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Meta-Analysis
. 2025 May 14;7(5):e1261.
doi: 10.1097/CCE.0000000000001261. eCollection 2025 May 1.

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

Sameer Sharif  1   2   3 , Holden Flindall  4 , John Basmaji  5 , Enyo Ablordeppey  6 , José L Díaz-Gómez  7 , Michael Lanspa  8 , Sara Nikravan  9 , Joshua Piticaru  10 , Kimberley Lewis  2   3
Affiliations
Meta-Analysis

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

Sameer Sharif et al. Crit Care Explor. .

Abstract

Objectives: To determine the safety and efficacy of critical care ultrasonography (CCUS) guided volume management in acutely ill patients.

Data sources: We searched MEDLINE, Embase, Wiley CENTRAL, and unpublished sources from inception to February 6, 2024.

Study selection: We included randomized controlled trials (RCTs) of acutely ill adult patients randomized to receive CCUS as compared with no CCUS to guide fluid management.

Data extraction: Reviewers screened abstracts, full texts, and extracted data independently and in duplicate. We pooled data using a random-effects model, assessed the risk of bias using the modified Cochrane tool and assessed the certainty of evidence using the Grading Recommendations Assessment, Development, and Evaluation approach.

Data synthesis: We included 17 RCTs (n = 1765 patients) in this review. Pooled analyses found that the use of CCUS for volume management in acutely ill patients may decrease mortality at the longest reported time period (relative risk [RR], 0.79; 95% CI, 0.67-0.95; low certainty) and decreases the fluid balance up to 72 hours after admission (mean difference [MD], 0.72 L lower; 95% CI, 1.5 L lower to 0.07 L higher; low certainty). CCUS had an uncertain effect on duration of mechanical ventilation (MD, 1.14 d fewer; 95% CI, 3.35 d fewer to 1.07 d more; very low certainty), ICU length of stay (LOS) (MD, 0.01 d fewer; 95% CI, 1.12 d fewer to 1.09 d more; very low certainty), the need for vasopressors (RR, 0.39; 95% CI, 0.10-1.62; very low certainty), acute kidney injury (AKI) (RR, 0.94; 95% CI, 0.32-2.72; very low certainty), and the need for renal replacement therapy (RRT) (RR, 0.79; 95% CI, 0.17-3.66; very low certainty).

Conclusions: In acutely ill adult patients, CCUS for the use of targeted volume management may reduce mortality and fluid balance up to 72 hours after admission. CCUS has an uncertain effect on ICU LOS, duration of mechanical ventilation, duration of vasopressor use, AKI, and the need for RRT. However, this evidence is limited by imprecision and indirectness.

Keywords: critical care; point-of-care ultrasound; sepsis; ultrasound; volume overload.

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Conflict of interest statement

Dr. Nikravan has received funds from Verathon. Dr. Sharif holds a McMaster University Department of Medicine Internal Career Research Award. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Figures

Figure 1.
Figure 1.
Forest plot comparing critical care ultrasonography (CCUS) and no CCUS for the outcome of mortality. df = degrees of freedom, M-H = Mantel-Haenszel.
Figure 2.
Figure 2.
Forest plot comparing critical care ultrasonography (CCUS) and no CCUS for the outcome of fluid balance up to 72 hr. df = degrees of freedom.
Figure 3.
Figure 3.
Forest plot comparing critical care ultrasonography (CCUS) and no CCUS for the outcome of fluid balance up to 72 hr separated by the subgroup of patients with and without sepsis. df = degrees of freedom.
See this image and copyright information in PMC

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