肺复张手法引起的每搏量变异度预测机械通气患者液体反应性的系统评价和荟萃分析。

Stroke volume variation induced by lung recruitment maneuver to predict fluid responsiveness in patients receiving mechanical ventilation: A systematic review and meta-analysis.

机构信息

Department of Anesthesiology, West China Hospital, Sichuan University No. 37th, Guoxue Alley, Wuhou District, Chengdu, Sichuan, China.

Department of Anesthesiology, Sichuan Cancer Hospital & Institute, Sichuan Cancer Center, School of Medicine, University of Electronic Science and Technology of China, No.55th, People's South Road, Chengdu, Sichuan, China.

出版信息

J Clin Anesth. 2024 Oct;97:111545. doi: 10.1016/j.jclinane.2024.111545. Epub 2024 Jul 5.

DOI:10.1016/j.jclinane.2024.111545

Abstract

STUDY OBJECTIVE

The aim of this study was to evaluate the accuracy of lung recruitment maneuver induced stroke volume variation (ΔSV) in predicting fluid responsiveness in mechanically ventilated adult patients by systematic review and meta-analysis.

METHODS

A comprehensive electronic search of relevant literature was conducted in PubMed, Web of Science, Cochrane Library, Ovid Medline, Embase and Chinese databases (including China National Knowledge Infrastructure, Wanfang and VIP databases). Review Manager 5.4, Meta-DiSc 1.4 and STATA 16.0 were selected for data analysis, and QUADAS-2 tool was used for quality assessment. Data from selected studies were pooled to obtain sensitivity, specificity, diagnostic likelihood ratio (DLR) of positive and negative, diagnostic odds ratio (DOR), and summary receiver operating characteristic curve.

RESULTS

A total of 6 studies with 256 patients were enrolled through March 2024. The risk of bias and applicability concerns for each included study were low, and there was no significant publication bias. There was moderate to substantial heterogeneity for the non-threshold effect, but not for the threshold effect. The combined sensitivity and specificity were 0.84 (95% CI, 0.77-0.90) and 0.79 (95% CI, 0.70-0.86), respectively. The DOR and the area under the curve (AUC) were 22.15 (95%CI, 7.62-64.34) and 0.90 (95% CI, 0.87-0.92), respectively. The positive and negative predictive values of DLR were 4.53 (95% CI, 2.50-8.18) and 0.19 (95% CI, 0.11-0.35), respectively. Fagan's nomogram showed that with a pre-test probability of 52%, the post-test probability reached 83% and 17% for the positive and negative tests, respectively.

CONCLUSIONS

Based on the currently available evidence, ΔSV has a good diagnostic value for predicting the fluid responsiveness in adult patients undergoing mechanical ventilation. Given the heterogeneity and limitations of the published data, further studies with large sample sizes and different clinical settings are needed to confirm the diagnostic value of ΔSV in predicting fluid responsiveness. PROSPERO registration number: CRD42023490598.

摘要

研究目的

本研究旨在通过系统评价和荟萃分析评估肺复张操作引起的每搏量变异度（ΔSV）预测机械通气成人患者液体反应性的准确性。

方法

对PubMed、Web of Science、Cochrane Library、Ovid Medline、Embase 和中文数据库（包括中国知网、万方和 VIP 数据库）进行全面的电子文献检索。使用 Review Manager 5.4、Meta-DiSc 1.4 和 STATA 16.0 进行数据分析，并使用 QUADAS-2 工具进行质量评估。对入选研究的数据进行汇总，获得阳性和阴性诊断似然比（DLR）、诊断优势比（DOR）和汇总受试者工作特征曲线。

结果

共纳入 6 项研究共 256 例患者，均为 2024 年 3 月前发表。每个纳入研究的偏倚风险和适用性问题均较低，且不存在显著的发表偏倚。对于非阈值效应，存在中度至高度异质性，但对于阈值效应，则不存在异质性。联合敏感度和特异度分别为 0.84（95%CI，0.77-0.90）和 0.79（95%CI，0.70-0.86）。DOR 和曲线下面积（AUC）分别为 22.15（95%CI，7.62-64.34）和 0.90（95%CI，0.87-0.92）。阳性和阴性 DLR 的预测值分别为 4.53（95%CI，2.50-8.18）和 0.19（95%CI，0.11-0.35）。Fagan 列线图显示，在预测试概率为 52%时，阳性和阴性试验的后测试概率分别达到 83%和 17%。