Diaphragm Ultrasound To Predict Weaning Outcome Of Critical Patients:Meta-Analysis

BackgroundFailure to withdraw is common in patients with mechanical ventilation,but traditional parameters for predicting the weaning outcome have limitations,such as the shallow fast breathing index,so deciding the optimal timing for extubation in patients who are mechanically ventilated can be challenging.With the development of bedside intensive ultrasound,the application of the D-RSBI to predict the weaning outcome has attracted everyone’s attention.TargetThe aim of this meta-analysis was to evaluate the value of D-RSBI in predicting the weaning outcome of critical patients.MethodsTwo reviewers searched 7 databases independently,including:PubMed,Embase,Cochrane Clinical Trial Database,Web of Science,China Academic Journals Online Publishing Database,Chinese Science and Technology Periodicals Database and Wanfang Journal Articles Database,published in English or Chinese up to December 31,2019.The search used the terms with"diaphragm Or breathing muscle"and"ultrasound"and"weaning or extubation or discontinuation of mechanical ventilation".Methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies-2(QUADAS-2)in Review Manager 5.3.Meta analysis was performed using the Metan module of STATA 15.0,and the combined effects were sensitivity,specificity and AUC(area under the ROC curve);the heterogeneity was evaluated using Cochran Q test and I~2statistics;sensitivity analysis was used to evaluate the stability of the research results Sex;the results are statistically significant with P<0.05 as the difference.ResultsA total of 394 articles were retrieved from all databases,including 260 articles in English and 134 articles in Chinese.Imported and retrieved documents through Endnote software.After deleting duplicates and filtering titles and abstracts,379 articles were e-xcluded.The remaining 15 documents were screened in full text:1 meeting abstract,1subject was unfinished experiment,3 subjects were inappropriate experiments and 3 su-bjects were incomplete data.Finally this meta-analysis included a total of 7 prospective cohort studies,including 3 in English and 4 in Chinese.A total of 520 patients were inc-luded.For predicting weaning faliure,the sensitivity of the D-RSBI group was 91.23%(95%CI:79.28%,100.00%),and the sensitivity of the RSBI group was 60.55%(95%CI:42.63%,78.47%),follow-up was significant(P<0.05;two studies included);the sp-ecificity of the D-RSBI group was 83.32%(95%CI:48.78%,100.00%),and the speci-ficity of the RSBI group was 79.93%(95%CI:44.79%,100%),follow-up was not sign-ificant(P>0.05;two studies were included);the AUC of the D-RSBI group was 90.0%(95%CI:84.0%,96.0%),the AUC of the RSBI group was 74.0%(95%CI:68.0%,80.0%),and follow-up was significant(P<0.05;4 studies included).For predicting we-aning success,The AUC of the D-RSBI group is 91.0%(95%CI:82.0%,100%)and the AUC is 90.0%(95%CI:86.0%,94.0%),follow-up was significant(P<0.05;included3 studies).ConclusionCompared with RSBI,D-RSBI is a more meaningful parameter for predicting the weaning outcome,due to heterogeneities among the included studies,large scale studies are warranted to confifirm our findings.