Could judicious use of lung ultrasound reduce radiographic examinations in pediatric cardiac surgery patients?

Cantinotti, Massimiliano; Giordano, Raffaele; Gargani, Luna; Marchese, Pietro; Franchi, Eliana; Köestenberger, Martin; Kutty, Shelby; Ait-Alì, Lamia; Assanta, Nadia

doi:10.1016/j.jclinane.2019.109638

Cited by 9 publications

(7 citation statements)

References 5 publications

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“…Recently, an increasing number of studies have reported that lung ultrasonography can also be used in children with CHD undergoing cardiac surgery to accurately diagnose common pulmonary conditions postoperatively, to reclassify plain chest radiographic findings in a larger number of patients quickly and at low cost, and to reduce the number of plain chest radiographic examinations without any adverse patient outcome 20,21 . In our study, we also found that cardiac surgery using cardiopulmonary bypass for children with CHD not only increased the incidence of atelectasis but exacerbated alveolar lung collapse and atelectasis, since the iPEEPRM reduced the incidence of atelectasis from 92% to 38% after the surgery instead of reduction from 76% to 15% before the surgery.…”

Section: Discussionsupporting

confidence: 62%

Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

Sun

Zhang

et al. 2020

Pediatric Pulmonology

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Aim To explore the effect of incremental positive end‐expiratory pressure recruitment maneuver (iPEEPRM) in children with congenital heart diseases (CHDs) using lung ultrasound. Methods Thirty‐six children aged 3 months to 5 years scheduled for cardiac surgery participated. iPEEPRM was performed with PEEP stepwise increase (0‐5‐10‐15 cmH2O) and decrease at the same rate before and after surgery. Atelectatic areas, ultrasound scores, arterial oxygen pressure (PaO2), and respiratory system dynamic compliance per kilogram body weight (CDyn/kg) were analyzed before and after iPEEPRM. The primary outcome is the incidence of atelectasis. Secondary outcomes are oxygenation, ventilation, CDyn/kg, and atelectasis area. Results iPEEPRM was successfully applied in 92% (33/36) children before surgery and 71% (24/34) children after surgery. The incidence of atelectasis was significantly reduced by iPEEPRM from 76% to 15% before surgery and from 92% to 38% after surgery, respectively (P < .001). Before surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 32.5 (0‐128.1) mm2 vs 0 (0‐0) mm2 and 8 (3‐12) vs 2 (0‐4). PaO2 and CDyn/kg were significantly increased after iPEEPRM: 243 (129‐275) mm Hg vs 278 (207‐323) mm Hg and 0.6 (0.4‐0.7) mL/cmH2O/kg vs 0.8 (0.6‐1.0) mL/cmH2O/kg. After surgery, iPEEPRM significantly reduced atelectatic areas and ultrasound scores: 45.7 (13.1‐115.8) mm2 vs 0 (0‐34.7) mm2, and 9 (6‐12) vs 3 (0‐5). PaO2 and CDyn/kg were also significantly increased after iPEEPRM. Conclusions iPEEPRM effectively reduced atelectasis, improved lung aeration, oxygenation, and CDyn/kg in children undergoing cardiac surgery.

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Section: Discussionsupporting

confidence: 62%

Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

Sun

Zhang

et al. 2020

Pediatric Pulmonology

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“…Angiotensin II levels are found to be notably increased in the plasma of those infected with SARS-CoV-2 whilst high ACE2 levels were seen in those less affected by the virus and these levels reportedly decrease with age. Decreasing levels of ACE2 may explain why the elderly are at a higher risk of severe illness from COVID-19 compared to the paediatric population [14].…”

Section: Discussionmentioning

confidence: 99%

Management Congenital Heart Disease Surgery during COVID-19: A Review Article

Gofur¹,

Gofur²,

Soesilaningtyas³

et al. 2022

JCRR

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Introduction: Congenital heart disease is a form of heart abnormality that has been acquired since the newborn. The clinical course of this disorder varies from mild to severe. In mild forms, there are often no symptoms, and no abnormalities are found on clinical examination. Whereas in severe CHD, symptoms have been visible since birth and require immediate action. Generally, the management of congenital heart disease includes non-surgical management and surgical management. Non-surgical management includes medical management and interventional cardiology. Medical management is generally secondary as a result of complications from heart disease itself or due to other accompanying disorders. In this case, the goal of medical therapy is to relieve symptoms and signs in addition to preparing for surgery. The duration and method of administration of drugs depend on the type of disease at hand. Discussion: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which led to the coronavirus disease 2019 (COVID-19) pandemic, was initially reported in Wuhan, China in December, 2019. The rapid rise in the number of cases worldwide led to hospitals struggling to cope with the sudden influx of patients. This has had a ripple effect on other parts of health care as manpower and supplies needed to be reallocated. Within cardiology, this has led to outpatient appointments and elective surgeries being reduced and/or postponed. COVID-19 appears to have a complicated relationship with cardiovascular system, as studies have suggested cardiovascular diseases increase disease severity and mortality rates in those who are infected. However, the virus has also been shown to cause cardiovascular complications such as acute myocardial injury, heart failure, and arrhythmia. Conclusion: Coronavirus may also cause myocardial injury via the cytokine storm that occurs in response to a possible large immune response during the infection. Cardiac involvement such as right ventricular failure and congestion can either be a result of respiratory distress or direct cardiac injury caused by the virus, as suggested by the raised cardiac troponin I in critical patients compared to non-critical patients.

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“…27 The perioperative use of LUS could significantly reduce the frequency of radiographic examinations associated with substantial cost benefits. 28 Besides the increased use of LUS, it was found that the ingenious application of linear and convex transducers for evaluation of retrosternal area could provide additional diagnostic information beyond conventional echocardiography after pediatric cardiac surgery. 29 However, limited data had been found in children undergoing lateral thoracotomy cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, the utility of LUS in children undergoing congenital heart surgery is gaining consensus, not only for the increased accuracy in the diagnosis of pulmonary complications, but also for the high prognostic value of LUS scores in the prediction of CICU stay and extubation time after pediatric cardiac surgery 27 . The perioperative use of LUS could significantly reduce the frequency of radiographic examinations associated with substantial cost benefits 28 . Besides the increased use of LUS, it was found that the ingenious application of linear and convex transducers for evaluation of retrosternal area could provide additional diagnostic information beyond conventional echocardiography after pediatric cardiac surgery 29 .…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass

Yang

et al. 2021

Pediatric Pulmonology

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Objectives: To assess the effects of postural lung recruitment maneuvers on the postoperative atelectasis assessed by lung ultrasound (LUS) compared with supine position recruitment maneuvers in children undergoing right lateral thoracotomy cardiac surgery with cardiopulmonary bypass.Methods: In this randomized and controlled trial, 84 patients aged 3 years or younger, scheduled for right lateral thoracotomy cardiac surgery with cardiopulmonary bypass (CPB) were randomly allocated to postural lung recruitment group or control group. The first LUS exam was performed immediately upon completion of the cardiac surgery (T1), and a repeat ultrasound exam started 1 min after lung recruitment maneuvers (T2). The primary outcome was the incidence of significant atelectasis at T2. Results:The incidence of significant atelectasis at T2 in the postural lung recruitment maneuver group was lower compared with that in the control group (30.2% vs. 58.1%; odds ratio: 0.31; 95% confidence interval: 0.13-0.76; p = .009). The LUS scores for consolidations and B-lines of the left lung were higher than those of the right lung in both groups at T1. More significant reduction of the left LUS scores and sizes of atelectatic areas were found in the postural lung recruitment group than those in the control group.Conclusions: Postoperative postural recruitment maneuver was more effective to improve reaeration of lung than supine position recruitment maneuver in children undergoing right lateral thoracotomy cardiac surgery with CPB.

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Could judicious use of lung ultrasound reduce radiographic examinations in pediatric cardiac surgery patients?

Cited by 9 publications

References 5 publications

Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

Lung ultrasound evaluation of incremental PEEP recruitment maneuver in children undergoing cardiac surgery

Management Congenital Heart Disease Surgery during COVID-19: A Review Article

Effectiveness of postural lung recruitment on postoperative atelectasis assessed by lung ultrasound in children undergoing lateral thoracotomy cardiac surgery with cardiopulmonary bypass

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