Critical Care Ultrasonography for Volume Management: A Systematic Review, Meta-Analysis, and Trial Sequential...

Area of Science:

• Critical Care Medicine
• Point-of-Care Ultrasound
• Fluid Management

Background:

• Acutely ill patients often experience complex fluid balance challenges.
• Optimizing fluid management is crucial for improving patient outcomes in critical care settings.

Purpose of the Study:

• To evaluate the safety and efficacy of critical care ultrasonography (CCUS) for guiding volume management in critically ill adult patients.
• To synthesize evidence from randomized controlled trials (RCTs) on CCUS use in fluid management.

Main Methods:

• A systematic review and meta-analysis of 17 RCTs involving 1765 patients.
• Searched multiple databases (MEDLINE, Embase, Wiley CENTRAL) up to February 6, 2024.
• Assessed risk of bias and certainty of evidence using established methodologies.

Main Results:

• CCUS use was associated with a potential reduction in mortality (RR, 0.79; low certainty).
• Fluid balance up to 72 hours post-admission was reduced with CCUS (MD, 0.72 L lower; low certainty).
• Effects on mechanical ventilation duration, ICU length of stay, vasopressor use, acute kidney injury, and renal replacement therapy were uncertain (very low certainty).

Conclusions:

• CCUS-guided volume management may decrease mortality and improve fluid balance in acutely ill adults.
• Evidence regarding CCUS impact on other critical care outcomes is limited by imprecision and indirectness.
• Further high-quality research is needed to clarify the role of CCUS in comprehensive critical care management.