Table 3 Quality of evidence by GRADE
Certainty assessment | № of patients | Effect | Certainty | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
№ of studies | Study design | Risk of bias | Inconsistency | Indirectness | Imprecision | Other considerations | Ultrasound-guided | Control | Relative (95% CI) | Absolute (95% CI) | ||
Incidence of atelectasis | ||||||||||||
9 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 52/222 (23.4%) | 169/221 (76.5%) | RR 0.31 (0.25 to 0.40) | 528 fewer per 1000 (from 574 to 459 fewer) | ⨁⨁⨁⨁ High | Critical |
Subgroup analysis of atelectasis by age | ||||||||||||
9 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 52/222 (23.4%) | 169/221 (76.5%) | RR 0.31 (0.25 to 0.40) | 528 fewer per 1000 (from 574 to 459 fewer) | ⨁⨁⨁⨁ High | Critical |
Subgroup analysis of atelectasis by age—age ≥ 18 (adult) | ||||||||||||
3 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 25/60 (41.7%) | 52/61 (85.2%) | RR 0.49 (0.36 to 0.67) | 435 fewer per 1000 (from 546 to 281 fewer) | ⨁⨁⨁⨁ High | Critical |
Subgroup analysis of atelectasis by age—age < 18 (children) | ||||||||||||
6 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 27/162 (16.7%) | 117/160 (73.1%) | RR 0.23 (0.17 to 0.33) | 563 fewer per 1000 (from 607 to 490 fewer) | ⨁⨁⨁⨁ High | Critical |
Subgroup analysis of atelectasis by LRM or Non-LRM used in the control group | ||||||||||||
9 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 52/222 (23.4%) | 169/221 (76.5%) | RR 0.31 (0.25 to 0.40) | 528 fewer per 1000 (from 574 to 459 fewer) | ⨁⨁⨁⨁ High | Critical |
Subgroup analysis of atelectasis by LRM or non-LRM used in the control group-compare to LRM in the control group | ||||||||||||
3 | Randomized trials | not serious | Not serious | Not serious | Not serious | None | 14/100 (14.0%) | 59/99 (59.6%) | RR 0.24 (0.14 to 0.39) | 453 fewer per 1000 (from 513 to 364 fewer) | ⨁⨁⨁⨁ High | Critical |
Subgroup analysis of atelectasis by LRM or non-LRM used in the control group-compare to non-LRM in the control group | ||||||||||||
6 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 38/122 (31.1%) | 110/122 (90.2%) | RR 0.35 (0.27 to 0.46) | 586 fewer per 1,000 (from 658 to 487 fewer) | ⨁⨁⨁⨁ High | Critical |
The application of PEEP after LRM | ||||||||||||
9 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 52/222 (23.4%) | 169/221 (76.5%) | RR 0.31 (0.25 to 0.40) | 528 fewer per 1,000 (from 574 to 459 fewer) | ⨁⨁⨁⨁ High | Critical |
The application of PEEP after LRM-PEEP(ultrasound-guided) = PEEP (control) | ||||||||||||
7 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 41/180 (22.8%) | 131/180 (72.8%) | RR 0.32 (0.24 to 0.42) | 495 fewer per 1000 (from 553 to 422 fewer) | ⨁⨁⨁⨁ High | Critical |
The application of PEEP after LRM-PEEP (ultrasound-guided) > PEEP (control) | ||||||||||||
2 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 11/42 (26.2%) | 38/41 (92.7%) | RR 0.29 (0.18 to 0.48) | 658 fewer per 1000 (from 760 to 482 fewer) | ⨁⨁⨁⨁ High | Critical |
LUS after LRM | ||||||||||||
6 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 122 | 122 | - | MD 6.24 lower (6.9 lower to 5.59 lower) | ⨁⨁⨁⨁ High | Critical |
LUS of each part of the lung after LRM | ||||||||||||
2 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 120 | 123 | – | MD 2.31 lower (2.69 lower to 1.94 lower) | ⨁⨁⨁⨁ High | Critical |
LUS of each part of the lung after LRM–anterior | ||||||||||||
2 | Randomised trials | Not serious | Not serious | Not serious | Not serious | None | 40 | 41 | – | MD 2 lower (2.49 lower to 1.51 lower) | ⨁⨁⨁⨁ High | Critical |
LUS of each part of the lung after LRM–lateral | ||||||||||||
2 | Randomised trials | Not serious | Not serious | Not serious | Not serious | None | 40 | 41 | – | MD 2.5 lower (3.2 lower to 1.8 lower) | ⨁⨁⨁⨁ High | Critical |
LUS of each part of the lung after LRM-posterior | ||||||||||||
2 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 40 | 41 | – | MD 3.24 lower (4.23 lower to 2.24 lower) | ⨁⨁⨁⨁ High | Critical |
Certainty assessment | № of patients | Effect | Certainty | Importance | ||||||||