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Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis.

Publication ,  Journal Article
Truong, D; Abo, S; Whish-Wilson, GA; D'Souza, AN; Beach, LJ; Mathur, S; Mayer, KP; Ntoumenopoulos, G; Baldwin, C; El-Ansary, D; Paris, MT ...
Published in: Crit Care Med
February 1, 2023

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.

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Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

February 1, 2023

Volume

51

Issue

2

Start / End Page

e24 / e36

Location

United States

Related Subject Headings

  • Ventilator Weaning
  • Ultrasonography
  • Reproducibility of Results
  • Humans
  • Emergency & Critical Care Medicine
  • Diaphragm
  • Critical Care
  • Adult
  • 4205 Nursing
  • 3202 Clinical sciences
 

Citation

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Truong, D., Abo, S., Whish-Wilson, G. A., D’Souza, A. N., Beach, L. J., Mathur, S., … Sarwal, A. (2023). Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis. Crit Care Med, 51(2), e24–e36. https://doi.org/10.1097/CCM.0000000000005739
Truong, Dominic, Shaza Abo, Georgina A. Whish-Wilson, Aruska N. D’Souza, Lisa J. Beach, Sunita Mathur, Kirby P. Mayer, et al. “Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis.Crit Care Med 51, no. 2 (February 1, 2023): e24–36. https://doi.org/10.1097/CCM.0000000000005739.
Truong D, Abo S, Whish-Wilson GA, D’Souza AN, Beach LJ, Mathur S, et al. Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis. Crit Care Med. 2023 Feb 1;51(2):e24–36.
Truong, Dominic, et al. “Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis.Crit Care Med, vol. 51, no. 2, Feb. 2023, pp. e24–36. Pubmed, doi:10.1097/CCM.0000000000005739.
Truong D, Abo S, Whish-Wilson GA, D’Souza AN, Beach LJ, Mathur S, Mayer KP, Ntoumenopoulos G, Baldwin C, El-Ansary D, Paris MT, Mourtzakis M, Morris PE, Pastva AM, Granger CL, Parry SM, Sarwal A. Methodological and Clinimetric Evaluation of Inspiratory Respiratory Muscle Ultrasound in the Critical Care Setting: A Systematic Review and Meta-Analysis. Crit Care Med. 2023 Feb 1;51(2):e24–e36.

Published In

Crit Care Med

DOI

EISSN

1530-0293

Publication Date

February 1, 2023

Volume

51

Issue

2

Start / End Page

e24 / e36

Location

United States

Related Subject Headings

  • Ventilator Weaning
  • Ultrasonography
  • Reproducibility of Results
  • Humans
  • Emergency & Critical Care Medicine
  • Diaphragm
  • Critical Care
  • Adult
  • 4205 Nursing
  • 3202 Clinical sciences