Correlation between lung ultrasound score and postoperative pulmonary complications after cardiac surgery_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

KANG Hui ¹ , ZHONG Xiaofei ² ,  YANG Jian ¹ , YIN Wanhong ³ , ZOU Tongjuan ³ , DENG Lijing ³ , YANG Jing ³ , LI Yi ³ , PU Huqiong ³ , JI Lin ⁴

1. Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
2. Department of Sonography, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
3. Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;
4. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, P.R.China;

Corresponding author：

YANG Jian, Email: ak8328@163.com

Keywords：

Bedside ultrasound; lung ultrasound score; cardiac surgery; pulmonary complications

DOI：

10.7507/1007-4848.201810024

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the correlation between lung ultrasonography and pulmonary complications after cardiac surgery.Methods Fifty-two patients after cardiac surgery in our hospital from January to May 2017 were recruited. There were 27 males and 25 females, aged 60.50±10.43 years. Lung ultrasonography was performed by specially trained observers, video data were saved, and lung ultrasound score (LUS) were recorded. The correlation between the LUS and the patients' pulmonary function was evaluated.Results LUS was 17.80±3.87, which was negatively correlated to the ratio of arterial PO₂ to the inspired oxygen fraction (PaO₂/FiO₂₎ during examination, without significant difference (r=–0.363, P=0.095), but significantly negatively correlated to PaO₂/FiO₂ changes 24 hours postoperatively (r=–0.464, P=0.034).Conclusion The changes of lung ventilation area may occur earlier than the changes of lung function. Bedside LUS is an effective method for clinical monitoring of pulmonary complications.

Citation： KANG Hui, ZHONG Xiaofei, YANG Jian, YIN Wanhong, ZOU Tongjuan, DENG Lijing, YANG Jing, LI Yi, PU Huqiong, JI Lin. Correlation between lung ultrasound score and postoperative pulmonary complications after cardiac surgery. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(7): 688-692. doi: 10.7507/1007-4848.201810024 Copy

1.	Goodwin AT, Goddard M, Taylor GJ, et al. Clinical versus actual outcome in cardiac surgery: a post-mortem study. Eur J Cardiothorac Surg, 2000, 17(6): 747-751.
2.	Lee AH, Borek BT, Gallagher PJ, et al. Prospective study of the value of necropsy examination in early death after cardiac surgery. Heart, 1997, 78(1): 34-38.
3.	Zehr KJ, Liddicoat JR, Salazar JD, et al. The autopsy: still important in cardiac surgery. Ann Thorac Surg, 1997, 64(2): 380-383.
4.	Ubben JF, Lance MD, Buhre WF, et al. Clinical strategies to prevent pulmonary complications in cardiac surgery: an overview. J Cardiothorac Vasc Anesth, 2015, 29(2): 481-490.
5.	Doyle RL, Szaflarski N, Modin GW, et al. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med, 1995, 152(6 Pt 1): 1818-1824.
6.	Heckerling PS, Tape TG, Wigton RS, et al. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med, 1990, 113(9): 664-670.
7.	Winkler MH, Touw HR, van de Ven PM, et al. Diagnostic accuracy of chest radiograph, and when concomitantly studied lung ultrasound, in critically Ⅲ patients with respiratory symptoms: a systematic review and meta-analysis. Crit Care Med, 2018, 46(7): e707-e714.
8.	Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012, 38(4): 577-591.
9.	Kor DJ, Warner DO, Carter RE, et al. Extravascular lung water and pulmonary vascular permeability index as markers predictive of postoperative acute respiratory distress syndrome: a prospective cohort investigation. Crit Care Med, 2015, 43(3): 665-673.
10.	Zhao Z, Jiang L, Xi X, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med, 2015, 15: 98.
11.	Shen P, Luo R, Gao Y, et al. Assessment of positive end-expiratory pressure induced lung volume change by ultrasound in mechanically ventilated patients. Zhonghua Jie He He Hu Xi Za Zhi, 2014, 37(5): 332-336.
12.	Le Neindre A, Mongodi S, Philippart F, et al. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care, 2016, 31(1): 101-109.
13.	李莲花, 杨倩, 李黎明, 等. 肺部超声评分评估急性呼吸窘迫综合征患者病情严重程度及预后的价值. 中华危重病急救医学, 2015, 27(7): 579-584.
14.	Cortellaro F, Colombo S, Coen D, et al. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J, 2012, 29(1): 19-23.
15.	Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest, 2012, 142(4): 965-972.
16.	黄鹤, 崔云亮, 田昭涛, 等. 急性呼吸窘迫综合征的肺部超声诊断价值. 中华危重病急救医学, 2014, 26(8): 606-608.
17.	沈鹏, 罗汝斌, 高玉芝, 等. 床旁超声对机械通气患者呼气末正压诱导肺容积改变的评估价值. 中华结核和呼吸杂志, 2014, 37(5): 332-336.
18.	Cortellaro F, Ceriani E, Spinelli M, et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern Emerg Med, 2017, 12(7): 1011-1017.
19.	Gargani L, Frassi F, Soldati G, et al. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail, 2008, 10(1): 70-77.
20.	Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest, 2011, 140(4): 859-866.
21.	Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically Ⅲ. Chest, 2015, 147(6): 1659-1670.
22.	Mongodi S, Bouhemad B, Orlando A, et al. Modified lung ultrasound score for assessing and monitoring pulmonary aeration. Ultraschall Med, 2017, 38(5): 530-537.
23.	康慧, 曹舸, 杨建, 等. 床旁肺部超声评估对心脏术后早期肺实变和肺不张的诊断准确性研究. 中国胸心血管外科临床杂志, 2017, 24(2): 162-165.
24.	Touw HR, Parlevliet KL, Beerepoot M, et al. Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia, 2018, 73(8): 946-954.
25.	Lichtenstein D, Mézière G, Biderman P, et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med, 1997, 156(5): 1640-1646.
26.	Corradi F, Ball L, Brusasco C, et al. Assessment of extravascular lung water by quantitative ultrasound and CT in isolated bovine lung. Respir Physiol Neurobiol, 2013, 187(3): 244-249.
27.	Jambrik Z, Gargani L, Adamicza A, et al. B-lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury. Ultrasound Med Biol, 2010, 36(12): 2004-2010.
28.	Ma H, Huang D, Zhang M, et al. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol, 2015, 15: 162.
29.	Agricola E, Bove T, Oppizzi M, et al. "Ultrasound comet-tail images": a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest, 2005, 127(5): 1690-1695.
30.	Baldi G, Gargani L, Abramo A, et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med, 2013, 39(1): 74-84.
31.	Gargani L, Lionetti V, Di Cristofano C, et al. Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med, 2007, 35(12): 2769-2774.
32.	Soummer A, Perbet S, Brisson H, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med, 2012, 40(7): 2064-2072.
33.	Agricola E, Picano E, Oppizzi M, et al. Assessment of stress-induced pulmonary interstitial edema by chest ultrasound during exercise echocardiography and its correlation with left ventricular function. J Am Soc Echocardiogr, 2006, 19(4): 457-463.
34.	Tsubo T, Sakai I, Suzuki A, et al. Density detection in dependent left lung region using transesophageal echocardiography. Anesthesiology, 2001, 94(5): 793-798.
35.	Leblanc D, Bouvet C, Degiovanni F, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med, 2014, 40(10): 1468-1474.
36.	Bataille B, Rao G, Cocquet P, et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome. J Clin Monit Comput, 2015, 29(1): 169-176.
37.	Rouby JJ, Arbelot C, Gao Y, et al. Training for lung ultrasound score measurement in critically Ⅲ patients. Am J Respir Crit Care Med, 2018, doi: 10.1164/rccm.201802-0227LE.[Epub ahead of print].
38.	Caltabeloti F, Monsel A, Arbelot C, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care, 2014, 18(3): R91.

1. Goodwin AT, Goddard M, Taylor GJ, et al. Clinical versus actual outcome in cardiac surgery: a post-mortem study. Eur J Cardiothorac Surg, 2000, 17(6): 747-751.
2. Lee AH, Borek BT, Gallagher PJ, et al. Prospective study of the value of necropsy examination in early death after cardiac surgery. Heart, 1997, 78(1): 34-38.
3. Zehr KJ, Liddicoat JR, Salazar JD, et al. The autopsy: still important in cardiac surgery. Ann Thorac Surg, 1997, 64(2): 380-383.
4. Ubben JF, Lance MD, Buhre WF, et al. Clinical strategies to prevent pulmonary complications in cardiac surgery: an overview. J Cardiothorac Vasc Anesth, 2015, 29(2): 481-490.
5. Doyle RL, Szaflarski N, Modin GW, et al. Identification of patients with acute lung injury. Predictors of mortality. Am J Respir Crit Care Med, 1995, 152(6 Pt 1): 1818-1824.
6. Heckerling PS, Tape TG, Wigton RS, et al. Clinical prediction rule for pulmonary infiltrates. Ann Intern Med, 1990, 113(9): 664-670.
7. Winkler MH, Touw HR, van de Ven PM, et al. Diagnostic accuracy of chest radiograph, and when concomitantly studied lung ultrasound, in critically Ⅲ patients with respiratory symptoms: a systematic review and meta-analysis. Crit Care Med, 2018, 46(7): e707-e714.
8. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med, 2012, 38(4): 577-591.
9. Kor DJ, Warner DO, Carter RE, et al. Extravascular lung water and pulmonary vascular permeability index as markers predictive of postoperative acute respiratory distress syndrome: a prospective cohort investigation. Crit Care Med, 2015, 43(3): 665-673.
10. Zhao Z, Jiang L, Xi X, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med, 2015, 15: 98.
11. Shen P, Luo R, Gao Y, et al. Assessment of positive end-expiratory pressure induced lung volume change by ultrasound in mechanically ventilated patients. Zhonghua Jie He He Hu Xi Za Zhi, 2014, 37(5): 332-336.
12. Le Neindre A, Mongodi S, Philippart F, et al. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review. J Crit Care, 2016, 31(1): 101-109.
13. 李莲花, 杨倩, 李黎明, 等. 肺部超声评分评估急性呼吸窘迫综合征患者病情严重程度及预后的价值. 中华危重病急救医学, 2015, 27(7): 579-584.
14. Cortellaro F, Colombo S, Coen D, et al. Lung ultrasound is an accurate diagnostic tool for the diagnosis of pneumonia in the emergency department. Emerg Med J, 2012, 29(1): 19-23.
15. Reissig A, Copetti R, Mathis G, et al. Lung ultrasound in the diagnosis and follow-up of community-acquired pneumonia: a prospective, multicenter, diagnostic accuracy study. Chest, 2012, 142(4): 965-972.
16. 黄鹤, 崔云亮, 田昭涛, 等. 急性呼吸窘迫综合征的肺部超声诊断价值. 中华危重病急救医学, 2014, 26(8): 606-608.
17. 沈鹏, 罗汝斌, 高玉芝, 等. 床旁超声对机械通气患者呼气末正压诱导肺容积改变的评估价值. 中华结核和呼吸杂志, 2014, 37(5): 332-336.
18. Cortellaro F, Ceriani E, Spinelli M, et al. Lung ultrasound for monitoring cardiogenic pulmonary edema. Intern Emerg Med, 2017, 12(7): 1011-1017.
19. Gargani L, Frassi F, Soldati G, et al. Ultrasound lung comets for the differential diagnosis of acute cardiogenic dyspnoea: a comparison with natriuretic peptides. Eur J Heart Fail, 2008, 10(1): 70-77.
20. Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest, 2011, 140(4): 859-866.
21. Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically Ⅲ. Chest, 2015, 147(6): 1659-1670.
22. Mongodi S, Bouhemad B, Orlando A, et al. Modified lung ultrasound score for assessing and monitoring pulmonary aeration. Ultraschall Med, 2017, 38(5): 530-537.
23. 康慧, 曹舸, 杨建, 等. 床旁肺部超声评估对心脏术后早期肺实变和肺不张的诊断准确性研究. 中国胸心血管外科临床杂志, 2017, 24(2): 162-165.
24. Touw HR, Parlevliet KL, Beerepoot M, et al. Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia, 2018, 73(8): 946-954.
25. Lichtenstein D, Mézière G, Biderman P, et al. The comet-tail artifact. An ultrasound sign of alveolar-interstitial syndrome. Am J Respir Crit Care Med, 1997, 156(5): 1640-1646.
26. Corradi F, Ball L, Brusasco C, et al. Assessment of extravascular lung water by quantitative ultrasound and CT in isolated bovine lung. Respir Physiol Neurobiol, 2013, 187(3): 244-249.
27. Jambrik Z, Gargani L, Adamicza A, et al. B-lines quantify the lung water content: a lung ultrasound versus lung gravimetry study in acute lung injury. Ultrasound Med Biol, 2010, 36(12): 2004-2010.
28. Ma H, Huang D, Zhang M, et al. Lung ultrasound is a reliable method for evaluating extravascular lung water volume in rodents. BMC Anesthesiol, 2015, 15: 162.
29. Agricola E, Bove T, Oppizzi M, et al. "Ultrasound comet-tail images": a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest, 2005, 127(5): 1690-1695.
30. Baldi G, Gargani L, Abramo A, et al. Lung water assessment by lung ultrasonography in intensive care: a pilot study. Intensive Care Med, 2013, 39(1): 74-84.
31. Gargani L, Lionetti V, Di Cristofano C, et al. Early detection of acute lung injury uncoupled to hypoxemia in pigs using ultrasound lung comets. Crit Care Med, 2007, 35(12): 2769-2774.
32. Soummer A, Perbet S, Brisson H, et al. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med, 2012, 40(7): 2064-2072.
33. Agricola E, Picano E, Oppizzi M, et al. Assessment of stress-induced pulmonary interstitial edema by chest ultrasound during exercise echocardiography and its correlation with left ventricular function. J Am Soc Echocardiogr, 2006, 19(4): 457-463.
34. Tsubo T, Sakai I, Suzuki A, et al. Density detection in dependent left lung region using transesophageal echocardiography. Anesthesiology, 2001, 94(5): 793-798.
35. Leblanc D, Bouvet C, Degiovanni F, et al. Early lung ultrasonography predicts the occurrence of acute respiratory distress syndrome in blunt trauma patients. Intensive Care Med, 2014, 40(10): 1468-1474.
36. Bataille B, Rao G, Cocquet P, et al. Accuracy of ultrasound B-lines score and E/Ea ratio to estimate extravascular lung water and its variations in patients with acute respiratory distress syndrome. J Clin Monit Comput, 2015, 29(1): 169-176.
37. Rouby JJ, Arbelot C, Gao Y, et al. Training for lung ultrasound score measurement in critically Ⅲ patients. Am J Respir Crit Care Med, 2018, doi: 10.1164/rccm.201802-0227LE.[Epub ahead of print].
38. Caltabeloti F, Monsel A, Arbelot C, et al. Early fluid loading in acute respiratory distress syndrome with septic shock deteriorates lung aeration without impairing arterial oxygenation: a lung ultrasound observational study. Crit Care, 2014, 18(3): R91.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Correlation between lung ultrasound score and postoperative pulmonary complications after cardiac surgery

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