Accuracy of Transthoracic Lung Ultrasound for Diagnosing Anesthesia-induced Atelectasis in Children

Acosta, Cecilia; Maidana, Gustavo A.; Jacovitti, Daniel; Belaunzarán, Agustín; Cereceda, Silvana; Rae, Elizabeth; Molina, Ananda; Gonorazky, Sergio Eduardo; Böhm, Stephan H.; Tusman, Gerardo

doi:10.1097/aln.0000000000000231

Cited by 154 publications

(223 citation statements)

References 41 publications

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“…In compressive atelectasis, the underlying lung is not consolidated and therefore will change in shape with respiration, demonstrating jellyfish sign and sinusoid sign (Table 5). LUS is an accurate tool for the diagnosis of obstructive atelectasis [23]. The early appearance of atelectasis is a homogenous liver-like lesion (Fig.…”

Section: Introductionmentioning

confidence: 99%

Lung ultrasound—a primary survey of the acutely dyspneic patient

Lee

2016

j intensive care

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There has been an explosion of knowledge and application of clinical lung ultrasound (LUS) in the last decade. LUS has important applications in the ambulatory, emergency, and critical care settings and its deployability for immediate bedside assessment allows many acute lung conditions to be diagnosed and early interventional decisions made in a matter of minutes. This review detailed the scientific basis of LUS, the examination techniques, and summarises the current applications in several acute lung conditions. It is to be hoped that clinicians, after reviewing the evidence within this article, would see LUS as an important first-line modality in the primary evaluation of an acutely dyspneic patient.

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Section: Introductionmentioning

confidence: 99%

Lung ultrasound—a primary survey of the acutely dyspneic patient

Lee

2016

j intensive care

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“…In poorly ventilated zones, lung sliding is abolished, and comet tail artifacts originating from water-thickened interlobular septa are often present (2,30,36,43). Pulmonary ultrasound has also shown high sensitivity and specificity for detecting lung collapse (1,55). In the present study, ULC must have represented lung collapse, because of the following: 1) The protocol lasted 1.5 h, including 1 h at 1 G and 10 min of hypergravity.…”

Section: Ultrasound Vs Spect/ctmentioning

confidence: 94%

Hyperoxia and hypergravity are independent risk factors of atelectasis in healthy sitting humans: a pulmonary ultrasound and SPECT/CT study

Dussault¹,

Gontier

Verret³

et al. 2016

J Appl Physiol

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Aeroatelectasis has developed in aircrew flying routine peacetime flights on the latest generation high-performance aircraft, when undergoing excessive oxygen supply. To single out the effects of hyperoxia and hypergravity on lung tissue compression, and on ventilation and perfusion, eight subjects were studied before and after 1 h 15 min exposure to +1 to +3.5 Gz in a human centrifuge. They performed the protocol three times, breathing air, 44.5% O2, or 100% O2 and underwent functional and topographical imaging of the whole lung by ultrasound and single-photon emission computed tomography combined with computed tomography (SPECT/CT). Ultrasound lung comets (ULC) and atelectasis both increased after exposure. The number of ULC was <1 pre protocol (i.e., normal lung) and larger post 100% O2 (22 ± 3, mean ± SD) than in all other conditions (P < 0.001). Post 44.5% O2 differed from air (P < 0.05). Seven subjects showed low- to medium-grade atelectasis post 100% O2 There was an effect on grade of gas mixture and hypergravity, with interaction (P < 0.001, respectively); 100% O2, 44.5% O2, and air differed from each other (P < 0.05). SPECT ventilation and perfusion were always normal. Ultrasound concurred with CT in showing normal lung in the upper third and ULC/atelectasis in posterior and inferior areas, not for other localizations. In conclusion, hyperoxia and hypergravity are independent risk factors of reversible atelectasis formation. Ultrasound is a useful screening tool. Together with electrical impedance tomography measurements (reported separately), these findings show that zones with decreased ventilation prone to transient airway closure are present above atelectatic areas.

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“…Lung ultrasound (LUS) has demonstrated its high sensitivity and specificity for diagnosing the entity of anesthesia-induced atelectasis in mechanically ventilated patients [11, 12]. LUS can also reveal tidal recruitment occurring mainly at the boundary of atelectatic lung tissue and its complete resolution after an appropriate lung recruitment maneuver [13].…”

Section: Introductionmentioning

confidence: 99%

Doppler images of intra-pulmonary shunt within atelectasis in anesthetized children

et al. 2016

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BackgroundDoppler images of pulmonary vessels in pulmonary diseases associated with subpleural consolidations have been described. Color Doppler easily identifies such vessels within consolidations while spectral Doppler analysis allows the differentiation between pulmonary and bronchial arteries. Thus, Doppler helps in diagnosing the nature of consolidations. To our knowledge, Doppler analysis of pulmonary vessels within anesthesia-induced atelectasis has never been described before. The aim of this case series is to demonstrate the ability of lung ultrasound to detect the shunting of blood within atelectatic lung areas in anesthetized children.FindingsThree anesthetized and mechanically ventilated children were scanned in the supine position using a high-resolution linear probe of 6–12 MHz. Once subpleural consolidations were detected in the most dependent posterior lung regions, the probe was rotated such that its long axis followed the intercostal space. In this oblique position, color Doppler mapping was performed to detect blood flow within the consolidation. Thereafter, pulsed waved spectral Doppler was applied in the previously identified vessels during a short expiratory pause, which prevented interferences from respiratory motion. Different flow patterns were identified which corresponded to both, pulmonary and bronchial vessels. Finally, a lung recruitment maneuver was performed which leads to the complete resolution of the aforementioned consolidation thereby confirming the pathophysiological entity of anesthesia-induced atelectasis.ConclusionsLung ultrasound is a non-invasive imaging tool that not only enables the diagnosis of anesthesia-induced atelectasis in pediatric patients but also analysis of shunting blood within this consolidation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13089-016-0055-7) contains supplementary material, which is available to authorized users.

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Accuracy of Transthoracic Lung Ultrasound for Diagnosing Anesthesia-induced Atelectasis in Children

Abstract: LUS is an accurate, safe, and simple bedside method for diagnosing anesthesia-induced atelectasis in children.

Cited by 154 publications

References 41 publications

Lung ultrasound—a primary survey of the acutely dyspneic patient

Lung ultrasound—a primary survey of the acutely dyspneic patient

Hyperoxia and hypergravity are independent risk factors of atelectasis in healthy sitting humans: a pulmonary ultrasound and SPECT/CT study

Doppler images of intra-pulmonary shunt within atelectasis in anesthetized children

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