Lung ultrasound for early diagnosis of postoperative need for ventilatory support: a prospective observational study

O. Dransart-Rayé, E. Roldi, L. Zieleskiewicz, P. G. Guinot, F. Mojoli, S. Mongodi, B. Bouhemad

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Summary: Pulmonary complications have a significant impact on morbidity and mortality in patients after major surgery. Lung ultrasound can be used at the bed-side, and has gained widespread acceptance in the intensive care unit. We conducted a prospective study to evaluate whether lung ultrasound could be used as a predictive marker for postoperative ventilatory support in high-risk surgical patients. We included 109 patients admitted to the intensive care unit while having mechanical ventilation of the lungs following major surgery. The PaO2/FIO2 ratio was calculated on admission and an ultrasound examination performed, including: lung (‘lung ultrasound score’, number of consolidated lung areas); cardiac (mitral flow); and inferior vena cava imaging (diameter and respiratory variation). Respiratory outcomes included: the need for ventilation support (mechanical ventilation, non-invasive ventilation or high-flow nasal cannula oxygen therapy); acute respiratory distress syndrome; cardiogenic pulmonary oedema; and early or late pulmonary infection. Patients with a lung ultrasound score ≥ 10 had a lower PaO2/FIO2 ratio, and needed more postoperative ventilatory support, than patients with lung ultrasound score < 10. Twenty patients had acute respiratory distress syndrome, and 14 had cardiogenic pulmonary oedema. The presence of ≥ 2 areas of consolidated lung was associated with a lower PaO2/FIO2 ratio, postoperative ventilatory support, longer intensive care stay and episodes of ventilator-associated pneumonia requiring antibiotics. Our results suggest that at intensive care unit admission, lung ultrasound scoring and detection of atelectasis can predict postoperative pulmonary outcomes after major visceral surgery, and could enhance bed-side decision making.

Original languageEnglish
JournalAnaesthesia
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Observational Studies
Early Diagnosis
Prospective Studies
Lung
Intensive Care Units
Adult Respiratory Distress Syndrome
Pulmonary Edema
Artificial Respiration
Ventilator-Associated Pneumonia
Noninvasive Ventilation
Pulmonary Atelectasis
Inferior Vena Cava
Critical Care
Ventilation
Decision Making
Oxygen
Anti-Bacterial Agents
Morbidity
Mortality

Keywords

  • diagnostic techniques
  • intensive care
  • lung ultrasound
  • point-of-care ultrasound
  • postoperative pulmonary complications
  • ultrasonography

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Lung ultrasound for early diagnosis of postoperative need for ventilatory support : a prospective observational study. / Dransart-Rayé, O.; Roldi, E.; Zieleskiewicz, L.; Guinot, P. G.; Mojoli, F.; Mongodi, S.; Bouhemad, B.

In: Anaesthesia, 01.01.2019.

Research output: Contribution to journalArticle

@article{d8211a44bc6143b3bae8c87b9b65f6ea,
title = "Lung ultrasound for early diagnosis of postoperative need for ventilatory support: a prospective observational study",
abstract = "Summary: Pulmonary complications have a significant impact on morbidity and mortality in patients after major surgery. Lung ultrasound can be used at the bed-side, and has gained widespread acceptance in the intensive care unit. We conducted a prospective study to evaluate whether lung ultrasound could be used as a predictive marker for postoperative ventilatory support in high-risk surgical patients. We included 109 patients admitted to the intensive care unit while having mechanical ventilation of the lungs following major surgery. The PaO2/FIO2 ratio was calculated on admission and an ultrasound examination performed, including: lung (‘lung ultrasound score’, number of consolidated lung areas); cardiac (mitral flow); and inferior vena cava imaging (diameter and respiratory variation). Respiratory outcomes included: the need for ventilation support (mechanical ventilation, non-invasive ventilation or high-flow nasal cannula oxygen therapy); acute respiratory distress syndrome; cardiogenic pulmonary oedema; and early or late pulmonary infection. Patients with a lung ultrasound score ≥ 10 had a lower PaO2/FIO2 ratio, and needed more postoperative ventilatory support, than patients with lung ultrasound score < 10. Twenty patients had acute respiratory distress syndrome, and 14 had cardiogenic pulmonary oedema. The presence of ≥ 2 areas of consolidated lung was associated with a lower PaO2/FIO2 ratio, postoperative ventilatory support, longer intensive care stay and episodes of ventilator-associated pneumonia requiring antibiotics. Our results suggest that at intensive care unit admission, lung ultrasound scoring and detection of atelectasis can predict postoperative pulmonary outcomes after major visceral surgery, and could enhance bed-side decision making.",
keywords = "diagnostic techniques, intensive care, lung ultrasound, point-of-care ultrasound, postoperative pulmonary complications, ultrasonography",
author = "O. Dransart-Ray{\'e} and E. Roldi and L. Zieleskiewicz and Guinot, {P. G.} and F. Mojoli and S. Mongodi and B. Bouhemad",
year = "2019",
month = "1",
day = "1",
doi = "10.1111/anae.14859",
language = "English",
journal = "Anaesthesia",
issn = "0003-2409",
publisher = "Wiley-Blackwell",

}

TY - JOUR

T1 - Lung ultrasound for early diagnosis of postoperative need for ventilatory support

T2 - a prospective observational study

AU - Dransart-Rayé, O.

AU - Roldi, E.

AU - Zieleskiewicz, L.

AU - Guinot, P. G.

AU - Mojoli, F.

AU - Mongodi, S.

AU - Bouhemad, B.

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Summary: Pulmonary complications have a significant impact on morbidity and mortality in patients after major surgery. Lung ultrasound can be used at the bed-side, and has gained widespread acceptance in the intensive care unit. We conducted a prospective study to evaluate whether lung ultrasound could be used as a predictive marker for postoperative ventilatory support in high-risk surgical patients. We included 109 patients admitted to the intensive care unit while having mechanical ventilation of the lungs following major surgery. The PaO2/FIO2 ratio was calculated on admission and an ultrasound examination performed, including: lung (‘lung ultrasound score’, number of consolidated lung areas); cardiac (mitral flow); and inferior vena cava imaging (diameter and respiratory variation). Respiratory outcomes included: the need for ventilation support (mechanical ventilation, non-invasive ventilation or high-flow nasal cannula oxygen therapy); acute respiratory distress syndrome; cardiogenic pulmonary oedema; and early or late pulmonary infection. Patients with a lung ultrasound score ≥ 10 had a lower PaO2/FIO2 ratio, and needed more postoperative ventilatory support, than patients with lung ultrasound score < 10. Twenty patients had acute respiratory distress syndrome, and 14 had cardiogenic pulmonary oedema. The presence of ≥ 2 areas of consolidated lung was associated with a lower PaO2/FIO2 ratio, postoperative ventilatory support, longer intensive care stay and episodes of ventilator-associated pneumonia requiring antibiotics. Our results suggest that at intensive care unit admission, lung ultrasound scoring and detection of atelectasis can predict postoperative pulmonary outcomes after major visceral surgery, and could enhance bed-side decision making.

AB - Summary: Pulmonary complications have a significant impact on morbidity and mortality in patients after major surgery. Lung ultrasound can be used at the bed-side, and has gained widespread acceptance in the intensive care unit. We conducted a prospective study to evaluate whether lung ultrasound could be used as a predictive marker for postoperative ventilatory support in high-risk surgical patients. We included 109 patients admitted to the intensive care unit while having mechanical ventilation of the lungs following major surgery. The PaO2/FIO2 ratio was calculated on admission and an ultrasound examination performed, including: lung (‘lung ultrasound score’, number of consolidated lung areas); cardiac (mitral flow); and inferior vena cava imaging (diameter and respiratory variation). Respiratory outcomes included: the need for ventilation support (mechanical ventilation, non-invasive ventilation or high-flow nasal cannula oxygen therapy); acute respiratory distress syndrome; cardiogenic pulmonary oedema; and early or late pulmonary infection. Patients with a lung ultrasound score ≥ 10 had a lower PaO2/FIO2 ratio, and needed more postoperative ventilatory support, than patients with lung ultrasound score < 10. Twenty patients had acute respiratory distress syndrome, and 14 had cardiogenic pulmonary oedema. The presence of ≥ 2 areas of consolidated lung was associated with a lower PaO2/FIO2 ratio, postoperative ventilatory support, longer intensive care stay and episodes of ventilator-associated pneumonia requiring antibiotics. Our results suggest that at intensive care unit admission, lung ultrasound scoring and detection of atelectasis can predict postoperative pulmonary outcomes after major visceral surgery, and could enhance bed-side decision making.

KW - diagnostic techniques

KW - intensive care

KW - lung ultrasound

KW - point-of-care ultrasound

KW - postoperative pulmonary complications

KW - ultrasonography

UR - http://www.scopus.com/inward/record.url?scp=85071020576&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85071020576&partnerID=8YFLogxK

U2 - 10.1111/anae.14859

DO - 10.1111/anae.14859

M3 - Article

C2 - 31549404

AN - SCOPUS:85071020576

JO - Anaesthesia

JF - Anaesthesia

SN - 0003-2409

ER -