Lung ultrasound could reduce X-ray after major lung resection

Abstract

OBJECTIVES: This study evaluated the role of ultrasound in postoperative care after major lung resection. BACKGROUND: High accuracy of lung ultrasound imaging was proved in various medical fi elds. The experience with ultrasound after thoracic surgery is limited. METHODS: Patients scheduled for major lung resection were consecutively included in a prospective study comparing two modalities of imaging examinations, namely those employing ultrasound and X-ray in the diagnoses of pneumothorax and pleural effusion. Two examinations were performed. One after recovery from anaesthesia, the second before chest tube removal. RESULTS: Forty-eight patients underwent 87 examinations. X-ray and ultrasound examinations showed substantial and fair agreements for pneumothorax (Cohen's kappa coeffi cients 0.775 and 0.397) and slight and substantial agreements for pleural effusion (Cohen's kappa coeffi cients 0.036 and 0.611). The sensitivity bounds for pneumothorax were 45.5-58.5 % at the fi rst and 29.7-59.4 % at the second examination. Sensitivity bounds for pleural effusion were 0-86.2 % at the fi rst and 32.6-36.9 % at the second examination. Except for two cases of pneumothorax being missed by X-ray imaging, the rest of mismatches were clinically irrelevant conditions with no impact on clinical decision and patient's outcome. CONCLUSION: The use of ultrasound can reduce the number of X-ray examinations and thus lower the radiation exposure after major lung resections (Tab. 4, Ref. 30).

Lung Ultrasound Reduces Chest X-rays in Postoperative Care after Thoracic Surgery: Is There a Role for Artificial Intelligence?—Systematic Review

“…Overall, 31 articles were screened by abstract for eligibility and 23 of them were excluded as irrelevant due to exclusion criteria. A total of 8 trials met the inclusion criteria [ 16 , 17 , 18 , 19 , 22 , 23 , 25 , 26 ]. Reference lists of these relevant articles were analyzed, and two more studies [ 15 , 20 ] were included in our review.…”

“…In Goudie et al [ 15 ] and Malík et al [ 22 ], patients after the whole spectrum of non-cardiac thoracic procedures were included, including procedures without lung resections. Dzian et al [ 23 ] and Messina et al [ 26 ] evaluated patients after major lung resections only; lobectomy was the most common procedure. In Smargiassi et al [ 18 ], thoracotomies, mini/invasive procedures, and robotic thymectomies were performed, but the details regarding surgical procedures were not available.…”

“…LUS was performed every time CXR was performed, but the strategy varied from postoperative examination [16,18], examination after chest tube removal [18,19], combination of postoperative examination and examination prior to chest tube removal [22,23], postoperative examination and examination after chest tube removal [20], postoperative examination and examinations prior and also after chest tube removal [25] and daily routine examination until chest tube removal [26]. The LUS was performed to detect PTX and lung re-expansion only [17,19,20,25]; or to detect PTX and PE [15,22,23]; or evaluation of PTX, PE, and lung consolidations [26]; or detection of PTX, PE, lung consolidations, subcutaneous emphysema and diaphragm position [16,18]. Evaluated LUS signs varied from detection of lung sliding only [17] to the use of complex protocols with additional signs [19,20].…”

“…Some studies have used the statistical methodology for the use of CXR as an imperfect reference [19,20,23]. Several studies evaluated the agreement between LUS and CXR [18,22,23,26] or therapeutical agreement based on LUS and CXR [19,20,25,26]. Some trials evaluated the exhaustiveness of LUS for clinical decision making [16] or the percentage of saved CXR [16,17,22,23].…”

“…CXR remains the standard imaging modality in the monitoring of surgically induced pneumothorax (PTX), pleural effusion (PE), and postoperative complications in this field. Growing evidence has shown the potential for LUS to reduce chest X-rays (CXR) in postoperative care after non-cardiac thoracic surgery and in chest tube management [ 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 ]. The optimal management of chest tubes and their removal after non-cardiac thoracic surgery and the role of imaging modalities in the detection of PTX, PE, and other conditions remain unclear [ 28 , 29 , 30 , 31 , 32 ].…”