Respiratory failure & ventilation
Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis
Authors' conclusion
Measurement of diaphragmatic excursion and diaphragmatic thickening fraction predict the probability of successful weaning from mechanical ventilation with satisfactory diagnostic accuracy; however, significant heterogeneity was evident in the different included studies.
Study context
- Population
- Patients on mechanical ventilation being weaned19 studies meta-analysed
- Participants
- 1,204 patients
- Comparison
- Diaphragmatic excursion and diaphragmatic thickening fraction (ultrasound) for predicting weaning success
- Outcome
- Diagnostic accuracy (sensitivity, specificity, DOR, AUC) for predicting successful weaning from mechanical ventilation
Methodological detailsrandom effects analysis, bivariate meta-regression, QUADAS-2, GRADE, 26 studies included, PUBMED, TRIP, EMBASE, COCHRANE, SCIENCE DIRECT, LILACS searched, January 2016–July 2022
- Random effects analysis
- Bivariate meta-regression
- QUADAS-2
- GRADE
- 26 studies included
- PUBMED, TRIP, EMBASE, COCHRANE, SCIENCE DIRECT, LILACS searched, January 2016–July 2022
Pooled result
As reported in the abstract
Prediction of successful weaning
| Group | Sensitivity | Specificity | AUC | Diagnostic odds ratios (DOR) |
|---|---|---|---|---|
| Diaphragmatic excursion | 0.80 (95% CI 0.77-0.83) | 0.80 (95% CI 0.75-0.84) | 0.87 | 17.1 (95% CI 10.2-28.6) |
| Thickening fraction | 0.85 (95% CI 0.82-0.87) | 0.75 (95% CI 0.69-0.80) | 0.87 | 17.2 (95% CI 9.16-32.3) |
Sensitivity
Diaphragmatic excursion0.80 (95% CI 0.77-0.83)
Thickening fraction0.85 (95% CI 0.82-0.87)
Specificity
Diaphragmatic excursion0.80 (95% CI 0.75-0.84)
Thickening fraction0.75 (95% CI 0.69-0.80)
AUC
Diaphragmatic excursion0.87
Thickening fraction0.87
Diagnostic odds ratios (DOR)
Diaphragmatic excursion17.1 (95% CI 10.2-28.6)
Thickening fraction17.2 (95% CI 9.16-32.3)
Further pooled results
Subgroup excluding studies with atypical cutoff values (subgroup)
- Sensitivity and specificity increased for thickening fraction; sensitivity increased and specificity decreased for diaphragmatic excursion
Pressure support vs T-tube studies (subgroup)
- No significant difference in sensitivity and specificity
Bivariate meta-regression
- Patient position at time of testing was a factor of heterogeneity
Original publication
Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis. Crit Care. Published 5 May 2023. doi:10.
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