Ultrasound for Perioperative Lung Monitoring of Patients Undergoing Thoracic Surgery with One-Lung Ventilation
,
Abstract
Background: The diagnostic efficacy of lung ultrasonography (LUS) has been widely investigated. However, the clinical value of LUS for perioperative monitoring has rarely been reported. The aim of this study was to evaluate the ability of LUS to assess lung aeration status after one-lung ventilation (OLV) using a validated scoring system.
Methods: In this prospective observational study, patients undergoing elective video-assisted thoracic surgery (VATS) with OLV underwent a lung ultrasound examination just after induction of anesthesia and at the end of the surgery. After each lung ultrasound examination, a semiquantitative score, the LUS score, was calculated to assess lung aeration on the ventilated dependent side and the non-dependent side separately. The relationship between the LUS scores and various patient-related factors was also investigated.
Results: Twenty-five patients were studied. All lung ultrasound examinations were successfully completed. LUS scores after OLV on the dependent side (median [IQR]: 2 [1–4]) increased significantly from baseline (1 [0–1.5], P < 0.001). Further, LUS scores on the non-dependent side (2 [1.5–3.5]) increased significantly from baseline (1 [0–1.5], P < 0.001). None of the factors analyzed was significantly correlated with LUS scores after OLV.
Conclusion: LUS examination is possible after VATS with OLV on both sides of the thorax. Ultrasonography-measured lung aeration scores increased from baseline on both sides.
[1] Yang D, Grant MC, Stone A, Wu CL, Wick EC. A meta-analysis of intraoperative ventilation strategies to prevent pulmonary complications: is low tidal volume alone sufficient to protect healthy lungs? Ann Surg 2016; 263:881–7.
[2] Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. Perioperative lung protective ventilation in obese patients. BMC Anesthesiol. 2015; 15:56.
[3] Güldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015; 123:692–713.
[4] Pelosi P, de Abreu MG. Acute respiratory distress syndrome: we can't miss regional lung perfusion! BMC Anesthesiol. 2015; 15:35.
[5] Acosta CM, Maidana GA, Jacovitti D, Belaunzarán A, Cereceda S, Rae E, et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology. 2014; 120:1370–9.
[6] Alzahrani SA, Al‑Salamah MA, Al‑Madani WH, Elbarbary MA. Systematic review and meta‑analysis for the use of ultrasound versus radiology in diagnosing of pneumonia. Crit Ultrasound J 2017; 9:6.
[7] Schwebel C, Clec'h C, Magne S, Minet C, Garrouste-Orgeas M, Bonadona A, et al. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study. Crit Care Med. 2013; 41:1919–28.
[8] Bouhemad B, Mongodi S, Via G, Rouquette I. Ultrasound for “lung monitoring” of ventilated patients. Anesthesiology. 2015; 122:437–47.
[9] Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008; 6:16.
[10] Monastesse A, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Lung ultrasonography for the assessment of perioperative atelectasis: a pilot feasibility study. Anesth Analg. 2017; 124:494–504.
[11] Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011; 364:749–57.
[12] Basile V, Di Mauro A, Scalini E, Comes P, Lofù I, Mostert M, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatrics. 2015; 15:63
[13] Tsubo T, Sakai I, Suzuki A, Okawa H, Ishihara H, Matsuki A. Density detection in dependent left lung region using transesophageal echocardiography. Anesthesiology. 2001; 94:793–8.
[14] Tsubo T, Yatsu Y, Tanabe T, Okawa H, Ishihara H, Matsuki A. Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography. Crit Care Med. 2004; 32:83–7.
[15] Stefanidis K, Dimopoulos S, Tripodaki ES, Vitzilaios K, Politis P, Piperopoulos P, et al. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Crit Care. 2011; 15:R185.
[16] Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014; 12:25.
[17] Zhao Z, Jiang L, Xi X, Jiang Q, Zhu B, Wang M, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med. 2015; 15:98.
[18] Koenig S, Mayo P, Volpicelli G, Millington SJ. Lung Ultrasound Scanning for Respiratory Failure in Acutely Ill Patients A Review. Chest. 2020; 158:2511-2516.
[19] Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Lung Ultrasound Study Group. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012; 40:2064–72.
[20] Ford JW, Heiberg J, Brennan AP, Royse CF, Canty DJ, El-Ansary D, et al. A pilot assessment of 3 point-of-care strategies for diagnosis of perioperative lung pathology. Anesth Analg. 2017; 124:734–42.
[21] Girard M, Généreux V, Monastesse A. Lung ultrasonography for the detection of anesthesia-induced lung atelectasis. Anesthesiology. 2015; 122:213–4.
[22] Kim SH, Jung KT, An TH. Effects of tidal volume and PEEP on arterial blood gases and pulmonary mechanics during one-lung ventilation. J Anesth. 2012; 26:568–73.
[23] Unzueta C, Tusman G, Suarez-Sipmann F, Böhm S, Moral V. Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial. Br J Anaesth. 2012; 108:517–24.
[24] Blank RS, Colquhoun DA, Durieux ME, Kozower BD, McMurry TL, Bender SP, et al. Management of one-lung ventilation: impact of tidal volume on complications after thoracic surgery. Anesthesiology. 2016; 124:1286–95.
[25] Lohser J, Slinger P. Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg. 2015; 121:302–18.
[26] Kim KN, Kim DW, Jeong MA, Sin YH, Lee SK. Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis. BMC Anesthesiol. 2016; 16:72.
[27] Terkawi AS, Karakitsos D, Elbarbary M, Blaivas M, Durieux ME. Ultrasound for the anesthesiologists: present and future. Scientific World Journal 2013; 2013:683685.
[28] Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014; 4:1.
[29] Reissig A, Kroegel C. Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. J Ultrasound Med. 2003; 22:173–80.
[30] Touw HR, Parlevliet KL, Beerepoot M, Schober P, Vonk A, Twisk JW, et al. Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia. 2018; 73(8):946-954.
[31] Touw HR, Schuitemaker AE, Daams F, van der Peet DL, Bronkhorst EM, Schober P,Boer C, et al. Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study. Ultrasound J. 2019; 11: 20.
[32] Yamaguchi Y, Moharir A, Burrier C, Tobias JD. Point-of-care lung ultrasound to evaluate lung isolation during one-lung ventilation in children: A case report. Saudi J Anaesth. 2019; 13:243-5.
[2] Fernandez-Bustamante A, Hashimoto S, Serpa Neto A, Moine P, Vidal Melo MF, Repine JE. Perioperative lung protective ventilation in obese patients. BMC Anesthesiol. 2015; 15:56.
[3] Güldner A, Kiss T, Serpa Neto A, Hemmes SN, Canet J, Spieth PM, et al. Intraoperative protective mechanical ventilation for prevention of postoperative pulmonary complications: a comprehensive review of the role of tidal volume, positive end-expiratory pressure, and lung recruitment maneuvers. Anesthesiology. 2015; 123:692–713.
[4] Pelosi P, de Abreu MG. Acute respiratory distress syndrome: we can't miss regional lung perfusion! BMC Anesthesiol. 2015; 15:35.
[5] Acosta CM, Maidana GA, Jacovitti D, Belaunzarán A, Cereceda S, Rae E, et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology. 2014; 120:1370–9.
[6] Alzahrani SA, Al‑Salamah MA, Al‑Madani WH, Elbarbary MA. Systematic review and meta‑analysis for the use of ultrasound versus radiology in diagnosing of pneumonia. Crit Ultrasound J 2017; 9:6.
[7] Schwebel C, Clec'h C, Magne S, Minet C, Garrouste-Orgeas M, Bonadona A, et al. Safety of intrahospital transport in ventilated critically ill patients: a multicenter cohort study. Crit Care Med. 2013; 41:1919–28.
[8] Bouhemad B, Mongodi S, Via G, Rouquette I. Ultrasound for “lung monitoring” of ventilated patients. Anesthesiology. 2015; 122:437–47.
[9] Copetti R, Soldati G, Copetti P. Chest sonography: a useful tool to differentiate acute cardiogenic pulmonary edema from acute respiratory distress syndrome. Cardiovasc Ultrasound. 2008; 6:16.
[10] Monastesse A, Girard F, Massicotte N, Chartrand-Lefebvre C, Girard M. Lung ultrasonography for the assessment of perioperative atelectasis: a pilot feasibility study. Anesth Analg. 2017; 124:494–504.
[11] Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011; 364:749–57.
[12] Basile V, Di Mauro A, Scalini E, Comes P, Lofù I, Mostert M, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatrics. 2015; 15:63
[13] Tsubo T, Sakai I, Suzuki A, Okawa H, Ishihara H, Matsuki A. Density detection in dependent left lung region using transesophageal echocardiography. Anesthesiology. 2001; 94:793–8.
[14] Tsubo T, Yatsu Y, Tanabe T, Okawa H, Ishihara H, Matsuki A. Evaluation of density area in dorsal lung region during prone position using transesophageal echocardiography. Crit Care Med. 2004; 32:83–7.
[15] Stefanidis K, Dimopoulos S, Tripodaki ES, Vitzilaios K, Politis P, Piperopoulos P, et al. Lung sonography and recruitment in patients with early acute respiratory distress syndrome: a pilot study. Crit Care. 2011; 15:R185.
[16] Gargani L, Volpicelli G. How I do it: lung ultrasound. Cardiovasc Ultrasound. 2014; 12:25.
[17] Zhao Z, Jiang L, Xi X, Jiang Q, Zhu B, Wang M, et al. Prognostic value of extravascular lung water assessed with lung ultrasound score by chest sonography in patients with acute respiratory distress syndrome. BMC Pulm Med. 2015; 15:98.
[18] Koenig S, Mayo P, Volpicelli G, Millington SJ. Lung Ultrasound Scanning for Respiratory Failure in Acutely Ill Patients A Review. Chest. 2020; 158:2511-2516.
[19] Soummer A, Perbet S, Brisson H, Arbelot C, Constantin JM, Lu Q, et al. Lung Ultrasound Study Group. Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit Care Med. 2012; 40:2064–72.
[20] Ford JW, Heiberg J, Brennan AP, Royse CF, Canty DJ, El-Ansary D, et al. A pilot assessment of 3 point-of-care strategies for diagnosis of perioperative lung pathology. Anesth Analg. 2017; 124:734–42.
[21] Girard M, Généreux V, Monastesse A. Lung ultrasonography for the detection of anesthesia-induced lung atelectasis. Anesthesiology. 2015; 122:213–4.
[22] Kim SH, Jung KT, An TH. Effects of tidal volume and PEEP on arterial blood gases and pulmonary mechanics during one-lung ventilation. J Anesth. 2012; 26:568–73.
[23] Unzueta C, Tusman G, Suarez-Sipmann F, Böhm S, Moral V. Alveolar recruitment improves ventilation during thoracic surgery: a randomized controlled trial. Br J Anaesth. 2012; 108:517–24.
[24] Blank RS, Colquhoun DA, Durieux ME, Kozower BD, McMurry TL, Bender SP, et al. Management of one-lung ventilation: impact of tidal volume on complications after thoracic surgery. Anesthesiology. 2016; 124:1286–95.
[25] Lohser J, Slinger P. Lung injury after one-lung ventilation: a review of the pathophysiologic mechanisms affecting the ventilated and the collapsed lung. Anesth Analg. 2015; 121:302–18.
[26] Kim KN, Kim DW, Jeong MA, Sin YH, Lee SK. Comparison of pressure-controlled ventilation with volume-controlled ventilation during one-lung ventilation: a systematic review and meta-analysis. BMC Anesthesiol. 2016; 16:72.
[27] Terkawi AS, Karakitsos D, Elbarbary M, Blaivas M, Durieux ME. Ultrasound for the anesthesiologists: present and future. Scientific World Journal 2013; 2013:683685.
[28] Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care. 2014; 4:1.
[29] Reissig A, Kroegel C. Transthoracic sonography of diffuse parenchymal lung disease: the role of comet tail artifacts. J Ultrasound Med. 2003; 22:173–80.
[30] Touw HR, Parlevliet KL, Beerepoot M, Schober P, Vonk A, Twisk JW, et al. Lung ultrasound compared with chest X-ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study. Anaesthesia. 2018; 73(8):946-954.
[31] Touw HR, Schuitemaker AE, Daams F, van der Peet DL, Bronkhorst EM, Schober P,Boer C, et al. Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study. Ultrasound J. 2019; 11: 20.
[32] Yamaguchi Y, Moharir A, Burrier C, Tobias JD. Point-of-care lung ultrasound to evaluate lung isolation during one-lung ventilation in children: A case report. Saudi J Anaesth. 2019; 13:243-5.
| Files | ||
| Issue | Vol 9 No 3 (2023): Summer |
|
| Section | Research Article(s) | |
| DOI | https://doi.org/10.18502/aacc.v9i3.13117 | |
| Keywords | ||
| Diagnostic imaging one-lung ventilation thoracic surgery lung ultrasonography | ||
| Rights and permissions | |
|
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Sunohara M, Maeda A, Nakanishi Y, Amano E, Okada T, Shibuya H. Ultrasound for Perioperative Lung Monitoring of Patients Undergoing Thoracic Surgery with One-Lung Ventilation. Arch Anesth & Crit Care. 2023;9(3):220-226.
