Lung Ultrasound in Pediatric Cardiac Surgery: A Complementary Tool for Predicting and Identifying Postoperative Pulmonary Complications

Abstract Background Pediatric cardiac patients are at risk for perioperative respiratory insufficiency. The objective of this study was to assess the utility of perioperative lung ultrasound examination in pediatric cardiac surgery. Methods In this randomized, controlled trial, children (5 yr old or younger) undergoing cardiac surgery were allocated into a control (n = 61) or intervention (n = 61) group. The control group received only lung ultrasound examinations at the end of surgery and 6 to 12 h after surgery. The intervention group received lung ultrasound examinations and an ultrasound-guided recruitment maneuver depending on ultrasound findings after inducing anesthesia, at the end of surgery, and 6 to 12 h after surgery. Primary outcomes were incidences of intra- and postoperative desaturation, and postoperative pulmonary complications. Multiple comparisons were corrected (P ≤ 0.017) in the primary outcome analysis. Results Of the 120 children included in the analysis, postoperative desaturation (64% vs. 27%; P < 0.001; odds ratio [OR], 0.210; 95% CI, 0.097 to 0.456) occurred more in the control group. The incidences of intraoperative desaturation (36% vs. 19%; P = 0.033; OR, 0.406; 95% CI, 0.176 to 0.939) and postoperative pulmonary complications (12% vs. 3%; P = 0.093; OR, 0.271; 95% CI, 0.054 to 1.361) were similar between the groups. Lung ultrasound scores were better in the intervention group than in the control group. Duration of mechanical ventilation was longer in the control group than in the intervention group (38 ± 43 vs. 26 ± 25 h; 95% CI of mean difference, 0 to 25; P = 0.048). Conclusions Perioperative lung ultrasound examination followed by ultrasound-guided recruitment maneuver helped decrease postoperative desaturation events and shorten the duration of mechanical ventilation in pediatric cardiac patients.

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Nurse‐guided incentive spirometry use and postoperative pulmonary complications among cardiac surgery patients: A randomized controlled trial

International Journal of Nursing Practice ◽

10.1111/ijn.13023 ◽

2021 ◽

Author(s):

Saja Ahmad Alwekhyan ◽

Jafar Alasad Alshraideh ◽

Khalil Moh'd Yousef ◽

Ferial Hayajneh

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Controlled Trial ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

Randomized Controlled ◽

Incentive Spirometry

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Lung ultrasound score to determine the effect of fraction inspired oxygen during alveolar recruitment on absorption atelectasis in laparoscopic surgery: A randomized controlled trial

10.21203/rs.3.rs-26725/v2 ◽

2020 ◽

Author(s):

Bo Rim Kim ◽

Seohee Lee ◽

Hansu Bae ◽

Minkyoo Lee ◽

Jae-Hyon Bahk ◽

...

Keyword(s):

Laparoscopic Surgery ◽

Lung Ultrasound ◽

Controlled Trial ◽

Pulmonary Complications ◽

Alveolar Recruitment ◽

Postoperative Pulmonary Complications ◽

Trendelenburg Position ◽

Alveolar Recruitment Maneuver ◽

Ultrasound Score ◽

Inspired Oxygen

Abstract Background The intraoperative alveolar recruitment maneuver (ARM) efficiently treats atelectasis, but the effect of Fio 2 during ARM on atelectasis is uncertain. Here, we investigated this effect. Methods Patients undergoing elective laparoscopic surgery in the Trendelenburg position were randomized to low- (Fio 2 0.4; n=44) and high-Fio 2 (Fio 2 1.0, n=46) groups. ARMs were performed 1-min post tracheal intubation and post changes between supine and Trendelenburg positions during surgery. Intraoperative Fio 2 was set at 0.4 for both groups. Modified lung ultrasound (LUS) scores were calculated to assess lung aeration after inducing anesthesia and at surgery completion. The primary outcome was modified LUS score at the end of the surgery, and secondary outcomes were the intra- and postoperative Pao 2 to Fio 2 ratio and postoperative pulmonary complications. Results Both groups presented similar modified LUS scores before capnoperitoneum and ARM ( P =0.747). However, the postoperative modified LUS score was significantly lower in the low- than in the high-Fio 2 group (7.0±4.1 vs 11.7±4.2, mean difference 4.7, 95% CI 2.96–6.44, P <0.001). Significant atelectasis postoperatively was more common in the high-Fio 2 group (relative risk 1.77, 95% CI 1.27‒2.47, P <0.001). Intra- and postoperative Pao 2 to Fio 2 were similar and no postoperative pulmonary complications occurred. Atelectasis occurred more frequently when ARM was performed with high than with low Fio 2 . High-Fio 2 did not benefit oxygenation. Conclusions In patients undergoing laparoscopic surgery in the Trendelenburg position, absorption atelectasis occurred more frequently when the ARM was performed with high rather than low Fio 2 . No oxygenation benefit was observed in the high-Fio 2 group.

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Could judicious use of lung ultrasound reduce radiographic examinations in pediatric cardiac surgery patients?

Journal of Clinical Anesthesia ◽

10.1016/j.jclinane.2019.109638 ◽

2020 ◽

Vol 61 ◽

pp. 109638 ◽

Cited By ~ 2

Author(s):

Massimiliano Cantinotti ◽

Raffaele Giordano ◽

Luna Gargani ◽

Pietro Marchese ◽

Eliana Franchi ◽

...

Keyword(s):

Cardiac Surgery ◽

Lung Ultrasound ◽

Pediatric Cardiac Surgery

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Reducing Postoperative Pulmonary Complications in Cardiac Surgery Patients With the Use of the Best Evidence

Journal of Nursing Care Quality ◽

10.1097/00001786-200404000-00004 ◽

2004 ◽

Vol 19 (2) ◽

pp. 95-99 ◽

Cited By ~ 8

Author(s):

Mary Friel Fanning

Keyword(s):

Cardiac Surgery ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications

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Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS): A protocol for a randomized, controlled trial

10.21203/rs.2.28/v3 ◽

2019 ◽

Author(s):

Brian O'Gara ◽

Balachundhar Subramaniam ◽

Shahzad Shaefi ◽

Ariel Mueller ◽

Valerie Banner-Goodspeed ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Lung Injury ◽

Ischemia Reperfusion ◽

Controlled Trial ◽

Pulmonary Inflammation ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

Randomized Controlled

Abstract Background Patients undergoing cardiac surgery with cardiopulmonary bypass are at an increased risk of developing postoperative pulmonary complications, potentially leading to excess morbidity and mortality. It is likely that pulmonary ischemia-reperfusion (IR) injury during cardiopulmonary bypass is a major contributor to perioperative lung injury. Therefore, interventions that can minimize IR injury would be valuable in reducing the excess burden of this potentially preventable disease process. Volatile anesthetics including sevoflurane have been shown in both preclinical and human trials to effectively limit pulmonary inflammation in a number of settings including ischemia-reperfusion injury. However, this finding has not yet been demonstrated in the cardiac surgery population. The Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS) trial is a randomized, controlled trial investigating whether sevoflurane anesthetic maintenance can modulate pulmonary inflammation occurring during cardiac surgery with cardiopulmonary bypass, and whether this potential effect can translate to a reduction in postoperative pulmonary complications. Methods APLICS is a prospective, randomized controlled trial of adult cardiac surgical patients. Subjects will be randomized to receive intraoperative anesthetic maintenance with either sevoflurane or propofol. Patients in both groups will be ventilated according to protocols intended to minimize the influences of ventilator induced lung injury and hyperoxia. Bronchoalveolar lavage (BAL) and blood sampling will take place after anesthetic induction and between two to four hours after pulmonary reperfusion. The primary outcome is a difference between groups in the degree of post-bypass lung inflammation, defined by BAL concentrations of TNFa. Secondary outcomes will include differences in additional relevant BAL and systemic inflammatory markers and the incidence of postoperative pulmonary complications. Discussion APLICS investigates whether anesthetic choice can influence lung inflammation and pulmonary outcomes following cardiac surgery with cardiopulmonary bypass. A positive result from this trial would add to the growing body of evidence describing the lung protective properties of the volatile anesthetics and potentially reduce unnecessary morbidity for cardiac surgery patients. Trial Registration ClinicalTrials.gov identifier NCT02918877, registered on September 29, 2016.

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Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS): A protocol for a randomized, controlled trial

10.21203/rs.2.28/v2 ◽

2019 ◽

Author(s):

Brian P. O’Gara ◽

Balachundhar Subramaniam ◽

Shahzad Shaefi ◽

Ariel Mueller ◽

Valerie Banner-Goodspeed ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Cardiac Surgery ◽

Cardiopulmonary Bypass ◽

Lung Injury ◽

Ischemia Reperfusion ◽

Controlled Trial ◽

Pulmonary Inflammation ◽

Pulmonary Complications ◽

Postoperative Pulmonary Complications ◽

Randomized Controlled

Abstract Background Patients undergoing cardiac surgery with cardiopulmonary bypass are at an increased risk of developing postoperative pulmonary complications, potentially leading to excess morbidity and mortality. It is likely that pulmonary ischemia-reperfusion (IR) injury during cardiopulmonary bypass is a major contributor to perioperative lung injury. Therefore, interventions that can minimize IR injury would be valuable in reducing the excess burden of this potentially preventable disease process. Volatile anesthetics including sevoflurane have been shown in both preclinical and human trials to effectively limit pulmonary inflammation in a number of settings including ischemia-reperfusion injury. However, this finding has not yet been demonstrated in the cardiac surgery population. The Anesthetics to Prevent Lung Injury in Cardiac Surgery (APLICS) trial is a randomized, controlled trial investigating whether sevoflurane anesthetic maintenance can modulate pulmonary inflammation occurring during cardiac surgery with cardiopulmonary bypass, and whether this potential effect can translate to a reduction in postoperative pulmonary complications. Methods APLICS is a prospective, randomized controlled trial of adult cardiac surgical patients. Subjects will be randomized to receive intraoperative anesthetic maintenance with either sevoflurane or propofol. Patients in both groups will be ventilated according to protocols intended to minimize the influences of ventilator induced lung injury and hyperoxia. Bronchoalveolar lavage (BAL) and blood sampling will take place after anesthetic induction and between two to four hours after pulmonary reperfusion. The primary outcome is a difference between groups in the degree of post-bypass lung inflammation, defined by BAL concentrations of TNFa. Secondary outcomes will include differences in additional relevant BAL and systemic inflammatory markers and the incidence of postoperative pulmonary complications. Discussion APLICS investigates whether anesthetic choice can influence lung inflammation and pulmonary outcomes following cardiac surgery with cardiopulmonary bypass. A positive result from this trial would add to the growing body of evidence describing the lung protective properties of the volatile anesthetics and potentially reduce unnecessary morbidity for cardiac surgery patients. Trial Registration ClinicalTrials.gov identifier NCT02918877, registered on September 29, 2016.

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