Assessment of lung ultrasound for early detection of respiratory complications in thoracic surgery

Bosch, Laetitia; Mathe, Olivier; Robin, Jean-Jacques; Serres, Isabelle; Labaste, François; Masquère, Pierre; Grigoli, Maxime; Brouchet, Laurent; Conil, Jean-Marie; Minville, Vincent

doi:10.1016/j.bjane.2021.01.006

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Brazilian Journal of Anesthesiology

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ORIGINAL INVESTIGATION • para Braz. J. Anesthesiol. 72 (01) • Jan-Feb 2022 • https://doi.org/10.1016/j.bjane.2021.01.006 copy

Assessment of lung ultrasound for early detection of respiratory complications in thoracic surgery

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background and objectives:

To assess lung ultrasound for the diagnosis and monitoring of respiratory complications in thoracic surgery.

Methods:

Prospective observational study in a University hospital, single institution. Adult patients scheduled for pulmonary resection surgery excluding pneumonectomy. An ultrasound follow-up was performed from the day before the surgery to the third day after surgery with calculation of B-line and lung score (reaeration and loss of aeration scores). Respiratory complications were collected throughout the hospitalization period.

Results:

Fifty-six patients were included. Eighteen patients presented a respiratory complication (32%), and they presented significantly higher BMI and ASA scores. Patients operated by videothoracoscopy were less at risk of complications. At day 3, a reaeration score ≤ 2 on the ventilated side or ≤-2 on the operated side, and a B-line score > 6 on the operated side were in favor of a complication.

Conclusion:

Lung ultrasound can help in the diagnosis of respiratory complications following pulmonary resection surgery.

KEYWORDS
Ultrasound; Thoracic surgery; Complications; Bedside

	Global population	No respiratory complication	Respiratory complication	p < 0,05
Age (years)	64 (61-68)	64 (58-68)	64 (59-67)	0.9371
Sex (M/W)	34/22	22/16	12/6	0.5727
IMC (kg.m^-2)	25,8 (23.1-26.7)	24,9 (22.9-26.5)	27,9 (22,8-32,8)	0.0474^a
ASA > 2	9 (16.1%)	3 (7.9%)	6 (33.3%)	0.0101^a
Preoperative spirometry
TV (% theoric value)	94.5 (91.2-98.3)	95.5 (92.8-100.3)	91.5 (81.2-99.0)	0.2613
FEV1 (% theoric value)	92 (87.3-99.6)	91 (88-103.6)	93 (74.0-100.9)	0.2800
Tiffeneau (%)	80 (73-83)	81 (74.4-85.5)	72.5 (67.0-85.7)	0.3482
Duration of surgery (min)	130 (120-180)	137 (120-180)	127 (111-180)	0.5201
Duration of global ventilation (min)	167 (150-210)	192 (150-215)	165 (150-216)	0.7921
One lung ventilation
Duration (min)	120 (105-140)	120 (105-165)	115 (90-134)	0.4190
FiO2 (%)	85 (80-100)	80 (80-100)	95 (80-100)	0.5751
Pplat (cmH₂O)	23 (22,4-24,0)	23 (22-24)	24 (23,0-26,7)	0.2828
PEEP (cmH₂O)	5 (5-5)	5 (5-5)	5 (5-5)	0.9477
TV/BIW (mL.kg^-1)	6.10 (5.86-6.32)	6.10 (5.92-6.39)	6.02 (5.57-6.43)	0.6233
Two-lung Ventilation
FiO2 (%)	70 (60-80)	70 (60-80)	65 (60-80)	0.6098
Pplat (cmH₂O)	19 (17-20)	19 (17-20)	19 (15.5-22.4)	0.7717
PEEP (cmH₂O)	5 (5-5)	5 (5-5)	5 (5-5)	0.7595
TV/IBW (mL.kg^-1)	6.95 (6.77-7.26)	6.87 (6.55-7.19)	7.16 (6.79-7.58)	0.2194
Duration of hospitalization (days)	6 (6-7)	6 (6-6)	9.5 (7.0-13.8)	0.0001^a
Duration of hospitalization in Intensive Care (days)	3 (2-3.8)	2 (2-3)	4.5 (3.33-7.6)	0.0001^a

	Global population	No respiratory complication	Respiratory complication	p
Surgical Approach
Thoracotomy/Thoracoscopy	42/14	25/13	17/1	0.0232*
Operated Side
Right/Left	34/22	24/14	10/8	0.7702
Pathology
Adenocarcinoma	34 (60.7%)	23 (60.5%)	13 (72.2%)	0.5522
Epidermoid carcinoma	4 (7.1%)	2 (5.3%)	2 (11.1%)	0.5866
Neuro-endocrine tumor	6 (10.7%)	5 (13.2%)	1 (5.6%)	0.6522
Others	12 (21.4%)	8 (21.0%)	2 (11.1%)

Reaeration score	No respiratory complication	Respiratory complication	p
Excluded lung
Day 1	-1 [-1;0]	-0.5 [-1;1.6]	0.6839
Day 2	0 [-2;0.5]	-2 [-4;1.6]	0.4870
Day 3	0 [-1;1]	-2 [-5;0.1]	0.0297*
Ventilated lung
Day 1	2 [0;3]	0.5 [0;3.6]	0.7312
Day 2	2.5 [1;4]	-1 [-2;3]	0.1040
Day 3	3 [1;5]	-0.5 [-2;4]	0.0124*

B-line score	No respiratory complication	Respiratory complication	p
Excluded lung
Day - 1	0 [0;0]	1 [0;2]	0.0747
Day 0	2 [0;3]	6 [4;8.2]	0.6536
Day 1	2 [0;3]	6.5 [4;9.6]	0.8812
Day 2	2 [0;3]	7.5 [4;10.6]	0.4762
Day 3	2 [0;3]	8 [4;11]	0.0251*
Ventilated lung
Day - 1	0 [0; 0]	0.5 [0;2]	0.1481
Day 0	8 [7;9]	5.5 [3;7.6]	0.0624
Day 1	5.5 [4;7]	3.5 [1.3;6.6]	0.0573
Day 2	5 [4;6]	4.5 [1.3;6.6]	0.7782
Day 3	3 [1;5]	3 [2.2;7]	0.1685

	AUC	Threshold	Se %	Sp %	PPV %	NPV %	Gray zone
Reaeration score on ventilated lung at Day 3	0.73 [0.58; 0.85]	≤ 2	71.4	70.5	50	85.7	[-1.6; 5.6]
Reaeration score on excluded lung at Day 3	0.70 [0.55; 0.82]	≤-2	57.1	76.4	50	81.2	[-4.3; 1.6]
B-lines score on excluded lung at Day 3	0.702 [0.55; 0.82]	> 6	66.7	64.7	45.5	81.5	[1.5;8.9]

Factors of respiratory complication	p	Odds ratio	IC95%
Reaeration score on ventilated lung at Day 3	0.0388	0.79	0.629-0.987
B-lines score on excluded lung at Day 3	0.0257	1.24	1.026-1.505
Videothoracoscopy	0.0814	0.10	0.007-1.334
AUC	0.84 (0.7--0.93)
Hosmer-Lemeshow Test	0.7274
Cases correctly classified	79.2%

Sociedade Brasileira de Anestesiologia (SBA) Rua Professor Alfredo Gomes, 36, Botafogo , cep: 22251-080 - Rio de Janeiro - RJ / Brasil , tel: +55 (21) 97977-0024 - Rio de Janeiro - RJ - Brazil
E-mail: editor.bjan@sbahq.org

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[1] * Corresponding author. E-mail: minville.v@chu-toulouse.fr (V. Minville).