UR-UM103 IMAGINE, Univ Montpellier, Division of Anesthesia Critical Care, Pain and Emergency Medicine, Nîmes University Hospital, Montpellier, France.
Anesthesiology and Intensive Care; Anesthesia and Critical Care Department B, Saint Eloi Teaching Hospital, PhyMedExp, University of Montpellier, INSERM U1046, 1, Montpellier, France.
Crit Care. 2024 Nov 19;28(1):378. doi: 10.1186/s13054-024-05162-0.
During central venous catheterization (CVC), ultrasound (US) guidance has been shown to reduce mechanical complications and increase success rates compared to the anatomical landmark (AL) technique. However, the impact of US guidance on catheter-related infections remains controversial. This systematic review and meta-analysis aimed to compare the risk of catheter-related infection with US-guided CVC versus AL technique.
A systematic search on MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science databases was conducted until July 31, 2024. Randomized controlled trials (RCTs) and non-randomized studies of intervention (NRSI) comparing US-guided versus AL-guided CVC placement were included. The primary outcome was a composite outcome including all types of catheter-related infection: catheter-related bloodstream infections (CRBSIs), central line-associated bloodstream infections (CLABSIs), catheter colonization, or any other type of reported infection. The secondary outcomes included individual infection types and mortality at day-28. Subgroup analyses based on study type and operator experience were also performed.
Pooling twelve studies (8 RCTs and 4 NRSI), with a total of 5,092 CVC procedures (2072 US-guided and 3020 AL-guided), US-guided CVC was associated with a significant reduction in catheter-related infections compared with the AL technique (risk ratio (RR) = 0.68, 95% confidence interval (CI) 0.53-0.88). In the RCT subgroup, the pooled RR was 0.65 (95% CI 0.49-0.87). This effect was more pronounced in procedures performed by experienced operators (RR = 0.60, 95% CI 0.41-0.89). In inexperienced operators, the infection risk reduction was not statistically significant. The pooled analysis of CRBSIs and CLABSIs also favored US guidance (RR = 0.65, 95% CI 0.48-0.87).
US-guided CVC placement significantly reduces the risk of catheter-related infections compared to the AL technique, particularly when performed by experienced operators. Trial registration PROSPERO CRD42022350884. Registered 13 August 2022.
在中心静脉置管（CVC）过程中，与解剖标志（AL）技术相比，超声（US）引导已被证明可降低机械并发症的发生率并提高成功率。然而，US 引导对导管相关感染的影响仍存在争议。本系统评价和荟萃分析旨在比较 US 引导下 CVC 与 AL 技术相比，导管相关感染的风险。
对 MEDLINE、Cochrane 对照试验中心注册库（CENTRAL）和 Web of Science 数据库进行了系统检索，检索时间截至 2024 年 7 月 31 日。纳入了比较 US 引导与 AL 引导 CVC 置管的随机对照试验（RCT）和非随机干预研究（NRSI）。主要结局为包括所有类型导管相关感染的复合结局：导管相关血流感染（CRBSI）、中心静脉相关血流感染（CLABSI）、导管定植或任何其他报告的感染。次要结局包括个别感染类型和第 28 天的死亡率。还根据研究类型和操作人员经验进行了亚组分析。
纳入 12 项研究（8 项 RCT 和 4 项 NRSI），共 5092 例 CVC 操作（2072 例 US 引导和 3020 例 AL 引导），与 AL 技术相比，US 引导 CVC 可显著降低导管相关感染的风险（风险比（RR）=0.68，95%置信区间（CI）0.53-0.88）。在 RCT 亚组中，汇总的 RR 为 0.65（95%CI 0.49-0.87）。在经验丰富的操作人员进行的操作中，这种效果更为明显（RR=0.60，95%CI 0.41-0.89）。在经验不足的操作人员中，感染风险降低不具有统计学意义。CRBSI 和 CLABSI 的汇总分析也有利于 US 引导（RR=0.65，95%CI 0.48-0.87）。
与 AL 技术相比，US 引导下 CVC 置管可显著降低导管相关感染的风险，尤其是在经验丰富的操作人员进行操作时。试验注册 PROSPERO CRD42022350884。注册于 2022 年 8 月 13 日。
