Effects of sedatives on diaphragm activity monitored by ultrasound: a systematic review and meta-analysis
Notice bibliographique
Résumé
Current research lacks comprehensive evaluations on the inhibitory effects of sedatives on diaphragm activity under ultrasound monitoring. This meta-analysis aims to launch this problem by systematically analyzing the available evidence. The EMBASE, PubMed, and Web of Science databases were searched. Original studies that explored the effects of sedative agents on human diaphragm activity via ultrasound were eligible. The quality of the included studies was evaluated using the Revised Cochrane Risk-of-Bias tool for randomized trials (RoB 2) and the Newcastle–Ottawa Scale (NOS). The pooled assessment encompassed alterations in diaphragmatic motion (DM) and diaphragmatic thickening fraction (DTF). Mean difference (MD) with 95% confidence intervals (CI) were calculated. The trial sequential analysis (TSA) was performed to calculate the required information size (RIS). The strength of evidence was assessed using the Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) Pro Guideline Development Tool (GDT). Subgroup analysis and meta-regression was conducted to explore heterogeneity. Sensitivity analysis was used to evaluate the robustness for the meta-analysis results. Six randomized controlled trials and four prospective observational studies involving 727 patients were ultimately included. In the pooled analysis, DM and DTF were measured at three time points: during sedation (T1), upon awakening (T2), and at baseline (T0). Comparisons were conducted between the values at each time point, revealing mean differences (MDs) for DM of 2.54 mm (95% CI [2.01, 3.08], P < 0.00001, I2 = 92%) (T0 vs. T1), − 1.14 mm (95% CI [-1.90, -0.93], P < 0.00001, I2 = 95%) (T1 vs. T2), and 1.47 mm (95% CI [ 0.90, 2.05], P < 0.00001, I2 = 92%) (T0 vs. T2). For DTF, the corresponding MDs were 0.11 (95% CI [0.09, 0.13], P < 0.00001, I2 = 89%), − 0.06 (95% CI [− 0.08, − 0.04], P < 0.00001, I2 = 88%), and 0.04 (95% CI [0.03, 0.05], P < 0.00001, I2 = 71%). Subgroup analyses further demonstrated that the MDs at T0 vs. T1 for DM and DTF were 3.62 mm (95% CI [3.15, 4.10], P < 0.00001, I2 = 76%) and 0.13 (95% CI [0.11, 0.14], P < 0.00001, I2 = 75%), respectively, in the propofol group, compared to 1.65 mm (95% CI [1.21, 2.09], P < 0.00001, I2 = 73%) (DM) and 0.09 (95% CI [0.08, 0.10], P < 0.00001, I2 = 0%) (DTF) in the group receiving propofol in combination with other sedatives. Sensitivity analysis suggested high robustness of the analysis for DTF. The TSA indicated that the sample size was sufficient. And GDT showed a low but important strength of this review. This meta-analysis reveals that sedatives can inhibit diaphragm activity, with this negative impact persisting post-awakening. Propofol alone achieves a more pronounced reduction in diaphragm activity than when combined with other sedatives. However, significant heterogeneity remains across studies due to data limitations and low evidence certainty. Further research is crucial to establish evidence-based recommendations for optimal diaphragm-protective sedation strategies. The protocol was registered at the PROSPERO international prospective register of systematic reviews (CRD42024514504).
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,007 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,016 | 0,003 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».