• Dominic Truong, Shaza Abo, Georgina A Whish-Wilson, Aruska N D'Souza, Lisa J Beach, Sunita Mathur, Kirby P Mayer, George Ntoumenopoulos, Claire Baldwin, Doa El-Ansary, Michael T Paris, Marina Mourtzakis, Peter E Morris, Amy M Pastva, Catherine L Granger, Selina M Parry, and Aarti Sarwal.
• Department of Physiotherapy, The University of Melbourne, Parkville, VIC, Australia.
• Crit. Care Med. 2023 Feb 1; 51 (2): e24e36e24-e36.

ObjectiveSignificant variations exist in the use of respiratory muscle ultrasound in intensive care with no society-level consensus on the optimal methodology. This systematic review aims to evaluate, synthesize, and compare the clinimetric properties of different image acquisition and analysis methodologies.Data SourcesSystematic search of five databases up to November 24, 2021.Study SelectionStudies were included if they enrolled at least 50 adult ICU patients, reported respiratory muscle (diaphragm or intercostal) ultrasound measuring either echotexture, muscle thickness, thickening fraction, or excursion, and evaluated at least one clinimetric property. Two independent reviewers assessed titles, abstracts, and full text against eligibility.Data ExtractionStudy demographics, ultrasound methodologies, and clinimetric data.Data SynthesisSixty studies, including 5,025 patients, were included with 39 studies contributing to meta-analyses. Most commonly measured was diaphragm thickness (DT) or diaphragm thickening fraction (DTF) using a linear transducer in B-mode, or diaphragm excursion (DE) using a curvilinear transducer in M-mode. There are significant variations in imaging methodology and acquisition across all studies. Inter- and intrarater measurement reliabilities were generally excellent, with the highest reliability reported for DT (ICC, 0.98; 95% CI, 0.94-0.99). Pooled data demonstrated acceptable to excellent accuracy for DT, DTF, and DE to predicting weaning outcome after 48 to 72 hours postextubation (DTF AUC, 0.79; 95% CI, 0.73-0.85). DT imaging was responsive to change over time. Only three eligible studies were available for intercostal muscles. Intercostal thickening fraction was shown to have excellent accuracy of predicting weaning outcome after 48-hour postextubation (AUC, 0.84; 95% CI, 0.78-0.91).ConclusionsDiaphragm muscle ultrasound is reliable, valid, and responsive in ICU patients, but significant variation exists in the imaging acquisition and analysis methodologies. Future work should focus on developing standardized protocols for ultrasound imaging and consider further research into the role of intercostal muscle imaging.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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