Lung ultrasound: a new basic, easy, multifunction imaging diagnostic tool in children undergoing pediatric cardiac surgery

Abstract

J Thorac Dis 2017;9(6):1396-1399 jtd.amegroups.com patients with multiple wounds and drainage. According to standardized protocols (3,4) for each hemi-thorax three major areas (anterior, lateral and posterior) delineated by the para-sternal, anterior axillary and posterior axillary line should be identified. Every area may be further divided into the upper and lower half. Thus for a complete LUS examination (3,4), six different quadrants for each hemithorax should be scanned (anterior superior, anterior inferior, lateral superior, lateral inferior, posterior superior, posterior inferior).Pulmonary complications are common in pediatric patients after cardiac surgery, and LUS may allow for fast diagnosis at patient's bed (5-8), and monitoring lung disease progression and/or the response to medical therapy (i.e., diuretics) and physiotherapy (5)(6)(7)(8). Despite this, the use of LUS in pediatric cardiac surgery remains very limited (6).The utility of LUS in neonatal ICU has been proved by several authors (9-13). In contrast only a few small works evaluated potentialities of LUS in children undergoing cardiac surgery (5-8). There is multiple potential application of LUS in pediatric cardiac surgery. LUS may be employed for the diagnosis of many common lung complications occurring after cardiac surgery including atelectasis, effusion, lung congestion, pneumonia, pneumothorax and diaphragmatic motion anomalies (5-8). In contrast to X-RAY, LUS may allow to differentiate among effusion and atelectasis that are very common sequelae of cardiac surgery which require different therapeutic approaches (5)(6)(7)(8)14). Our group (5) recently described a new potential application of chest ultrasound in the diagnosis of retrosternal clots after pediatric cardiac surgery, that are common cause of hemodynamic unbalance and often difficult to diagnosis with conventional echocardiography. LUS may also guide interventional procedures such as drainage insertion for pleural effusion and pneumothorax (8,15). Large studies conducted in adults have shown how the routine use of LUS may drastically reduce (i.e., from 8.8% to 0.97%, P<0.0001) the risk of pneumothorax in thoracentesis (15). LUS may be used also to monitor the occurrence of pneumothorax after drainage removal, avoiding the repetition of chest X-RAY examinations (that is a routine practice in many Centers) (6,15). Utility of LUS has been proved also for tracheal tube verification in NICU (14). A recent review (14) on the accuracy and feasibility of LUS for tracheal tube placement in children reported how direct visualization of tracheal tube tip was highly feasible (i.e., 83% to 100%) in 165 cases evaluated from nine different studies. LUS held a high sensitivity (i.e., 1.00) for tracheal placement versus oesophageal placement, but only one study reported oesophageal intubation (i.e., specificity of 1.00). When assessing the appropriate tracheal tube depth for tracheal intubation using LUS, LUS also showed a good sensitivity (i.e., 0.91 to 1.00) and sufficient specificity (i.e...

Lung Ultrasound: The Emerging Role of Respiratory Therapists

“…Although LUS requires only a short period of training, there remains considerable debate as to who should perform LUS. 32 Long regarded as a technique to be performed by a physician, some recent studies 33,34 suggest that the performance of LUS should be extended to other health care professionals, including physiotherapists and nurses. 33,34 There is a paucity of literature that reflects the role and exposure of respiratory therapists (RTs) in LUS; we also looked into related areas such as respiratory physiotherapy and nursing, with an emphasis on their experience with LUS.…”

Pediatric lung ultrasound: its role in the perioperative period

“…In children, each hemithorax can be divided into several regions, and different scanning schemes have been suggested [15,16]. A recent editorial recommended that at least six quadrants of each hemithorax should be scanned for a complete lung ultrasound examination [17]. Fig.…”

“…4). The lung behind the effusion displays different degrees of aeration [17]. Although simple effusion is homogeneous, complex effusions, such as a hemothorax or empyema, are heterogeneous [19].…”

“…Despite the proven diagnostic power of lung ultrasound and its impact on decision-making and therapeutic management, there are still significant barriers to the widespread adoption of this tool [17]. Primary challenges in implementing lung ultrasound in daily anesthetic practice are its operator dependency and variable expertise in skill among anesthesiologists.…”

“…Although lung ultrasound has great promise with the establishment of correct training and accreditation processes, it remains in its infancy, particularly in the pediatric population [21]. The development of a validated lung ultrasound program is mandatory and requires a combination of dedicated personnel, adequate instrumentation, and training protocols [17].…”