The role of ultrasonographic lung aeration score in the prediction of postoperative pulmonary complications: an observational study

Abstract

Background Postoperative pulmonary complications (PPCs) are important contributors to mortality and morbidity after surgery. The available predicting models are useful in preoperative risk assessment, but there is a need for validated tools for the early postoperative period as well. Lung ultrasound is becoming popular in intensive and perioperative care and there is a growing interest to evaluate its role in the detection of postoperative pulmonary pathologies. Objectives We aimed to identify characteristics with the potential of recognizing patients at risk by comparing the lung ultrasound scores (LUS) of patients with/without PPC in a 24-h postoperative timeframe. Methods Observational study at a university clinic. We recruited ASA 2–3 patients undergoing elective major abdominal surgery under general anaesthesia. LUS was assessed preoperatively, and also 1 and 24 h after surgery. Baseline and operative characteristics were also collected. A one-week follow up identified PPC+ and PPC- patients. Significantly differing LUS values underwent ROC analysis. A multi-variate logistic regression analysis with forward stepwise model building was performed to find independent predictors of PPCs. Results Out of the 77 recruited patients, 67 were included in the study. We evaluated 18 patients in the PPC+ and 49 in the PPC- group. Mean ages were 68.4 ± 10.2 and 66.4 ± 9.6 years, respectively (p = 0.4829). Patients conforming to ASA 3 class were significantly more represented in the PPC+ group (66.7 and 26.5%; p = 0.0026). LUS at baseline and in the postoperative hour were similar in both populations. The median LUS at 0 h was 1.5 (IQR 1–2) and 1 (IQR 0–2; p = 0.4625) in the PPC+ and PPC- groups, respectively. In the first postoperative hour, both groups had a marked increase, resulting in scores of 6.5 (IQR 3–9) and 5 (IQR 3–7; p = 0.1925). However, in the 24th hour, median LUS were significantly higher in the PPC+ group (6; IQR 6–10 vs 3; IQR 2–4; p < 0.0001) and it was an independent risk factor (OR = 2.6448 CI95% 1.5555–4.4971; p = 0.0003). ROC analysis identified the optimal cut-off at 5 points with high sensitivity (0.9444) and good specificity (0.7755). Conclusion Postoperative LUS at 24 h can identify patients at risk of or in an early phase of PPCs.

Reliability and clinical correlations of semi-quantitative lung ultrasound on BLUE points in COVID-19 mechanically ventilated patients: The ‘BLUE-LUSS’—A feasibility clinical study

“…The situation is different for parameters that provide information on the patients' actual oxygenation. In our assumption, lung ultrasound should be able to link two very important clinical features: the actual oxygenation status and the current lung aeration of the patient [29,42,43,55]. We were therefore pleased to see that our data showed a significant negative correlation between actual P/F ratio and BLUE-LUSS values of the patients.…”

Correlation of Perioperative Atelectasis With Duration of Anesthesia, Pneumoperitoneum, and Length of Surgery in Patients Undergoing Laparoscopic Cholecystectomy

“…ASA grade I, II, and III were statistically significant at time points A (p-value < 0.01), B (p-value < 0.001), C (p-value < 0.001), and D (p-value = 0.01). In a study by Szabó et al, it was discovered that patients in the ASA grade III class had a much higher rate of postoperative pulmonary problems, such as atelectasis [ 14 ]. Lung ultrasonography can be used during the perioperative phase to track atelectasis and diagnose respiratory problems.…”

“…As a result, we used lung ultrasonography to track these changes and compare them to the patient’s final prognosis. Although there have been studies that have employed lung ultrasound to detect diaphragm mobility and link it with pulmonary functions in the postoperative phase, there have been limited studies that have documented the relevance of serial lung ultrasonography in predicting postoperative outcomes [ 14 , 15 ].…”

Preoperative Ultrasound-based Protocol for Optimisation of Fluid Therapy to Prevent Early Intraoperative Hypotension: A Randomised Controlled Study

“…As uid overload is a well described risk factor of postoperative pulmonary complications [24,25], immediate postoperative pO 2 and LUS of the 24th hour after surgery were collected. Lung ultrasound is a sensitive and non-invasive way to detect any form of postoperative pulmonary complication (PPC) [26], and higher LUS levels are strongly predictive of its later developing forms [27,28]. The postoperative quantitative lung ultrasound score method relied on a validated protocol of assessing lung aeration optimised for perioperative purposes.…”