Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA)
Background and Aims: Accurate prediction of extubation success is crucial in critical care to avoid complications from premature or prolonged mechanical ventilation. Bedside diaphragmatic ultrasonography has emerged as a promising tool for assessing extubation readiness, but its effectiveness requir...
Saved in:
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2025-01-01
|
| Series: | Indian Journal of Anaesthesia |
| Subjects: | |
| Online Access: | https://journals.lww.com/10.4103/ija.ija_881_24 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832087379121274880 |
|---|---|
| author | Lan Ma Na Zhou Kaiming Yuan Zihao Xue Kai Lv Jingying Huang |
| author_facet | Lan Ma Na Zhou Kaiming Yuan Zihao Xue Kai Lv Jingying Huang |
| author_sort | Lan Ma |
| collection | DOAJ |
| description | Background and Aims:
Accurate prediction of extubation success is crucial in critical care to avoid complications from premature or prolonged mechanical ventilation. Bedside diaphragmatic ultrasonography has emerged as a promising tool for assessing extubation readiness, but its effectiveness requires further validation. This meta-analysis evaluates the effectiveness of this method and uses trial sequential analysis (TSA) to assess evidence reliability and identify the need for further research.
Methods:
A comprehensive literature search was conducted across PubMed, Medline, Embase, Cochrane CENTRAL, Ovid, ISI Web of Science, and the Wanfang Database from 2014 to 2023. The included studies assessed diaphragmatic ultrasonography for predicting extubation success. Successful extubation is defined as maintaining spontaneous breathing for at least 48 hours post-extubation. Data extraction and quality assessment were performed using a random-effects model. Quality was assessed via the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated through funnel plots and Egger’s test. Cumulative meta-analysis, sub-group analyses, and TSA were used to explore heterogeneity and assess evidence reliability.
Results:
Fourteen studies were included, demonstrating high quality. Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were significant predictors of extubation success. The diagnostic odds ratio (DOR) was 4.80 [95% confidence interval (CI): 3.86, 5.97)], with a sensitivity of 81.48% and a specificity of 86.86%. Significant heterogeneity was observed (I2 =85%, χ2 =87.19, P < 0.00001). TSA indicated that the cumulative evidence was insufficient.
Conclusions:
Diaphragmatic ultrasound, particularly DE and DTF, is useful for predicting extubation success, but current evidence is inconclusive. Further research is required to confirm these findings. |
| format | Article |
| id | doaj-art-75a264fcb585446d9a53b61182240320 |
| institution | Kabale University |
| issn | 0019-5049 0976-2817 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Indian Journal of Anaesthesia |
| spelling | doaj-art-75a264fcb585446d9a53b611822403202025-02-06T05:26:09ZengWolters Kluwer Medknow PublicationsIndian Journal of Anaesthesia0019-50490976-28172025-01-01691385310.4103/ija.ija_881_24Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA)Lan MaNa ZhouKaiming YuanZihao XueKai LvJingying HuangBackground and Aims: Accurate prediction of extubation success is crucial in critical care to avoid complications from premature or prolonged mechanical ventilation. Bedside diaphragmatic ultrasonography has emerged as a promising tool for assessing extubation readiness, but its effectiveness requires further validation. This meta-analysis evaluates the effectiveness of this method and uses trial sequential analysis (TSA) to assess evidence reliability and identify the need for further research. Methods: A comprehensive literature search was conducted across PubMed, Medline, Embase, Cochrane CENTRAL, Ovid, ISI Web of Science, and the Wanfang Database from 2014 to 2023. The included studies assessed diaphragmatic ultrasonography for predicting extubation success. Successful extubation is defined as maintaining spontaneous breathing for at least 48 hours post-extubation. Data extraction and quality assessment were performed using a random-effects model. Quality was assessed via the Newcastle-Ottawa Scale (NOS), and publication bias was evaluated through funnel plots and Egger’s test. Cumulative meta-analysis, sub-group analyses, and TSA were used to explore heterogeneity and assess evidence reliability. Results: Fourteen studies were included, demonstrating high quality. Diaphragm excursion (DE) and diaphragm thickening fraction (DTF) were significant predictors of extubation success. The diagnostic odds ratio (DOR) was 4.80 [95% confidence interval (CI): 3.86, 5.97)], with a sensitivity of 81.48% and a specificity of 86.86%. Significant heterogeneity was observed (I2 =85%, χ2 =87.19, P < 0.00001). TSA indicated that the cumulative evidence was insufficient. Conclusions: Diaphragmatic ultrasound, particularly DE and DTF, is useful for predicting extubation success, but current evidence is inconclusive. Further research is required to confirm these findings.https://journals.lww.com/10.4103/ija.ija_881_24diaphragmdiaphragm excursiondiaphragm thickening fractionextubationgeneral anaesthesiameta-analysispostoperative complicationspredictive valuetrial sequential analysisultrasonography |
| spellingShingle | Lan Ma Na Zhou Kaiming Yuan Zihao Xue Kai Lv Jingying Huang Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA) Indian Journal of Anaesthesia diaphragm diaphragm excursion diaphragm thickening fraction extubation general anaesthesia meta-analysis postoperative complications predictive value trial sequential analysis ultrasonography |
| title | Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA) |
| title_full | Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA) |
| title_fullStr | Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA) |
| title_full_unstemmed | Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA) |
| title_short | Predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia: A meta-analysis with trial sequential analysis (TSA) |
| title_sort | predictive value of bedside diaphragmatic ultrasonography for extubation success in critically ill patients after general anaesthesia a meta analysis with trial sequential analysis tsa |
| topic | diaphragm diaphragm excursion diaphragm thickening fraction extubation general anaesthesia meta-analysis postoperative complications predictive value trial sequential analysis ultrasonography |
| url | https://journals.lww.com/10.4103/ija.ija_881_24 |
| work_keys_str_mv | AT lanma predictivevalueofbedsidediaphragmaticultrasonographyforextubationsuccessincriticallyillpatientsaftergeneralanaesthesiaametaanalysiswithtrialsequentialanalysistsa AT nazhou predictivevalueofbedsidediaphragmaticultrasonographyforextubationsuccessincriticallyillpatientsaftergeneralanaesthesiaametaanalysiswithtrialsequentialanalysistsa AT kaimingyuan predictivevalueofbedsidediaphragmaticultrasonographyforextubationsuccessincriticallyillpatientsaftergeneralanaesthesiaametaanalysiswithtrialsequentialanalysistsa AT zihaoxue predictivevalueofbedsidediaphragmaticultrasonographyforextubationsuccessincriticallyillpatientsaftergeneralanaesthesiaametaanalysiswithtrialsequentialanalysistsa AT kailv predictivevalueofbedsidediaphragmaticultrasonographyforextubationsuccessincriticallyillpatientsaftergeneralanaesthesiaametaanalysiswithtrialsequentialanalysistsa AT jingyinghuang predictivevalueofbedsidediaphragmaticultrasonographyforextubationsuccessincriticallyillpatientsaftergeneralanaesthesiaametaanalysiswithtrialsequentialanalysistsa |