Diagnostic Accuracy of Vascular Ultrasonography for Postanesthesia Induction Hypotension: A Systematic Review and Network Meta-Analysis.
Journal
Anesthesia and analgesia
ISSN: 1526-7598
Titre abrégé: Anesth Analg
Pays: United States
ID NLM: 1310650
Informations de publication
Date de publication:
06 Jun 2024
06 Jun 2024
Historique:
medline:
6
6
2024
pubmed:
6
6
2024
entrez:
6
6
2024
Statut:
aheadofprint
Résumé
Arterial hypotension commonly occurs after anesthesia induction and is associated with negative clinical outcomes. Point-of-care ultrasound examination has emerged as a modality to predict postinduction hypotension (PIH). We performed a systematic review and network meta-analysis of the predictive performance of point-of-care ultrasound tests for PIH in noncardiac, nonobstetrical routine adult surgery. Online databases were searched for diagnostic test accuracy studies of point-of-care ultrasound for predicting PIH up to March 30, 2023. The systematic review followed the Cochrane methodology. A Bayesian diagnostic test accuracy network meta-analysis model was used, with PIH as defined by study authors as the main outcome. Risk of bias and applicability were examined through the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) score. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess evidence certainty. A total of 32 studies with 2631 participants were eligible for systematic review. Twenty-six studies with 2258 participants representing 8 ultrasound tests were included in the meta-analysis. Inferior vena cava collapsibility index (22 studies) sensitivity was 60% (95% credible interval [CrI], 49%-72%) and specificity was 83% (CrI, 74%-89%). Carotid artery corrected flow time (2 studies) sensitivity was 91% (CrI, 76%-98%) and specificity was 90% (CrI, 59%-98%). There were serious bias and applicability concerns due to selection bias and inappropriate blinding. The certainty of evidence was very low for all tests. The predictive performance of point-of-care ultrasound for PIH is uncertain. There is a need for high-quality randomized controlled trials with appropriate blinding and void of selection bias.
Sections du résumé
BACKGROUND
BACKGROUND
Arterial hypotension commonly occurs after anesthesia induction and is associated with negative clinical outcomes. Point-of-care ultrasound examination has emerged as a modality to predict postinduction hypotension (PIH). We performed a systematic review and network meta-analysis of the predictive performance of point-of-care ultrasound tests for PIH in noncardiac, nonobstetrical routine adult surgery.
METHODS
METHODS
Online databases were searched for diagnostic test accuracy studies of point-of-care ultrasound for predicting PIH up to March 30, 2023. The systematic review followed the Cochrane methodology. A Bayesian diagnostic test accuracy network meta-analysis model was used, with PIH as defined by study authors as the main outcome. Risk of bias and applicability were examined through the QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies) score. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework was used to assess evidence certainty.
RESULTS
RESULTS
A total of 32 studies with 2631 participants were eligible for systematic review. Twenty-six studies with 2258 participants representing 8 ultrasound tests were included in the meta-analysis. Inferior vena cava collapsibility index (22 studies) sensitivity was 60% (95% credible interval [CrI], 49%-72%) and specificity was 83% (CrI, 74%-89%). Carotid artery corrected flow time (2 studies) sensitivity was 91% (CrI, 76%-98%) and specificity was 90% (CrI, 59%-98%). There were serious bias and applicability concerns due to selection bias and inappropriate blinding. The certainty of evidence was very low for all tests.
CONCLUSIONS
CONCLUSIONS
The predictive performance of point-of-care ultrasound for PIH is uncertain. There is a need for high-quality randomized controlled trials with appropriate blinding and void of selection bias.
Identifiants
pubmed: 38843091
doi: 10.1213/ANE.0000000000007108
pii: 00000539-990000000-00829
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 International Anesthesia Research Society.
Déclaration de conflit d'intérêts
Conflicts of Interest: See Disclosures at the end of the article.
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