Ahmed Alsaddique1, Alistair G Royse2, Colin F Royse2, Abdulelah Mobeirek1, Fayez El Shaer1, Hanan AlBackr1, Mohammed Fouda1, David J Canty3. 1. King Fahad Cardiac Center and College of Medicine, King Saud University, Riyadh, Saudi Arabia; 2. Department of Surgery, University of Melbourne, Royal Parade, Parkville, Australia; Royal Melbourne Hospital, Grattan Street, Parkville, Australia. 3. Department of Surgery, University of Melbourne, Royal Parade, Parkville, Australia; Royal Melbourne Hospital, Grattan Street, Parkville, Australia. Electronic address: dj_canty@hotmail.com.
Abstract
OBJECTIVES: Cardiorespiratory complications are common after cardiac surgery and current monitors used to diagnose these are invasive and have limitations. Transthoracic echocardiography and lung ultrasound are noninvasive and frequently improve diagnosis in critically ill patients but have not been reported for routine postoperative monitoring after coronary, valve, and aortic surgery. The aim was to determine whether both repeated postoperative transthoracic echocardiography and lung ultrasound revealed or excluded clinically important cardiac and respiratory disorders compared to conventional monitoring and chest x-ray. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PARTICIPANTS: Ninety-one patients aged older than 18 undergoing cardiac surgery INTERVENTIONS: Postoperative clinical patient assessment for significant cardiac and respiratory disorders by the treating physician was recorded at 3 time points (day after surgery, after extubation and removal of chest drains and at discharge) using conventional monitoring and chest x-ray. After each assessment, transthoracic echocardiography and lung ultrasound were performed, and differences in diagnosis from conventional assessment were recorded. MEASUREMENTS AND MAIN RESULTS: Transthoracic echocardiography was interpretable in at least 1 echocardiographic window in 99% of examinations. Transthoracic echocardiography and/or lung ultrasound changed the diagnosis of important cardiac and/or respiratory disorders in 61 patients (67%). New cardiac findings included cardiac dysfunction (38 patients), pericardial effusion (5), mitral regurgitation (2), and hypovolemia (1). New respiratory findings included pleural effusion (30), pneumothorax (4), alveolar interstitial syndrome (3) and consolidation (1). CONCLUSIONS: Routine repeated monitoring with cardiac and lung ultrasound after cardiac surgery is feasible and frequently alters diagnosis of clinically important cardiac and respiratory pathology.
OBJECTIVES: Cardiorespiratory complications are common after cardiac surgery and current monitors used to diagnose these are invasive and have limitations. Transthoracic echocardiography and lung ultrasound are noninvasive and frequently improve diagnosis in critically illpatients but have not been reported for routine postoperative monitoring after coronary, valve, and aortic surgery. The aim was to determine whether both repeated postoperative transthoracic echocardiography and lung ultrasound revealed or excluded clinically important cardiac and respiratory disorders compared to conventional monitoring and chest x-ray. DESIGN: Prospective observational study. SETTING: Tertiary university hospital. PARTICIPANTS: Ninety-one patients aged older than 18 undergoing cardiac surgery INTERVENTIONS: Postoperative clinical patient assessment for significant cardiac and respiratory disorders by the treating physician was recorded at 3 time points (day after surgery, after extubation and removal of chest drains and at discharge) using conventional monitoring and chest x-ray. After each assessment, transthoracic echocardiography and lung ultrasound were performed, and differences in diagnosis from conventional assessment were recorded. MEASUREMENTS AND MAIN RESULTS: Transthoracic echocardiography was interpretable in at least 1 echocardiographic window in 99% of examinations. Transthoracic echocardiography and/or lung ultrasound changed the diagnosis of important cardiac and/or respiratory disorders in 61 patients (67%). New cardiac findings included cardiac dysfunction (38 patients), pericardial effusion (5), mitral regurgitation (2), and hypovolemia (1). New respiratory findings included pleural effusion (30), pneumothorax (4), alveolar interstitial syndrome (3) and consolidation (1). CONCLUSIONS: Routine repeated monitoring with cardiac and lung ultrasound after cardiac surgery is feasible and frequently alters diagnosis of clinically important cardiac and respiratory pathology.
Authors: H R Touw; K L Parlevliet; M Beerepoot; P Schober; A Vonk; J W Twisk; P W Elbers; C Boer; P R Tuinman Journal: Anaesthesia Date: 2018-03-12 Impact factor: 6.955