Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis

Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume...

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Autores principales:	Sukhminder Jit Singh Bajwa, Madhuri S Kurdi, Jagadish G Sutagatti, Sukhwinder K Bajwa, Kaushic A Theerth
Formato:	article
Lenguaje:	EN
Publicado:	Wolters Kluwer Medknow Publications 2021
Materias:	echocardiography extravascular lung water lung obstetric point-of-care systems pre-eclampsia pregnancy pulmonary oedema toxaemia ultrasonography Anesthesiology RD78.3-87.3
Acceso en línea:	https://doaj.org/article/cc9e06bb38404e3ab1ba2c4899c4f06d
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spelling	oai:doaj.org-article:cc9e06bb38404e3ab1ba2c4899c4f06d2021-11-12T10:10:47ZPoint-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis0019-50490976-281710.4103/ija.ija_820_21https://doaj.org/article/cc9e06bb38404e3ab1ba2c4899c4f06d2021-01-01T00:00:00Zhttp://www.ijaweb.org/article.asp?issn=0019-5049;year=2021;volume=65;issue=10;spage=716;epage=730;aulast=Singhhttps://doaj.org/toc/0019-5049https://doaj.org/toc/0976-2817Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient. Methods: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I2 statistics. Funnel plots were used for the assessment of publication bias. Results: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5–5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03–0.84) and 0.1 (0–0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies. Conclusion: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.Sukhminder Jit Singh BajwaMadhuri S KurdiJagadish G SutagattiSukhwinder K BajwaKaushic A TheerthWolters Kluwer Medknow Publicationsarticleechocardiographyextravascular lung waterlungobstetricpoint-of-care systemspre-eclampsiapregnancypulmonary oedematoxaemiaultrasonographyAnesthesiologyRD78.3-87.3ENIndian Journal of Anaesthesia, Vol 65, Iss 10, Pp 716-730 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	echocardiography extravascular lung water lung obstetric point-of-care systems pre-eclampsia pregnancy pulmonary oedema toxaemia ultrasonography Anesthesiology RD78.3-87.3
spellingShingle	echocardiography extravascular lung water lung obstetric point-of-care systems pre-eclampsia pregnancy pulmonary oedema toxaemia ultrasonography Anesthesiology RD78.3-87.3 Sukhminder Jit Singh Bajwa Madhuri S Kurdi Jagadish G Sutagatti Sukhwinder K Bajwa Kaushic A Theerth Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis
description	Background and Aims: Appropriate volume assessment and fluid management can prevent maternal deaths in the severely pre-eclamptic (SPE) parturients. We planned a systematic review and meta-analysis (MA) to evaluate the role and ability of point-of-care ultrasound (POCUS) in the assessment of volume status and early detection of lung oedema in an SPE parturient. Methods: An e-literature search was done from several databases. Data were extracted under five domains including POCUS-derived parameters like echo comet score (ECS), lung ultrasound (LUS) scores, B-patterns, optic nerve sheath diameter (ONSD), E/e' ratio, presence of pleural effusion, pulmonary interstitial syndrome and pulmonary congestion. The risk of bias was assessed. Extracted data were analysed using MetaXL and Revman 5.3. Heterogeneity in the studies was evaluated using the Cochrane Q test and I2 statistics. Funnel plots were used for the assessment of publication bias. Results: Seven prospective studies including 574 parturients (including 396 pre-eclamptics) were selected. POCUS included lung, optic nerve, cardiac and thoracic US. In two studies, the ECS and LUS scores pre-delivery were higher in pre-eclamptics. Two studies found a mean ONSD of 5–5.84 mm before delivery. MA revealed a significantly lower mean ECS score at post-delivery than pre-delivery, and the summary prevalence of B-pattern and pleural effusion among SPE parturients was found to be 0.28 (0.03–0.84) and 0.1 (0–0.2), respectively. A good correlation was observed between B-line patterns and diastolic dysfunction (increased E/e' ratio), LUS score and thoracic fluid content, ONSD and ECS in individual studies. Conclusion: POCUS parameters can be useful as early markers of fluid status and serve as useful tools in the precise clinical management of pre-eclampsia.
format	article
author	Sukhminder Jit Singh Bajwa Madhuri S Kurdi Jagadish G Sutagatti Sukhwinder K Bajwa Kaushic A Theerth
author_facet	Sukhminder Jit Singh Bajwa Madhuri S Kurdi Jagadish G Sutagatti Sukhwinder K Bajwa Kaushic A Theerth
author_sort	Sukhminder Jit Singh Bajwa
title	Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis
title_short	Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis
title_full	Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis
title_fullStr	Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis
title_full_unstemmed	Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis
title_sort	point-of-care ultrasound (pocus) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: a systematic review and meta-analysis
publisher	Wolters Kluwer Medknow Publications
publishDate	2021
url	https://doaj.org/article/cc9e06bb38404e3ab1ba2c4899c4f06d
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Point-of-Care Ultrasound (POCUS) for the assessment of volume status and fluid management in patients with severe pre-eclampsia: A systematic review and meta-analysis

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