Effectiveness of diaphragmatic ultrasound as a predictor of successful weaning from mechanical ventilation: a systematic review and meta-analysis.

BACKGROUND: Several measurements have been used to predict the success of weaning from mechanical ventilation; however, their efficacy varies in different studies. In recent years, diaphragmatic ultrasound has been used for this purpose. We conducted a systematic review and meta-analysis to evaluate the effectiveness of diaphragmatic ultrasound in predicting the success of weaning from mechanical ventilation. METHODS: Two investigators independently searched PUBMED, TRIP, EMBASE, COCHRANE, SCIENCE DIRECT, and LILACS for articles published between January 2016 and July 2022. The methodological quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool; additionally, the certainty of the evidence is evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) methodology. Sensitivity and specificity analysis was performed for diaphragmatic excursion and diaphragmatic thickening fraction; positive and negative likelihood ratios and diagnostic odds ratios (DOR) with their confidence intervals (95% CI) were calculated by random effects analysis, summary receiver operating characteristic curve was estimated. Sources of heterogeneity were explored by subgroup analysis and bivariate meta-regression. RESULTS: Twenty-six studies were included, of which 19 were included in the meta-analysis (1204 patients). For diaphragmatic excursion, sensitivity was 0.80 (95% CI 0.77-0.83), specificity 0.80 (95% CI 0.75-0.84), area under the summary receiver operating characteristic curve 0.87 and DOR 17.1 (95% CI 10.2-28.6). For the thickening fraction, sensitivity was 0.85 (95% CI 0.82-0.87), specificity 0.75 (95% CI 0.69-0.80), area under the summary receiver operating characteristic curve 0.87 and DOR 17.2 (95% CI 9.16-32.3). There was heterogeneity among the included studies. When performing a subgroup analysis and excluding studies with atypical cutoff values, sensitivity and specificity increased for diaphragmatic thickening fraction; sensitivity increased and specificity decreased for diaphragmatic excursion; when comparing studies using pressure support (PS) versus T-tube, there was no significant difference in sensitivity and specificity; bivariate meta-regression analysis shows that patient position at the time of testing was a factor of heterogeneity in the included studies. CONCLUSIONS: 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. Studies of high methodological quality in specific subgroups of patients in intensive care units are needed to evaluate the role of diaphragmatic ultrasound as a predictor of weaning from mechanical ventilation.

El COVID-19: una visión desde lo biopsicosocial y cultural / COVID-19: a biopsychosocial and cultural perspective

RESUMEN La pandemia por la COVID-19 ha generado un revuelo mundial; desde su aparición y la declaratoria de pandemia, ha provocado decisiones que día a día involucran medidas de salud pública encaminadas a la mitigación del efecto en las condiciones de bienestar de la población originadas por la enfermedad. Los esfuerzos del personal médico, de los organismos gubernamentales y no gubernamentales se han encaminado especialmente en la prevención de la enfermedad y en la promoción de hábitos saludables que permita evitar a toda costa el contagio o incluso controlar los efectos de la enfermedad. Sin embargo, cabe resaltar que, por las directrices de aislamiento y distanciamiento físico, las condiciones de vida, el efecto de la enfermedad y la influencia de los medios, se han visto influenciadas no solo la salud física, sino, en general, todas las esferas del individuo, comunidad y población en general. En el presente ensayo se pretende realizar una breve revisión desde un punto de vista bio-psicosocial y cultural de las implicaciones y efectos que ha dejado el paso del COVID-19 en la población.

ABSTRACT The COVID-19 pandemic has generated a worldwide commotion, since its appearance and the declaration of the pandemic, has provoked decisions that day by day involve public health measures aimed at mitigating the effect on the welfare conditions of the population caused by the disease. The efforts of medical personnel, governmental and non-govern-mental agencies have been directed especially towards the prevention of the disease and the promotion of healthy habits that will make it possible to avoid contagion at all costs or even to control the effects of the disease. However, it should be emphasized that, because of the guidelines of isolation and physical distancing, living conditions, the effect of the disease and the influence of the media, not only physical health but all spheres of the individual, community and population in general have been influenced. This trial aims to carry out a brief review from a bio-psycho-social and cultural point of view of the implications and effects that the passage of COVID-19 has left in the population.