Diagnostic value of lung ultrasound in diagnosing postoperative atelectasis, pleural effusion and pneumothorax in adult patients: a systematic review and meta-analysis / 中华麻醉学杂志

ABSTRACT

Objective:To systematically evaluate the diagnostic value of lung ultrasound (LUS) in diagnosing postoperative atelectasis, pleural effusion and pneumothorax in adult patients.Methods:PubMed, Embase, Cochrane Library, Web of Science, Wanfang Database, China Science and Technology Journal Database and China National Knowledge Infrastructure were searched for studies comparing the accuracy of LUS Chest radiograph (CXR) or computed tomography (CT) in the diagnosis of postoperative atelectasis, pleural effusion and pneumothorax, and the parameters were the sensitivity and specificity of LUS in diagnosing postoperative atelectasis, pleural effusion and pneumothorax, and the area under the receiver operating characteristic curve (AUC). Analysis was performed using MetaDiSc 1.4, Review Manager 5.4, and STATA 16.0 softewares. CXR and CT were used as standard imaging examination methods, and the combined sensitivity, specificity and AUC of LUS were calculated. Meta regression analysis was conducted on the types of surgeries, standard imaging examination methods (CXR, CT), CXR (CT)/LUS examination intervals (>3 h, ≤3 h), and time points of postoperative LUS examination.Results:Fifteen studies involving 1 585 patients were finally enrolled in the present study. The combined sensitivity of LUS in diagnosing postoperative atelectasis, pleural effusion and pneumothorax was 0.91 (95% confidence interval [ CI] 0.88-0.93), 0.75 (95% CI 0.71-0.78) and 0.53 (95% CI 0.48-0.58), respectively, and the combined specificity was 0.96 (95% CI 0.95-0.97), 0.82 (95% CI 0.81-0.84) and 0.94 (95% CI 0.93-0.95), respectively, and AUC was 0.936 8 ( SE=0.044 2), 0.839 7 ( SE=0.076 7) and 0.914 7 ( SE=0.030 9), respectively. Meta-regression analysis showed that the type of surgery was a source of heterogeneity affecting the diagnosis of pneumothorax by LUS ( P=0.001), and the standard imaging examination method was the source of heterogeneity affecting the diagnosis of pleural effusion by LUS ( P=0.023). Conclusions:Although LUS has a weak ability in detecting non-clinically related pneumothorax (≤3 cm) and a low overall sensitivity in diagnosing postoperative pneumothorax, the specificity is high in adult patients.