Jose D. Jimenez-Santana , Danila Azzolina , Gaetano Scaramuzzo , Guido Mazzinari , Martin Dres , Alberto Fogagnolo , Gianmaria Cammarota , Carlo A. Volta , Savino Spadaro
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引用次数: 0
Abstract
Introduction
Postoperative diaphragmatic dysfunction (PDD) is a common complication following major surgeries, contributing to adverse clinical outcomes. Ultrasound-based assessment has emerged as the preferred method for evaluating PDD. We aimed to assess the association between PDD and postoperative pulmonary complications (PPCs) and their relationship with pneumonia.
Methods
We systematically searched PubMed, Scopus, and Embase for clinical studies assessing PDD via ultrasound. The inclusion period ranged from January 10th, 2025, to March 20th, 2025. Two authors independently selected the investigations according to the following criteria: [1] observational study or randomized clinical trials enrolling adult patients undergoing cardiac, thoracic, or abdominal surgery [2] evaluation of PDD using diaphragmatic excursion (DE) or diaphragmatic thickening fraction (DTF) after surgery, and [3] report an association between PDD and PPCs or pneumonia as clinical outcomes. Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines were followed. Two authors independently performed data extraction. The Methodological Index for Nonrandomized Studies (MINORS) assessed study quality. The primary outcome was the association between PDD and PPCs. The secondary outcomes evaluated prevalence of PDD and pneumonia as an individual component of PPCs when it was reported separately, and its association with PDD.
Results
The systematic review included 19 studies, and six studies met the criteria for meta-analysis. PDD was significantly associated with higher odds of PPCs (OR 2.99, 95 % CI: 2.01–4.45) and pneumonia (OR 5.41, 95 % CI: 2.36–12.42). No significant publication bias was detected. Heterogeneity was low for both outcomes.
Conclusion
Ultrasound-assessed postoperative diaphragmatic dysfunction is significantly associated with higher odds of postoperative pulmonary complications, including pneumonia, highlighting its clinical relevance at the bedside. PDD, assessed via ultrasound, is strongly associated with an increased risk of PPCs and pneumonia in postoperative patients. These findings underscore the importance of routine postoperative diaphragmatic assessment and the potential for targeted interventions to mitigate PDD-related complications. However, the current evidence is constrained by methodological variability and the absence of standardized diagnostic criteria. Future studies should focus on establishing consensus definitions for PDD and ensuring consistent assessment of key clinical outcomes.
期刊介绍:
The Journal of Clinical Anesthesia (JCA) addresses all aspects of anesthesia practice, including anesthetic administration, pharmacokinetics, preoperative and postoperative considerations, coexisting disease and other complicating factors, cost issues, and similar concerns anesthesiologists contend with daily. Exceptionally high standards of presentation and accuracy are maintained.
The core of the journal is original contributions on subjects relevant to clinical practice, and rigorously peer-reviewed. Highly respected international experts have joined together to form the Editorial Board, sharing their years of experience and clinical expertise. Specialized section editors cover the various subspecialties within the field. To keep your practical clinical skills current, the journal bridges the gap between the laboratory and the clinical practice of anesthesiology and critical care to clarify how new insights can improve daily practice.