSH) terms and relevant keywords. We defined our eligibility criteria based on the PICO framework. Two authors performed the data extraction using a standardized sheet. The pooled mean difference was calculated using random effects model and Hedges' g along with SD estimation. R and RStudio were used for the statistical analysis and creating forest and funnel plots. The pooled mean difference was 7.25 (95% CI: 4.20, 10.21) for DE among the two groups. We found a statistically significant difference between the two groups indicating that those with successful weaning from intubation had higher means of DE compared to those with failed weaning attempt (p-value<0.01). The mean difference of DTF was also higher among those with successful weaning from intubation compared to those with failed weaning attempt with the pooled mean difference of 14.52 (95% CI: 10.51, 18.54, p-value<0.01). The mean difference of RSBI was lower among those with successful weaning from intubation compared to those with failed weaning attempt with the pooled mean difference of -28.86 (95% CI: -41.82, -15.91, p-value<0.01). Our results suggest that evaluating diaphragmatic excursion and thickening fraction can reliably anticipate successful liberation from mechanical ventilation. However, significant heterogeneity was present among the included studies. High-quality research, particularly randomized clinical trials, is required to further elucidate the role of diaphragmatic ultrasound in predicting weaning from mechanical ventilation.
膈肌超声因其便携性和安全性而受到重视，可评估膈肌的结构和功能方面。虽然一些研究支持其预测价值，但其他研究则存在冲突。这项荟萃分析旨在阐明膈肌超声在预测重症监护环境中机械通气成功撤机方面的作用。截至2024年3月，在科学网、Scopus和PubMed上进行了系统检索。检索策略包括相关医学主题词（MeSH）术语和相关关键词的组合。我们根据PICO框架定义了纳入标准。两名作者使用标准化表格进行数据提取。使用随机效应模型和Hedges' g以及标准差估计计算合并平均差。使用R和RStudio进行统计分析并创建森林图和漏斗图。两组间DE的合并平均差为7.25（95%CI：4.20，10.21）。我们发现两组之间存在统计学显著差异，表明插管成功撤机者的DE均值高于撤机尝试失败者（p值<0.01）。与撤机尝试失败者相比，插管成功撤机者的DTF平均差也更高，合并平均差为14.52（95%CI：10.51，18.54，p值<0.01）。与撤机尝试失败者相比，插管成功撤机者的RSBI平均差更低，合并平均差为-28.86（95%CI：-41.82，-15.91，p值<0.01）。我们的结果表明，评估膈肌移动度和增厚分数可以可靠地预测机械通气的成功撤机。然而，纳入的研究之间存在显著异质性。需要高质量的研究，特别是随机临床试验，以进一步阐明膈肌超声在预测机械通气撤机中的作用。
