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

Abstract

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 I 2 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.

Recent advances in obstetric anaesthesia and critical care

“…The number of B-lines (> 3) in at least 2 bilateral lung zones is a definitive finding of interstitial syndrome and a real-time lung US benefit in the assessment of extravascular lung water, disease progression, or resolution. [ 56 ] It has also emerged as a useful aid for pregnant patients with coronavirus disease-19 to diagnose and treat respiratory failure.…”

Innovative research and technological advancements: Oars of the boat of progress

“…[ 3 – 8 ] In the intensive care unit (ICU) too, the ultrasound plays a major role with its ability to diagnose extravascular lung water in the lungs at an early stage, increased intracranial pressure, conditions such as pneumothorax, pneumonia, and pulmonary embolism and in mechanical ventilation. [ 9 , 10 ]…”

A tripartite challenge of orphaned manuscripts, heedless writing and reluctant reviewing...... revamping the editing process!

“…Systematic reviews, meta-analysis and randomised controlled trials occupy the highest position in evidence-based medicine, but in spite of this academic awareness, authors are nowadays resorting to quick research recipes like retrospective studies and online surveys. [ 3 ] The small number of meta-analyses[ 4 5 6 ] and large number of surveys[ 7 8 9 10 11 ] and retrospective studies[ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ] published in the IJA in the last few years are an evidence to this. The commonly known inverse ratio of quantity to quality has also been equally observed at IJA with this enhanced submission process.…”