Basmaji John, Tang J Elaine, Arntfield Robert, Desai Karishma, Ball Ian M, Fiorini Kyle, Slessarev Marat, Honarmand Kimia, Jones Phil, Lau Vincent, Lewis Kimberley, Orozco Nicolas, Meade Maureen, Park Brian, Prager Ross, Rochwerg Bram, Thabane Lehana, Wong Michelle Y S, Guyatt Gordon
Division of Critical Care Medicine, Department of Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
Can J Anaesth. 2025 Jul 2. doi: 10.1007/s12630-025-02997-1.
We sought to conduct a systematic review to determine the diagnostic test accuracy of point-of-care ultrasound (POCUS) for the specific etiologies and subtypes of shock.
We searched MEDLINE, Embase, and the grey literature for prospective studies in adult populations with shock. We collected data on study design, patient characteristics, operator characteristics, POCUS protocol, and true and false positives and negatives, and assessed the risk of bias.
We found 18 eligible studies with a total of N = 2,088 patients. The pooled sensitivity and specificity of POCUS for determining shock subtype were 90% (95% confidence interval [CI], 81 to 95) and 95% (95% CI, 90 to 97) for hypovolemic shock, 95% (95% CI, 84 to 98) and 98% (95% CI, 97 to 99) for cardiogenic shock, 78% (95% CI, 69 to 85) and 97% (95% CI, 94 to 99) for distributive shock, 94% (95% CI, 85 to 97) and 99% (95% CI, 98 to 100) for obstructive shock, and 85% (95% CI, 77 to 91) and 98% (95% CI, 91 to 100) for mixed shock (all low to moderate quality evidence). The pooled sensitivity and specificity of POCUS for determining specific shock etiologies were 78% (95% CI, 18 to 98) and 96% (95% CI, 87 to 99) for sepsis, 92% (95% CI, 71 to 98) and 99% (95% CI, 83 to 100) for pulmonary embolism, and 100% (95% CI, 69 to 100) and 100% (95% CI, 98 to 100) for cardiac tamponade. The quality of the evidence ranged from very low to moderate.
On the basis of very low to moderate quality evidence, POCUS may perform better at ruling in shock subtypes and specific shock etiologies than ruling them out. Point-of-care ultrasound is a promising tool for the diagnosis of shock.
PROSPERO ( CRD42020160001 ); first submitted 1 December 2019.
我们试图进行一项系统评价，以确定床旁超声（POCUS）对休克特定病因和亚型的诊断测试准确性。
我们检索了MEDLINE、Embase和灰色文献，以查找有关成人休克患者的前瞻性研究。我们收集了有关研究设计、患者特征、操作者特征、POCUS方案以及真阳性、假阳性、真阴性和假阴性的数据，并评估了偏倚风险。
我们发现了18项符合条件的研究，共有N = 2088例患者。POCUS用于确定休克亚型的合并敏感性和特异性，对于低血容量性休克分别为90%（95%置信区间[CI]，81至95）和95%（95%CI，90至97），对于心源性休克分别为95%（95%CI，84至98）和98%（95%CI，97至99），对于分布性休克分别为78%（95%CI，69至85）和97%（95%CI，94至99），对于梗阻性休克分别为94%（95%CI，85至97）和99%（95%CI，98至100），对于混合性休克分别为85%（95%CI，77至91）和98%（95%CI，91至100）（均为低至中等质量证据）。POCUS用于确定特定休克病因的合并敏感性和特异性，对于脓毒症分别为78%（95%CI，18至98）和96%（95%CI，87至99），对于肺栓塞分别为92%（95%CI，71至98）和99%（95%CI，83至100），对于心脏压塞分别为100%（95%CI，69至100）和100%（95%CI，98至100）。证据质量从极低到中等不等。
基于极低到中等质量的证据，POCUS在诊断休克亚型和特定休克病因方面，可能在确定存在方面比排除方面表现更好。床旁超声是一种很有前景的休克诊断工具。
PROSPERO（CRD42020160001）；于2019年12月1日首次提交。
