PDF(Pubmed)
Abstract：
BACKGROUND: Acute respiratory distress syndrome (ARDS) is a life-threatening respiratory condition with high mortality rates, accounting for 10% of all intensive care unit admissions. Lung ultrasound (LUS) as diagnostic tool for acute respiratory failure has garnered widespread recognition and was recently incorporated into the updated definitions of ARDS. This raised the hypothesis that LUS is a reliable method for diagnosing ARDS.
OBJECTIVE: We aimed to establish the accuracy of LUS for ARDS diagnosis and classification of focal versus non-focal ARDS subphenotypes.
METHODS: This systematic review and meta-analysis used a systematic search strategy, which was applied to PubMed, EMBASE and cochrane databases. Studies investigating the diagnostic accuracy of LUS compared to thoracic CT or chest radiography (CXR) in ARDS diagnosis or focal versus non-focal subphenotypes in adult patients were included. Quality of studies was evaluated using the QUADAS-2 tool. Statistical analyses were performed using \"Mada\" in Rstudio, version 4.0.3. Sensitivity and specificity with 95% confidence interval of each separate study were summarized in a Forest plot.
RESULTS: The search resulted in 2648 unique records. After selection, 11 reports were included, involving 2075 patients and 598 ARDS cases (29%). Nine studies reported on ARDS diagnosis and two reported on focal versus non-focal ARDS subphenotypes classification. Meta-analysis showed a pooled sensitivity of 0.631 (95% CI 0.450-0.782) and pooled specificity of 0.942 (95% CI 0.856-0.978) of LUS for ARDS diagnosis. In two studies, LUS could accurately differentiate between focal versus non-focal ARDS subphenotypes. Insufficient data was available to perform a meta-analysis.
CONCLUSIONS: This review confirms the hypothesis that LUS is a reliable method for diagnosing ARDS in adult patients. For the classification of focal or non-focal subphenotypes, LUS showed promising results, but more research is needed.
OBJECTIVE: We aimed to establish the accuracy of LUS for ARDS diagnosis and classification of focal versus non-focal ARDS subphenotypes.
METHODS: This systematic review and meta-analysis used a systematic search strategy, which was applied to PubMed, EMBASE and cochrane databases. Studies investigating the diagnostic accuracy of LUS compared to thoracic CT or chest radiography (CXR) in ARDS diagnosis or focal versus non-focal subphenotypes in adult patients were included. Quality of studies was evaluated using the QUADAS-2 tool. Statistical analyses were performed using \"Mada\" in Rstudio, version 4.0.3. Sensitivity and specificity with 95% confidence interval of each separate study were summarized in a Forest plot.
RESULTS: The search resulted in 2648 unique records. After selection, 11 reports were included, involving 2075 patients and 598 ARDS cases (29%). Nine studies reported on ARDS diagnosis and two reported on focal versus non-focal ARDS subphenotypes classification. Meta-analysis showed a pooled sensitivity of 0.631 (95% CI 0.450-0.782) and pooled specificity of 0.942 (95% CI 0.856-0.978) of LUS for ARDS diagnosis. In two studies, LUS could accurately differentiate between focal versus non-focal ARDS subphenotypes. Insufficient data was available to perform a meta-analysis.
CONCLUSIONS: This review confirms the hypothesis that LUS is a reliable method for diagnosing ARDS in adult patients. For the classification of focal or non-focal subphenotypes, LUS showed promising results, but more research is needed.
摘要：
背景：急性呼吸窘迫综合征（ARDS）是一种危及生命的呼吸系统疾病，死亡率高，占所有重症监护病房入院人数的10%。肺超声（LUS）作为急性呼吸衰竭的诊断工具已获得广泛认可，最近被纳入ARDS的最新定义中。这提出了LUS是诊断ARDS的可靠方法的假设。
目的：我们旨在建立LUS对ARDS诊断的准确性以及局灶性与非局灶性ARDS亚型的分类。
方法：本系统综述和荟萃分析使用了系统搜索策略，适用于PubMed，EMBASE和Cochrane数据库。研究包括研究LUS在ARDS诊断中与胸部CT或胸部X线照相（CXR）相比的诊断准确性，或成人患者的局灶性与非局灶性亚表型。使用QUADAS-2工具评估研究质量。使用Rstudio中的“Mada”进行统计分析，版本4.0.3。在森林地块中总结了每个单独研究的95％置信区间的敏感性和特异性。
结果：搜索产生了2648条唯一记录。选择后，包括11份报告，涉及2075例患者和598例ARDS病例（29％）。9项研究报道了ARDS诊断，2项报道了局灶性与非局灶性ARDS亚型分类。荟萃分析显示，LUS诊断ARDS的合并敏感性为0.631（95％CI0.450-0.782），合并特异性为0.942（95％CI0.856-0.978）。在两项研究中，LUS可以准确区分局灶性与非局灶性ARDS亚型。没有足够的数据进行荟萃分析。
结论：这篇综述证实了LUS是诊断成人患者ARDS的可靠方法的假设。对于局灶性或非局灶性亚表型的分类，LUS显示了有希望的结果，但是需要更多的研究。
目的：我们旨在建立LUS对ARDS诊断的准确性以及局灶性与非局灶性ARDS亚型的分类。
方法：本系统综述和荟萃分析使用了系统搜索策略，适用于PubMed，EMBASE和Cochrane数据库。研究包括研究LUS在ARDS诊断中与胸部CT或胸部X线照相（CXR）相比的诊断准确性，或成人患者的局灶性与非局灶性亚表型。使用QUADAS-2工具评估研究质量。使用Rstudio中的“Mada”进行统计分析，版本4.0.3。在森林地块中总结了每个单独研究的95％置信区间的敏感性和特异性。
结果：搜索产生了2648条唯一记录。选择后，包括11份报告，涉及2075例患者和598例ARDS病例（29％）。9项研究报道了ARDS诊断，2项报道了局灶性与非局灶性ARDS亚型分类。荟萃分析显示，LUS诊断ARDS的合并敏感性为0.631（95％CI0.450-0.782），合并特异性为0.942（95％CI0.856-0.978）。在两项研究中，LUS可以准确区分局灶性与非局灶性ARDS亚型。没有足够的数据进行荟萃分析。
结论：这篇综述证实了LUS是诊断成人患者ARDS的可靠方法的假设。对于局灶性或非局灶性亚表型的分类，LUS显示了有希望的结果，但是需要更多的研究。
