Diagnostic Accuracy of Parasternal Intercostal Muscle Thickening in Weaning Outcomes: A Systematic Review and Meta-Analysis

Background:Critically ill patients often require mechanical ventilation; moreover, diaphragmatic ultrasonography has emerged as a valuable method for predicting the optimal time for weaning. Nonetheless, it faces numerous challenges; thus, the parasternal intercostal muscles have evolved as a simple alternative method with comparable accuracy. However, no systematic reviews have discussed the diagnostic accuracy of parasternal intercostal thickening in predicting weaning outcomes.Methods: Two independent operators searched five different databases. Finally, seven articles were available for qualitative analysis, and five studies were included in the meta-analysis. The quality of the studies was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Additionally, pooled sensitivity, specificity, and summary receiver operating characteristic curves were calculated for the included studies.Results: The parasternal intercostal thickening fraction demonstrated good diagnostic accuracy, with a pooled sensitivity of 91% and specificity of 79%, as well as an area under the receiver operating characteristic (ROC) curve of 0.87. The cutoff values varied between 7% and 15%. Significant heterogeneity was observed in the sensitivity and the area under the curve of the included studies.Conclusion: The parasternal intercostal thickening fraction can accurately predict weaning outcomes, with an AUC of 0.87. The included studies were of high quality, as assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool.