Questioning the Role of Carotid Artery Ultrasound in Assessing Fluid Responsiveness in Critical Illness: A Systematic Review and Meta-Analysis.

IF 1.8 Q3 CRITICAL CARE MEDICINE Critical Care Research and Practice Pub Date : 2024-04-27 eCollection Date: 2024-01-01 DOI:10.1155/2024/9102961
Samuel C D Walker, Adam C Lipszyc, Matthew Kilmurray, Helen Wilding, Hamed Akhlaghi
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Abstract

Background: A noninvasive and accurate method of identifying fluid responsiveness in hemodynamically unstable patients has long been sought by physicians. Carotid ultrasound (US) is one such modality previously canvassed for this purpose. The aim of this novel systematic review and meta-analysis is to investigate whether critically unwell patients who are requiring intravenous (IV) fluid resuscitation (fluid responders) can be identified accurately with carotid US.

Methods: The protocol was registered with PROSPERO on the 30/11/2022 (ID number: CRD42022380284). Studies investigating carotid ultrasound accuracy in assessing fluid responsiveness in hemodynamically unstable patients were included. Studies were identified through searches of six databases, all run on 4 November 2022, Medline, Embase, Emcare, APA PsycInfo, CINAHL, and Cochrane Library. Risk of bias was assessed using the QUADAS-2 and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Results were pooled, meta-analysis was conducted where amenable, and hierarchical summary receiver operating characteristic models were established to compare carotid ultrasound measures.

Results: Seventeen studies were included (n = 842), with 1048 fluid challenges. 441 (42.1%) were fluid responsive. Four different carotid US measures were investigated, including change in carotid doppler peak velocity (∆CDPV), carotid blood flow (CBF), change in carotid artery velocity time integral (∆CAVTI), and carotid flow time (CFT). Pooled carotid US had a pooled sensitivity, specificity, and AUROC with 95% confidence intervals (CI) of 0.73 (0.66-0.78), 0.82 (0.72-0.90), and 0.81 (0.78-0.85), respectively. ∆CDPV had sensitivity, specificity, and AUROC with 95% CI of 0.72 (0.64-0.80), 0.87 (0.73-0.94), and 0.82 (0.78-0.85), respectively. CBF had sensitivity, specificity, and AUROC with 95% CI of 0.70 (0.56-0.80), 0.80 (0.50-0.94), and 0.77 (0.78-0.85), respectively. Risk of bias and assessment was undertaken using the QUADAS-2 and GRADE tools. The QUADAS-2 found that studies generally had an unclear or high risk of bias but with low applicability concerns. The GRADE assessment showed that ∆CDPV and CBF had low accuracy for sensitivity and specificity.

Conclusion: It appears that carotid US has a limited ability to predict fluid responsiveness in critically unwell patients. ∆CDPV demonstrates the greatest accuracy of all measures analyzed. Further high-quality studies using consistent study design would help confirm this.

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质疑颈动脉超声在评估危重病人输液反应性中的作用:系统回顾与元分析》。
背景:长期以来,医生们一直在寻找一种无创、准确的方法来确定血流动力学不稳定患者对液体的反应性。颈动脉超声(US)就是以前为此目的而研究过的一种方法。这项新颖的系统综述和荟萃分析旨在研究需要静脉输液复苏的危重病人(输液反应者)能否通过颈动脉超声准确识别:该方案于 2022 年 11 月 30 日在 PROSPERO 注册(ID 号:CRD42022380284)。纳入的研究调查了颈动脉超声评估血流动力学不稳定患者输液反应性的准确性。通过检索六个数据库(均于 2022 年 11 月 4 日运行)、Medline、Embase、Emcare、APA PsycInfo、CINAHL 和 Cochrane Library,确定了相关研究。采用 QUADAS-2 和建议、评估、发展和评价分级 (GRADE) 指南评估偏倚风险。对结果进行汇总,在可行的情况下进行荟萃分析,并建立分层汇总接收者操作特征模型来比较颈动脉超声测量结果:结果:共纳入 17 项研究(n = 842),进行了 1048 次体液挑战。441人(42.1%)对液体有反应。研究了四种不同的颈动脉超声测量方法,包括颈动脉多普勒峰值速度变化(∆CDPV)、颈动脉血流量(CBF)、颈动脉速度时间积分变化(∆CAVTI)和颈动脉血流时间(CFT)。汇总的颈动脉 US 的敏感性、特异性和 AUROC 的 95% 置信区间 (CI) 分别为 0.73 (0.66-0.78)、0.82 (0.72-0.90) 和 0.81 (0.78-0.85)。∆CDPV的灵敏度、特异性和AUROC的95% CI分别为0.72(0.64-0.80)、0.87(0.73-0.94)和0.82(0.78-0.85)。CBF 的敏感性、特异性和 AUROC 的 95% CI 分别为 0.70 (0.56-0.80)、0.80 (0.50-0.94) 和 0.77 (0.78-0.85)。采用 QUADAS-2 和 GRADE 工具对偏倚风险进行了评估。QUADAS-2 发现,研究的偏倚风险一般不明确或较高,但适用性问题较低。GRADE 评估显示,∆CDPV 和 CBF 的敏感性和特异性准确性较低:结论:颈动脉 US 预测危重病人输液反应性的能力似乎有限。在所有分析指标中,∆CDPV 的准确性最高。采用一致的研究设计进行更多高质量的研究将有助于证实这一点。
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来源期刊
Critical Care Research and Practice
Critical Care Research and Practice CRITICAL CARE MEDICINE-
CiteScore
3.60
自引率
0.00%
发文量
34
审稿时长
14 weeks
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