Laurent Zieleskiewicz1, Mickael Papinko2, Alexandre Lopez2, Alice Baldovini2, David Fiocchi2, Zoe Meresse2, Alain Boussuges3, Pascal Alexandre Thomas4, Stephane Berdah5, Ben Creagh-Brown6, Belaid Bouhemad7, Emmanuel Futier8, Noémie Resseguier9, François Antonini2, Gary Duclos2, Marc Leone10. 1. From the Department of Anesthesia and Intensive Care Medicine, Nord Hospital, and C2VN Inra, Inserm. 2. Department of Anesthesia and Intensive Care Medicine, Nord Hospital, Aix Marseille University, Assistance Publique Hôpitaux de Marseille (APHM), Marseille, France. 3. Centre de Recherche en Cardio Vasculaire et Nutrition (C2VN) Inra, Inserm, Aix Marseille University, Marseille, France. 4. Departments of Thoracic Surgery. 5. Digestive Surgery, Nord Hospital, Aix Marseille University, APHM, Marseille, France. 6. Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom. 7. Department of Anesthesia and Intensive Care Medicine, University Hospital of Dijon, and University de Bourgogne Franche-Comté, Lipides Nutrition Cancer (LNC) Unité Mixte de Recherche (UMR866), Dijon, France. 8. Department of Anesthesia and Intensive Care Medicine University Hospital of Clermont-Ferrand, Clermont-Ferrand, France. 9. Department of Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France. 10. Department of Anesthesia and Intensive Care Medicine, and Centre d 'Investigation Clinique, Nord Hospital, Aix Marseille University, APHM, Marseille, France.
Abstract
BACKGROUND: Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment. METHODS: Patients with an American Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models. RESULTS: Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7-18] vs 8 [4-12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2-11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57-0.71). CONCLUSIONS: When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.
BACKGROUND:Postoperative pulmonary complications are associated with increased morbidity. Identifying patients at higher risk for such complications may allow preemptive treatment. METHODS:Patients with an American Society of Anesthesiologists (ASA) score >1 and who were scheduled for major surgery of >2 hours were enrolled in a single-center prospective study. After extubation, lung ultrasound was performed after a median time of 60 minutes by 2 certified anesthesiologists in the postanesthesia care unit after a standardized tracheal extubation. Postoperative pulmonary complications occurring within 8 postoperative days were recorded. The association between lung ultrasound findings and postoperative pulmonary complications was analyzed using logistic regression models. RESULTS: Among the 327 patients included, 69 (19%) developed postoperative pulmonary complications. The lung ultrasound score was higher in the patients who developed postoperative pulmonary complications (12 [7-18] vs 8 [4-12]; P < .001). The odds ratio for pulmonary complications in patients who had a pleural effusion detected by lung ultrasound was 3.7 (95% confidence interval, 1.2-11.7). The hospital death rate was also higher in patients with pleural effusions (22% vs 1.3%; P < .001). Patients with pulmonary consolidations on lung ultrasound had a higher risk of postoperative mechanical ventilation (17% vs 5.1%; P = .001). In all patients, the area under the curve for predicting postoperative pulmonary complications was 0.64 (95% confidence interval, 0.57-0.71). CONCLUSIONS: When lung ultrasound is performed precociously <2 hours after extubation, detection of immediate postoperative alveolar consolidation and pleural effusion by lung ultrasound is associated with postoperative pulmonary complications and morbi-mortality. Further study is needed to determine the effect of ultrasound-guided intervention for patients at high risk of postoperative pulmonary complications.