Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery

Song, In Kyung; Kim, Eun‐Hee; Lee, Ji Hyun; Kang, Pyoyoon; Kim, Hee‐Soo; Kim, Jin‐Tae

doi:10.1097/aln.0000000000002069

Cited by 55 publications

(51 citation statements)

References 37 publications

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“…44 Under perioperative ultrasound-guided recruitment manoeuvres and moderate PEEP, the incidence of atelectasis and postoperative hypoxaemia decreased in both infants and paediatric cardiac patients. 42,45,46 Detecting the effects of different levels of PEEP and RM on PPCs by lung ultrasound still needs more research.…”

Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

Xie

Sun

You

et al. 2020

Preprint

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Background: Postoperative pulmonary complications (PPCs) and hypoxaemia is associated with morbidity and mortality. We aim to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxemia after general anesthesia and compare the results to those of thoracic computed tomography (CT). Methods: Adult patients who received general anesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analyzed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO 2 ) less than 92% for more than 30 seconds under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 hour before returning to the ward. Results: From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%). Conclusions: Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

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Section: Discussionmentioning

confidence: 99%

Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

Xie

Sun

You

et al. 2020

Preprint

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“…The degree of B‐lines was divided into four grades and scored from 0 to 3 (B‐line score): 0, fewer than 3 isolated B‐lines; 1, multiple well‐defined B‐lines; 2, multiple coalescent B‐lines; and 3, white lung. Significant atelectasis was defined as a consolidation score of ≥2 in any region following previous study performed by our group …”

Section: Methodsmentioning

confidence: 99%

“…Significant atelectasis was defined as a consolidation score of ≥2 in any region following previous study performed by our group. 20 Each region was characterized by the worst ultrasound finding, and video clips were stored for every region. The degree of consolidations and B-lines were separately scored for each region and were summed for analysis.…”

Section: Lung Ultrasound Examinationmentioning

confidence: 99%

Effect of different fraction of inspired oxygen on development of atelectasis in mechanically ventilated children: A randomized controlled trial

Song

Jang

Lee

et al. 2019

Pediatric Anesthesia

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Background The use of high fraction of inspired oxygen (FIO2) can cause direct pulmonary toxicity and pulmonary complications. The purpose of this study was to evaluate the effect of different FIO2 on development of intraoperative atelectasis in mechanically ventilated children using lung ultrasound. Methods In this randomized controlled, patient‐ and sonographer‐blinded trial, 86 children (≤6 years) undergoing noncardiac surgery were allocated into a low (n = 43) or high (n = 43) FIO2 group. The low FIO2 group consistently received 30% air‐oxygen mixture during preoxygenation, ultrasound‐guided recruitment maneuver, and mechanical ventilation. The high FIO2 group received 100% oxygen during preoxygenation and ultrasound‐guided recruitment maneuver and 60% air‐oxygen mixture during mechanical ventilation. Positive end‐expiratory pressure of 5 cm H2O was applied in both groups. Lung ultrasound was performed one minute after the start of mechanical ventilation and at the end of surgery in both groups. Primary outcome was significant atelectasis incidence (consolidation score of ≥2 in any region) on the postoperative lung ultrasound. Secondary outcomes included significant atelectasis incidence on the preoperative lung ultrasound, incidences of intra‐ and postoperative desaturation, and incidences of postoperative fever and postoperative pulmonary complications. Results Significant atelectasis incidence on the postoperative lung ultrasound was similar between the low and high FIO2 groups (28% vs 37%; Pearson chi‐square value = 0.847; P = .357; OR 1.531; 95% CI 0.617‐3.800). Significant atelectasis incidence on the preoperative lung ultrasound was also similar between the groups (12% vs 9%; Pearson chi‐square value = 0.124; P = .725; OR 0.779; 95% CI 0.194‐3.125). There were no statistically significant differences in the other secondary outcomes. Conclusions FIO2 did not affect significant atelectasis formation in mechanically ventilated children who received ultrasound‐guided recruitment maneuver and positive end‐expiratory pressure.

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“…Furthermore, it can continuously and dynamically monitor the changes in lung condition and guide a clinical intervention . Although LUS examination has been widely reported in adult and pediatric non‐heart surgical patients, only a few studies discuss its benefits in children with CHD, such as diagnosis of the postoperative pulmonary complications . The use of LUS as a diagnostic tool for PO before surgery is not routinely used and relatively limited in CHD children .…”

Section: Introductionmentioning

confidence: 99%

“…13 Although LUS examination has been widely reported in adult and pediatric non-heart surgical patients, only a few studies discuss its benefits in children with CHD, such as diagnosis of the postoperative pulmonary complications. 14,15 The use of LUS as a diagnostic tool for PO before surgery is not routinely used and relatively limited in CHD children. 16 Therefore, this study aimed to evaluate the feasibility of using LUS to assess PO in children with CHD and compare its diagnostic efficacy with CXR, using CT as a standard criterion.…”

mentioning

confidence: 99%

Feasibility of lung ultrasound to assess pulmonary overflow in congenital heart disease children

Hou

Lǚ

et al. 2018

Pediatric Pulmonology

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Background Pulmonary overflow (PO) is one of the most common complications in congenital heart disease (CHD) children with an incidence of 48‐60% approximately. This study explored the feasibility of using lung ultrasound (LUS) to assess pulmonary overcirculation in CHD children and compare the diagnostic performance of LUS and chest radiography (CXR) for the detection of pulmonary overcirculation. Method The upper anterior area, lower anterior area, upper lateral area, and lower posterior area, in each hemithorax were scanned in 59 children in the supine position. A‐lines, B‐lines in each scanned region were recorded, and the worst LUS abnormality in the video clip was considered to characterize the examined region. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of LUS and CXR were compared using computed tomography (CT) as a standard criterion. Results PO was diagnosed in 53% (31/59), 63% (37/59), and 51% (30/59) children with CT, CXR, and LUS, respectively. The sensitivity, specificity, and diagnostic accuracy of PO were 96%, 94%, and 95% for LUS and 74%, 50%, and 63% for CXR. The percentage of mild, moderate, and severe PO diagnosed via LUS were 31% (18/59), 19% (11/59), and 2% (1/59), respectively. Furthermore, the PO incidence diagnosed by LUS in CHD children less than 1 year old were significantly higher than those beyond 1 year old. Conclusion LUS is a noninvasive and useful tool for the detection and assessment of PO in CHD children at the operating room, and is better than CXR in sensitivity and specificity, comparable to CT.

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Utility of Perioperative Lung Ultrasound in Pediatric Cardiac Surgery

Cited by 55 publications

References 37 publications

Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

Feasibility and Efficacy of Lung Ultrasound to Investigate Pulmonary Complications in Patients Who Developed Postoperative Hypoxaemia-A Prospective Study

Effect of different fraction of inspired oxygen on development of atelectasis in mechanically ventilated children: A randomized controlled trial

Feasibility of lung ultrasound to assess pulmonary overflow in congenital heart disease children

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