Karigowda Lohith, Gupta Bhavna, Elkady Hatem, Deshpande Kush
Department of Intensive Care, Liverpool Hospital, Liverpool, New South Wales, Australia.
Department of Anaesthesiology, All India Institute of Medical Sciences, Rishikesh, India.
Indian J Crit Care Med. 2024 Dec;28(12):1159-1169. doi: 10.5005/jp-journals-10071-24851. Epub 2024 Nov 30.
This systematic review aimed to assess the accuracy of ultrasound in diagnosing shock types among intensive care patients.
A comprehensive search of PubMed, Embase, Scopus, Cochrane Central Register, and Google Scholar was conducted for controlled trials published up to June 2023. Two intensivists independently screened articles for full-text reviews and abstracts, evaluating study quality using the QUADAS-2 tool. Prospective studies assessing ultrasound for diagnosing shock types in critically ill patients with undifferentiated shock were included.
Among 7287 articles identified, four met the inclusion criteria for meta-analysis. Pooled positive likelihood ratios were 8.8 (95% CI: 2.4-32.37) for distributive shock and 137.56 (95% CI: 27.76-681.64) for obstructive shock. Summary receiver operating characteristic (SROC) curves showed an area under the curve (AUC) of 0.99 for cardiogenic and obstructive shock, 0.5 for hypovolemic and mixed shock, and 0.76 for distributive shock. Pooled negative likelihood ratios ranged from 0.05 (95% CI: 0.010 to 0.24) for cardiogenic shock to 0.22 (95% CI: 0.127-0.38) for mixed-etiology shock.
Ultrasound demonstrates high accuracy in diagnosing obstructive and cardiogenic shock among intensive care patients with undifferentiated shock. However, its utility for other shock types appears limited.
Karigowda L, Gupta B, Elkady H, Deshpande K. Diagnostic Accuracy of Ultrasound in Intensive Care Patients with Undifferentiated Shock: A Systematic Review and Meta-analysis. Indian J Crit Care Med 2024;28(12):1159-1169.
本系统评价旨在评估超声在诊断重症监护患者休克类型方面的准确性。
全面检索了截至2023年6月发表的对照试验的PubMed、Embase、Scopus、Cochrane中央注册库和谷歌学术。两名重症医学专家独立筛选文章进行全文综述和摘要，使用QUADAS-2工具评估研究质量。纳入了评估超声诊断未分化休克的危重病患者休克类型的前瞻性研究。
在7287篇识别出的文章中，有4篇符合荟萃分析的纳入标准。分布性休克的合并阳性似然比为8.8（95%CI：2.4-32.37），梗阻性休克为137.56（95%CI：27.76-681.64）。汇总的受试者工作特征（SROC）曲线显示，心源性和梗阻性休克的曲线下面积（AUC）为0.99，低血容量性和混合性休克为0.5，分布性休克为0.76。合并阴性似然比范围从心源性休克的0.05（95%CI：0.010至0.24）到混合病因休克的0.22（95%CI：0.127-0.38）。
超声在诊断未分化休克的重症监护患者的梗阻性和心源性休克方面显示出高准确性。然而，其对其他休克类型的效用似乎有限。
卡里 Gowda L，古普塔 B，埃尔卡迪 H，德什潘德 K。超声在未分化休克重症监护患者中的诊断准确性：一项系统评价和荟萃分析。《印度重症医学杂志》2024；28(12):1159-1169。
