Comparison of Lung Ultrasound to X-ray for Diagnosis of Pulmonary Complications after Cardiac Surgery in Children

Abstract

Background: The purpose of this study was to compare diagnostic performance of lung ultrasound in comparison to chest X-ray to detect pulmonary complication after cardiac surgery in children.Methods: A prospective observational study was conducted in tertiary center of Nepal. 141 consecutive paediatric patients aged less than 14 years scheduled for cardiac surgery were enrolled during the 6 months period. Ultrasound was done on the first post-operative day of cardiac surgery and compared to chest X-ray done on the same day to detect pleural effusion, consolidation, atelectasis and pneumothorax.Results: Sensitivity, specificity, positive and negative predictive values and diagnostic accuracy were calculated using standard formulas. lung ultrasonography had overall sensitivity of 60 %, specificity of 72.4%, positive predictive value of 31.9% and negative predictive value of 89.3% and diagnostic accuracy of 70.2% for diagnosing consolidation. Similarly, lung ultrasonography had overall sensitivity of 90%, specificity of 82.6%, positive predictive value of 46.1% and negative predictive value of 98% and diagnostic accuracy of 83.6 % for diagnosing pleural effusion. For atelectasis, ultrasonography had sensitivity of 50%, specificity of 76.9%, positive predictive value of 30.7% and negative predictive value of 88.2% and diagnostic accuracy of 72.3%. No pneumothoraxes were detected during our study period. Conclusions: Lung ultrasound is an alternative non-invasive technique which is able to diagnose pulmonary complications after cardiac surgery with acceptable diagnostic accuracy with no proven complications but with decreasing exposure to ionizing radiation and possibly cost.Keywords: Cardiac surgery; children; lung ultrasound; pulmonary complications

Refractory Atelectasis and Response to Chest Physiotherapy

“…Finally, although we agree that point-of-care ultrasound could have a role in assessing resolution of atelectasis without exposure to ionizing radiation, we do not believe it to be superior to chest radiograph (at least in our hands). It is worth noting that, while some have performed better, 7 ultrasonography had an accuracy of only 72% for detecting atelectasis in the reference 8 cited by Gates et al, along with unacceptably low sensitivity (50%) and specificity (77%). We believe that electrical impedance tomography ( Fig.…”

Refractory Atelectasis and Response to Chest Physiotherapy

“…This would offer similar diagnostic accuracy to chest radiograph with no exposure to ionizing radiation, a consideration that should not be dismissed, particularly where serial imaging may be required to monitor lung recruitment over time. 5 In countries where physiotherapy is an autonomous profession, standard practice would be for a thorough physiotherapy assessment with clinical reasoning to consider how these techniques are utilized on an individualized and patient-specific basis. It could be argued that creating a standardized protocol for airway clearance measures may make future prospective randomized controlled trials more feasible, something which has always been a challenge for our profession.…”

“…This would offer similar diagnostic accuracy to chest radiograph with no exposure to ionizing radiation, a consideration that should not be dismissed, particularly where serial imaging may be required to monitor lung recruitment over time. 5…”