Ultrasound-detected postoperative diaphragmatic dysfunction and its association with pulmonary complications. A systematic review and meta-analysis

IF 5.1 2区 医学 Q1 ANESTHESIOLOGY
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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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.
超声检测术后膈功能障碍及其与肺部并发症的关系。系统回顾和荟萃分析。
简介:术后膈肌功能障碍(PDD)是大手术后常见的并发症,会导致不良的临床结果。基于超声的评估已成为评估PDD的首选方法。我们的目的是评估PDD与术后肺部并发症(PPCs)之间的关系及其与肺炎的关系。方法:我们系统地检索PubMed, Scopus和Embase,通过超声评估PDD的临床研究。纳入期为2025年1月10日至2025年3月20日。两位作者根据以下标准独立选择研究:[1]观察性研究或随机临床试验,纳入接受心脏,胸部或腹部手术的成年患者;[2]术后使用膈移位(DE)或膈增厚分数(DTF)评估PDD;[3]报告PDD与PPCs或肺炎之间的关联作为临床结果。遵循系统评价和荟萃分析(PRISMA)指南的首选报告项目。两位作者独立进行了数据提取。非随机研究(未成年人)方法学指数评估研究质量。主要结局是PDD和PPCs之间的关系。次要结局评估PDD和肺炎作为单独报告的PPCs的单个组成部分的患病率及其与PDD的关系。结果:系统评价纳入19项研究,其中6项研究符合meta分析标准。PDD与PPCs (OR 2.99, 95% CI: 2.01-4.45)和肺炎(OR 5.41, 95% CI: 2.36-12.42)的高发生率显著相关。未发现显著的发表偏倚。两种结果的异质性都很低。结论:超声评估的术后膈功能障碍与术后肺部并发症(包括肺炎)的发生率显著相关,突出了其在床边的临床相关性。通过超声评估PDD与术后患者PPCs和肺炎风险增加密切相关。这些发现强调了术后常规膈评估的重要性,以及有针对性的干预以减轻pdd相关并发症的潜力。然而,目前的证据受到方法可变性和缺乏标准化诊断标准的限制。未来的研究应侧重于建立PDD的共识定义,并确保关键临床结果的一致评估。
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来源期刊
CiteScore
7.40
自引率
4.50%
发文量
346
审稿时长
23 days
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.
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