John Basmaji, J Elaine Tang, Robert Arntfield, Karishma Desai, Ian M Ball, Kyle Fiorini, Marat Slessarev, Kimia Honarmand, Phil Jones, Vincent Lau, Kimberley Lewis, Nicolas Orozco, Maureen Meade, Brian Park, Ross Prager, Bram Rochwerg, Lehana Thabane, Michelle Y S Wong, Gordon Guyatt
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引用次数: 0
Abstract
Purpose: We sought to conduct a systematic review to determine the diagnostic test accuracy of point-of-care ultrasound (POCUS) for the specific etiologies and subtypes of shock.
Methods: We searched MEDLINE, Embase, and the grey literature for prospective studies in adult populations with shock. We collected data on study design, patient characteristics, operator characteristics, POCUS protocol, and true and false positives and negatives, and assessed the risk of bias.
Results: We found 18 eligible studies with a total of N = 2,088 patients. The pooled sensitivity and specificity of POCUS for determining shock subtype were 90% (95% confidence interval [CI], 81 to 95) and 95% (95% CI, 90 to 97) for hypovolemic shock, 95% (95% CI, 84 to 98) and 98% (95% CI, 97 to 99) for cardiogenic shock, 78% (95% CI, 69 to 85) and 97% (95% CI, 94 to 99) for distributive shock, 94% (95% CI, 85 to 97) and 99% (95% CI, 98 to 100) for obstructive shock, and 85% (95% CI, 77 to 91) and 98% (95% CI, 91 to 100) for mixed shock (all low to moderate quality evidence). The pooled sensitivity and specificity of POCUS for determining specific shock etiologies were 78% (95% CI, 18 to 98) and 96% (95% CI, 87 to 99) for sepsis, 92% (95% CI, 71 to 98) and 99% (95% CI, 83 to 100) for pulmonary embolism, and 100% (95% CI, 69 to 100) and 100% (95% CI, 98 to 100) for cardiac tamponade. The quality of the evidence ranged from very low to moderate.
Conclusions: On the basis of very low to moderate quality evidence, POCUS may perform better at ruling in shock subtypes and specific shock etiologies than ruling them out. Point-of-care ultrasound is a promising tool for the diagnosis of shock.
Study registration: PROSPERO ( CRD42020160001 ); first submitted 1 December 2019.
期刊介绍:
The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’
Society and is published by Springer Science + Business Media, LLM (New York). From the
first year of publication in 1954, the international exposure of the Journal has broadened
considerably, with articles now received from over 50 countries. The Journal is published
monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article
types consist of invited editorials, reports of original investigations (clinical and basic sciences
articles), case reports/case series, review articles, systematic reviews, accredited continuing
professional development (CPD) modules, and Letters to the Editor. The editorial content,
according to the mission statement, spans the fields of anesthesia, acute and chronic pain,
perioperative medicine and critical care. In addition, the Journal publishes practice guidelines
and standards articles relevant to clinicians. Articles are published either in English or in French,
according to the language of submission.