Point‐of‐care ultrasound to confirm the position of bronchial blockers in children

Abstract

Purpose We described the accuracy of ultrasound in determining the position of bronchial blockers (BBs) in children underwent thoracoscopic surgery. Methods We enrolled 52 children with ASA grade I‐III who received thoracoscopic surgery with placement of BBs. Point‐of‐care ultrasound was performed according to the BLUE protocol. The ultrasound‐guided lung sliding sign and curtain sign were used to assess the position of BBs. The accuracy of ultrasound in evaluating the position of BBs, as well as the accuracy and operating time of sliding sign and curtain sign at each examination point were recorded and compared. Results The accuracy of ultrasound in evaluating the position of BBs was 88% (46/52, 95% CI 0.69–0.97). When using the curtain sign to assess the position of BBs, the accuracy was 90% (94/104, 95% CI 0.78–0.96), which was significantly higher than when using the sliding sign (65% (136/208), 95% CI 0.55–0.74) (p = 0.002). The accuracy of curtain sign at the left mid‐axillary line‐diaphragm and the right mid‐axillary line‐diaphragm was respectively 96% (50/52, 95% CI 0.80–0.99) and 84% (44/52, 95% CI 0.65–0.95), which were higher than that of sliding sign at upper blue points and lower blue points. There was no significant difference in the operating time between two ultrasound signs (the curtain sign, 13.4 ± 8.2 s vs. the lung sliding sign, 16.2 ± 10.0 s, p = 0.065). Conclusion Point‐of‐care ultrasound can effectively assess the position of BBs. The accuracy of using the curtain sign at the mid‐axillary line‐diaphragm is higher than that of using the lung sliding sign at the anterior chest wall.

Point‐of‐care ultrasound (POCUS): A new promising approach for the position of bronchial blockers in children

“…It is a very common technology in anesthetic airway management in thoracic surgery. The bronchus blockers (BBs) are placed on the affected side of the bronchus through the endotracheal tube, the same side of the lung is isolated through its inflatable cuff, so as to achieve the effect of one lung ventilation at the same time 1 . Accurate placement of BBs is the key to achieve this goal.…”

“…Wang et al have added a new method to use ultrasound signs to comprehensively evaluate the placement position and effect of the BBS in children, especially the first time to use curtain sign for the management of children's one‐lung ventilation, and to verify the reliability of this method 1 . Point‐of‐care ultrasound provides a new approach to anesthesia airway management, while expanding the application of ultrasound.…”

“…The bronchus blockers (BBs) are placed on the affected side of the bronchus through the endotracheal tube, the same side of the lung is isolated through its inflatable cuff, so as to achieve the effect of one lung ventilation at the same time. 1 Accurate placement of BBs is the key to achieve this goal. Fiberoptic bronchoscope is the most reliable method to determine the location of BBs, but the use of fiberoptic bronchoscope increases the cost of disinfection and the probability of intratracheal injury, especially for children.…”

“…3 In this study, excluding children with diseases that can image lung sliding syndrome and curtain syndrome, such as plural adhesions, plural effect, pulmonary edema, and so on, the examination sites (upper BLUE dot, lower BLUE dot, and diaphragm dot) in the BLUE scheme were used, and the location of the BBs was confirmed by fiberoptic bronchoscope. 1 The result was taken as the final judgment result. The location of the BBs was evaluated by lung sliding syndrome and curtain syndrome for the first time.…”

“…4 Wang et al have added a new method to use ultrasound signs to comprehensively evaluate the placement position and effect of the BBS in children, especially the first time to use curtain sign for the management of children's one-lung ventilation, and to verify the reliability of this method. 1 Point-of-care ultrasound provides a new approach to anesthesia airway management, while expanding the application of ultrasound. It should be pointed out that preoperative ultrasound can easily be used for targeted examinations, but intraoperative ultrasound examination becomes difficult or infeasible due to the limitation of patient position and operation, which is also a limitation of point-of-care ultrasound for an aesthesia airway management.…”