Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study

H R Touw, A E Schuitemaker, F Daams, D L van der Peet, E M Bronkhorst, P Schober, C Boer, P R Tuinman, H R Touw, A E Schuitemaker, F Daams, D L van der Peet, E M Bronkhorst, P Schober, C Boer, P R Tuinman

Abstract

Background: Postoperative pulmonary complications after major abdominal surgery are associated with adverse outcome. The diagnostic accuracy of chest X-rays (CXR) to detect pulmonary disorders is limited. Alternatively, lung ultrasound (LUS) is an established evidence-based point-of-care diagnostic modality which outperforms CXR in critical care. However, its feasibility and diagnostic ability for postoperative pulmonary complications following abdominal surgery are unknown. In this prospective observational feasibility study, we included consecutive patients undergoing major abdominal surgery with an intermediate or high risk developing postoperative pulmonary complications according to the Assess Respiratory risk In Surgical patients in CATalonia (ARISCAT) score. LUS was routinely performed on postoperative days 0-3 by a researcher blinded for CXR or other clinical findings. Then, reports were drawn up for LUS concerning feasibility and detection rates of postoperative pulmonary complications. CXRs were performed on demand according to daily clinical practice. Subsequently, we compared LUS and CXR findings.

Results: A total of 98 consecutive patients with an ARISCAT score of 41 (34-49) were included in the study. LUS was feasible in all patients. In 94 (95%) patients, LUS detected one or more postoperative pulmonary complications during the first four postoperative days. On day 0, LUS detected 31 out of 43 patients (72.1%) with one or more postoperative pulmonary complications, compared to 13 out of 36 patients (36.1%) with 1 or more postoperative pulmonary complications detected with CXR RR 2.0 (95 CI [1.24-3.20]) (p = 0.004). The number of discordant observations between both modalities was high for atelectasis 23 (43%) and pleural effusion 29 (54%), but not for pneumothorax, respiratory infection and pulmonary edema 8 (15%), 3 (5%), and 5 (9%), respectively.

Conclusions: This study shows that LUS is highly feasible and frequently detects postoperative pulmonary complications after major abdominal surgery. Discordant observations in atelectasis and pleural effusions for LUS and CXR can be explained by a superior diagnostic ability of LUS in detecting these conditions. The effects of LUS as primary imaging modality on patient outcome should be evaluated in future studies.

Keywords: Abdominal surgery; Chest X-ray and lung ultrasound; Postoperative complications; Surgical procedures.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
BLUE and PLAPS points. Anterior (upper BLUE) point. Anteromedial (lower BLUE) point. Posterior (PLAPS) point
Fig. 2
Fig. 2
A profile according to the BLUE protocol showing multiple A lines
Fig. 3
Fig. 3
B profile according to the BLUE protocol showing multiple B lines
Fig. 4
Fig. 4
C profile according to the BLUE protocol showing a C line. Arrow indicates a hypoechoic subpleural focal image generated by consolidated lung tissue
Fig. 5
Fig. 5
Posterolateral alveolar and/or pleural syndrome

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