Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis.
Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis.
复制标题
重症监护环境中吸气呼吸肌超声的方法学和临床评价：系统回顾和荟萃分析。
DOI：
10.1097/ccm.0000000000005739
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发表时间：
2023
影响因子：
8.8
通讯作者：
Granger
中科院分区：
文献类型：
--
作者：
Truong,Dominic;Abo,Shaza;Whish-Wilson,GeorginaA;D'Souza,AruskaN;Beach,LisaJ;Mathur,Sunita;Mayer,KirbyP;Ntoumenopoulos,George;Baldwin,Claire;El-Ansary,Doa;Paris,MichaelT;Mourtzakis,Marina;Morris,PeterE;Pastva,AmyM;Granger
目的：呼吸肌超声在重症监护中的应用存在显著差异，对最佳方法没有社会层面的共识。资料来源：系统检索截至2021年11月24日的5个数据库。研究选择：纳入至少50例成人ICU患者，报告呼吸肌（膈肌或肋间）超声测量回声纹理、肌肉厚度、增厚分数或偏移，并评价至少一种临床特征的研究。两名独立的评论家评估标题，摘要，和全文对eligibility.DATA EXTRACTION：研究人口统计学，超声方法，和clinimetric data.DATA SYNTHESIS：60项研究，包括5,025例患者，包括39项研究有助于荟萃分析。最常测量的是在B模式下使用线性换能器测量的隔膜厚度（DT）或隔膜增厚分数（DTF），或在M模式下使用曲线换能器测量的隔膜偏移（DE）。在所有研究中，成像方法和采集存在显著差异。动脉间和动脉内测量的可靠性通常很好，DT的可靠性最高（ICC，0.98; 95% CI，0.94-0.99）。汇总数据表明，DT、DTF和DE预测拔管后48 - 72小时撤机结局的准确性可接受至极佳（DTF AUC，0.79; 95% CI，0.73-0.85）。DT成像对随时间的变化有反应。仅3项合格的研究可用于肋间肌。肋间增厚分数被证明有很好的准确性预测拔管后48小时（AUC，0.84; 95%CI，0.78-0.91）。结论：膈肌超声是可靠的，有效的，并在ICU患者的反应，但显着的变化存在的成像采集和分析方法。未来的工作应集中在开发标准化的协议，超声成像，并考虑进一步研究的作用，肋间肌肉成像。
OBJECTIVE:Significant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies.DATA SOURCES:Systematic search of five databases up to November 24, 2021.STUDY SELECTION:Studies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility.DATA EXTRACTION:Study demographics, ultrasound methodologies, and clinimetric data.DATA SYNTHESIS:Sixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter-and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94–0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73–0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78–0.91).CONCLUSIONS:Diaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.