Prognostic value of lung ultrasonography after on-pump cardiac surgery

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Abstract

Rationale: Along with bedside plain chest radiography, lung ultrasonography is being increasingly used for detection of postoperative respiratory complications.
Aim: Our study was aimed at the evaluation of lung ultrasonography efficacy for the diagnosis of postoperative respiratory complications in patients after the on-pump cardiac surgery.
Materials and methods: The study included 39 patients who had undergone elective cardiac on-pump surgery. Assessment of hemodynamic parameters and blood gases was done at admittance to the intensive care unit (ICU), as well as at 6 and 24 hours after surgery. Lung ultrasonography was also performed including counting of B-lines in 12 lung quadrants at 6 and 24 hours after surgery, as well as chest radiography at 24 hours. Duration of mechanical ventilation, time in ICU and in-hospital stay were also evaluated.
Results: Gas exchange deterioration was associated with increased numbers of B-lines: 9 (5 to 15) at 24 hours after surgery. In the patients with PaO2/FiO2 above 300 mm Hg the number of B-lines at 24 hours after surgery was 4 (2 to 8) (р = 0.04). Plain chest radiography at 24 hours after surgery revealed abnormalities in 69% of the patients. Discoid atelectases were the most common findings (n = 13). The ROC analysis showed that increased numbers of B-lines above 10 at 6 hours after completion of the surgery was predictive of the development of X-ray abnormalities at 24 hours (AUC 0.82, р = 0.02, sensitivity 86%, specificity 76%). At 6 hours after the intervention the patients who subsequently required prolonged mechanical ventilation had increased numbers of B-lines (15 [14–27]) compared to those who could be extubated within the first 24 hours after surgery (10 [3–13], p = 0.02).
Conclusion: Lung ultrasonography monitoring accelerates the diagnosis of respiratory problems after cardiac surgery and allows timely identification of the patients requiring prolonged respiratory support and ICU stay.

About the authors

E. V. Fot

Northern State Medical University

Author for correspondence.
Email: ev_fot@mail.ru
ORCID iD: 0000-0003-0052-8086

Evgenia V. Fot - MD, PhD, Associate Professor, Department of Anesthesiology and Intensive Care Therapy.

51 Troitsky prospect, Arkhangelsk, 163000, Tel.: +7 (921) 295 06 85

Russian Federation

N. N. Izotova

Northern State Medical University

Email: fake@neicon.ru

Natalia N. Izotova - MD, Postgraduate Student, Department of Anesthesiology and Intensive Care Therapy.

51 Troitsky prospect, Arkhangelsk, 163000

Russian Federation

M. V. Vinogradov

Northern State Medical University

Email: fake@neicon.ru

Mikhail V. Vinogradov - MD, Resident, Department of Anesthesiology and Intensive Care Therapy.

51 Troitsky prospect, Arkhangelsk, 163000

Russian Federation

V. V. Kuzkov

Northern State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-8191-1185

Vsevolod V. Kuzkov - MD, PhD, Professor, Department of Anesthesiology and Intensive Care Therapy.

51 Troitsky prospect, Arkhangelsk, 163000

Russian Federation

M. Y. Kirov

Northern State Medical University

Email: fake@neicon.ru
ORCID iD: 0000-0002-4375-3374

Mikhail Y. Kirov - MD, PhD, Professor, Head of Department of Anesthesiology and Intensive Care Therapy.

51 Troitsky prospect, Arkhangelsk, 163000

Russian Federation

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Copyright (c) 2019 Fot E.V., Izotova N.N., Vinogradov M.V., Kuzkov V.V., Kirov M.Y.

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