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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: Critical Care Medicine
February 2023

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.Systematic search of five databases up to November 24, 2021.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.Study demographics, ultrasound methodologies, and clinimetric data.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).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

Critical Care Medicine

DOI

EISSN

1530-0293

ISSN

0090-3493

Publication Date

February 2023

Volume

51

Issue

2

Start / End Page

e24 / e36

Related Subject Headings

  • Ventilator Weaning
  • Ultrasonography
  • Reproducibility of Results
  • Humans
  • Emergency & Critical Care Medicine
  • Diaphragm
  • Critical Care
  • Adult
  • 1117 Public Health and Health Services
  • 1110 Nursing
 

Citation

APA
Chicago
ICMJE
MLA
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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. Critical Care Medicine, 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.Critical Care Medicine 51, no. 2 (February 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. Critical Care Medicine. 2023 Feb;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.Critical Care Medicine, vol. 51, no. 2, Feb. 2023, pp. e24–36. Epmc, 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. Critical Care Medicine. 2023 Feb;51(2):e24–e36.

Published In

Critical Care Medicine

DOI

EISSN

1530-0293

ISSN

0090-3493

Publication Date

February 2023

Volume

51

Issue

2

Start / End Page

e24 / e36

Related Subject Headings

  • Ventilator Weaning
  • Ultrasonography
  • Reproducibility of Results
  • Humans
  • Emergency & Critical Care Medicine
  • Diaphragm
  • Critical Care
  • Adult
  • 1117 Public Health and Health Services
  • 1110 Nursing