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Lione L, Busetto A, Verzeletti V, Cannone G, Bonis A, Berni A, Gasparini D, Mammana M, Rebusso A, Nicotra S, Gregori D, Dell’Amore A, Rea F. Thoracic Ultrasound as an Alternative to Chest X-ray in Thoracic Surgery Patients: A Single-Center Experience. J Clin Med 2024; 13:3663. [PMID: 38999229 PMCID: PMC11242563 DOI: 10.3390/jcm13133663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: Chest X-ray (CXR) is currently the most used investigation for clinical follow-up after major noncardiac thoracic surgery. This study explores the use of lung ultrasound (LUS) as an alternative to CXR in the postoperative management of patients who undergo major thoracic procedures. Methods: The patients in our cohort were monitored with both a CXR and a lung ultrasonography after surgery and the day after chest drain removal. The LUS was performed by a member of the medical staff of our unit who was blinded to both the images and the radiologist's report of the CXR. Findings were compared between the two methods. Results: In the immediate postoperative evaluation, 280 patients were compared, finding general agreement between the two procedures at 84% (kappa statistic, 0.603). The LUS showed a sensibility of 84.1%, a specificity of 84.3%, a positive predictive value (PPV) of 60.9%, and a negative predictive value (NPV) of 94.8%. We evaluated 219 out of 280 patients in the postdrainage-removal setting due to technical issues. Concordance between the methods in the postdrainage-removal setting was 89% (kappa statistic, 0.761) with the LUS demonstrating an 82.2% sensibility, a 93.2% specificity, a PPV of 85.7%, and an NPV of 91.3%. Conclusions: The results of this study showed a substantial agreement between LUS and CXR, suggesting that the LUS could reduce the number of X rays in certain conditions. The high NPV allows for the exclusion of PNX and pleural effusion without the need to expose patients to radiation. Discrepancies were noted in cases of mild pneumothorax or modest pleural effusion, without altering the clinical approach.
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Affiliation(s)
- Luigi Lione
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Alberto Busetto
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Vincenzo Verzeletti
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Giorgio Cannone
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Alessandro Bonis
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Alessandro Berni
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Daniele Gasparini
- Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Via L. Loredan 18, 35131 Padova, Italy; (D.G.); (D.G.)
| | - Marco Mammana
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Alessandro Rebusso
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Samuele Nicotra
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, University of Padua, Via L. Loredan 18, 35131 Padova, Italy; (D.G.); (D.G.)
| | - Andrea Dell’Amore
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
| | - Federico Rea
- Thoracic Surgery Unit, Department of Cardiac, Thoracic and Vascular Sciences and Public Health, University of Padova, Via N. Giustiniani, 2, 35121 Padova, Italy; (A.B.); (V.V.); (G.C.); (A.B.); (A.B.); (M.M.); (A.R.); (S.N.); (F.R.)
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Malík M, Dzian A, Števík M, Vetešková Š, Al Hakim A, Hliboký M, Magyar J, Kolárik M, Bundzel M, Babič F. Lung Ultrasound Reduces Chest X-rays in Postoperative Care after Thoracic Surgery: Is There a Role for Artificial Intelligence?-Systematic Review. Diagnostics (Basel) 2023; 13:2995. [PMID: 37761362 PMCID: PMC10527627 DOI: 10.3390/diagnostics13182995] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 08/16/2023] [Accepted: 08/26/2023] [Indexed: 09/29/2023] Open
Abstract
BACKGROUND Chest X-ray (CXR) remains the standard imaging modality in postoperative care after non-cardiac thoracic surgery. Lung ultrasound (LUS) showed promising results in CXR reduction. The aim of this review was to identify areas where the evaluation of LUS videos by artificial intelligence could improve the implementation of LUS in thoracic surgery. METHODS A literature review of the replacement of the CXR by LUS after thoracic surgery and the evaluation of LUS videos by artificial intelligence after thoracic surgery was conducted in Medline. RESULTS Here, eight out of 10 reviewed studies evaluating LUS in CXR reduction showed that LUS can reduce CXR without a negative impact on patient outcome after thoracic surgery. No studies on the evaluation of LUS signs by artificial intelligence after thoracic surgery were found. CONCLUSION LUS can reduce CXR after thoracic surgery. We presume that artificial intelligence could help increase the LUS accuracy, objectify the LUS findings, shorten the learning curve, and decrease the number of inconclusive results. To confirm this assumption, clinical trials are necessary. This research is funded by the Slovak Research and Development Agency, grant number APVV 20-0232.
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Affiliation(s)
- Marek Malík
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Martin Števík
- Radiology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Štefánia Vetešková
- Radiology Department, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Abdulla Al Hakim
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Kollárova 4248/2, 036 59 Martin, Slovakia
| | - Maroš Hliboký
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Ján Magyar
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Michal Kolárik
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - Marek Bundzel
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
| | - František Babič
- Department of Cybernetics and Artificial Intelligence, Faculty of Electrical Engineering and Informatics, Technical University of Košice, Letná 9, 040 01 Košice, Slovakia
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J. Jakobson D, Cohen O, Cherniavsky E, Batumsky M, Fuchs L, Yellin A. Ultrasonography can replace chest X-rays in the postoperative care of thoracic surgical patients. PLoS One 2022; 17:e0276502. [PMID: 36264957 PMCID: PMC9584362 DOI: 10.1371/journal.pone.0276502] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 10/07/2022] [Indexed: 11/07/2022] Open
Abstract
Objectives Lung ultrasound accurately identifies pulmonary and pleural pathologies. Presently it has not been accepted as a routine examination in the postoperative follow-up of thoracic surgical patients. The present study aimed to compare thoracic ultrasonography with chest X-ray for detecting and clinical relevance of pneumothorax, pleural effusion, and lung consolidation and determine whether ultrasonography could replace chest X-ray as the standard examination after surgery. Methods In this blinded, prospective, single-center study, lung ultrasound images were obtained within 2 hours of post-operative routine chest X-ray. A severity score was given to each examination in each technique. Lung ultrasound and chest X-ray results were compared by three methods: absolute comparison of normal to abnormal, the degree of pathology, and the clinical findings’ relevance. Results Eighty patients were enrolled from 2013 to 2017, and 215 ultrasonography images were obtained. For pneumothorax, the precise overlap was found in 129/180 (72%) images. In 24% of examinations, X-ray missed ultrasonography findings. There was an agreement between studies in 80/212 (38%) images for pleural effusion. 60% of pleural effusions were missed by chest X-ray and detected by ultrasonography, and only 2.4% were missed by ultrasound, all very small. Clinically relevant fluid accumulation found a precise match in 80%, and 20% were found only by lung ultrasound. For lung consolidation, a 100% overlap was found with both methods. Conclusions Our results suggest that lung ultrasound may replace chest X-ray as the standard examination in the postoperative care of patients undergoing thoracic surgical procedures.
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Affiliation(s)
- Daniel J. Jakobson
- Intensive Care Department, Barzilai University Medical Center, Ashkelon, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Ornit Cohen
- Faculty of Public Health Ben-Gurion University, Beer-Sheba, Israel
| | - Evgenia Cherniavsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Radiology Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Moris Batumsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- General Surgery Department, Barzilai University Medical Center, Ashkelon, Israel
| | - Lior Fuchs
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Intensive Care Department, Soroka University Medical Center, Beer Sheba, Israel
- * E-mail:
| | - Alon Yellin
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Thoracic Surgery Department, Barzilai University Medical Center, Ashkelon, Israel
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Grapatsas K, Leivaditis V, Ehle B, Papaporfyriou A. Can Chest Ultrasound Replace Chest X-ray in Thoracic Surgery? Tomography 2022; 8:2083-2092. [PMID: 36006073 PMCID: PMC9412512 DOI: 10.3390/tomography8040175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 08/16/2022] [Accepted: 08/18/2022] [Indexed: 11/16/2022] Open
Abstract
Background: There is growing evidence that supports the use of chest ultrasound (CUS) versus conventional chest X-ray (CXR) in order to diagnose postoperative complications. However, data regarding its use after thoracic surgery are scarce and contradictory. The aim of this study was to conduct a systematic review to evaluate the accuracy of CUS after thoracic surgery. Methods: An electronic search in MEDLINE (via PubMed), complemented by manual searches in article references, was conducted to identify eligible studies. Results: Six studies with a total of 789 patients were included in this meta-analysis. Performing CXR decreased in up to 61.6% of cases, with the main reasons for performing CXR being massive subcutaneous emphysema or complex hydrothorax. Agreement between CUS and routine-based therapeutic options was, in some studies, up to 97%. Conclusions: The selectively postoperative use of CUS may reduce the number of routinely performed CXR. However, if CUS findings are inconclusive, further radiological examinations are obligatory.
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Affiliation(s)
- Konstantinos Grapatsas
- Department of Thoracic Surgery, Klinikum Bielefeld, 33647 Bielefeld, Germany
- Correspondence:
| | - Vasileios Leivaditis
- Department of Cardiothoracic and Vascular Surgery, Westpfalz-Klinikum, 67655 Kaiserslautern, Germany
| | - Benjamin Ehle
- Department of Thoracic Surgery, Medical Center-University of Freiburg, Faculty of Medicine, 79098 Freiburg, Germany
| | - Anastasia Papaporfyriou
- Division of Pulmonology, Department of Internal Medicine II, Medical University of Vienna, 1090 Vienna, Austria
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Galetin T, Defosse J, Schieren M, Marks B, Lopez-Pastorini A, Koryllos A, Kosse N, Wappler F, Stoelben E. Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery. Eur J Cardiothorac Surg 2021; 57:846-853. [PMID: 31800020 DOI: 10.1093/ejcts/ezz332] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/21/2019] [Accepted: 11/04/2019] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Thoracic ultrasound is superior to chest X-ray for the detection of a pneumothorax in trauma and intensive care medicine. Data regarding its use in non-cardiac thoracic surgery are scarce and contradictory. Previous studies are heterogeneous regarding sonographic methodology and patient selection. This study aimed to evaluate the accuracy of thoracic ultrasound for pneumothorax assessment after lung resecting surgery in unselected patients. METHODS SONOR (SONOgraphy vs x-Ray) is a prospective observational trial (registry-ID DRKS00014557). A total of 123 consecutive patients with lung resecting surgery received a standardized thoracic ultrasound the same day and in addition to routine chest X-rays in erect position after removal of the chest tube. The sonographer was blinded to radiological findings and vice versa. RESULTS Sensitivity, specificity, positive and negative predictive values of ultrasound after removing the chest tube were 0.32, 0.85, 0.54, 0.69 for any pneumothorax and 1.0, 0.82, 0.19, 1.0 for pneumothorax ≥3 cm. No clinically relevant pneumothorax was missed. The agreement between sonography- and routine-based therapeutic decisions was 97%. Lung pulse was the most frequently detected sign to sonographically rule out a pneumothorax. CONCLUSIONS Postoperative thoracic ultrasound in unselected patients has a low overall sensitivity to detect a residual pneumothorax; however, its sensitivity and negative predictive values regarding clinically relevant pneumothorax are high. Test quality depends on the distinct sonographic methodology and patient selection. Anatomic differences in postsurgical and medical patients may be responsible for the contradictory results of previous trials. Studies with a larger population size are required to validate the accuracy of relevant pneumothoraces and identify appropriate selection criteria. CLINICAL TRIAL REGISTRATION NUMBER DRKS-German Clinical Trials Register, www.drks.de, registry-ID DRKS00014557.
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Affiliation(s)
- Thomas Galetin
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Jérôme Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Ben Marks
- Department of Radiology, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Alberto Lopez-Pastorini
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Nils Kosse
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Erich Stoelben
- Department of Thoracic Surgery, Lung Clinic, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
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Galetin T, Merres J, Schieren M, Marks B, Haffke Y, Defosse J, Wappler F, Koryllos A, Stoelben E. Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study. J Cardiothorac Surg 2021; 16:75. [PMID: 33849605 PMCID: PMC8045207 DOI: 10.1186/s13019-021-01454-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 03/31/2021] [Indexed: 11/30/2022] Open
Abstract
Background The few existing studies on the accuracy of lung ultrasound in the detection of a postoperative pneumothorax after thoracic surgery differ in the sonographic technique and the inclusion criteria. Several conditions are considered unfavourable in the sonographic examination of the lung. We aim to test these conditions for their impact on the diagnostic accuracy of lung ultrasound. Methods We compared lung ultrasound and chest roentgenograms for the detection of a pneumothorax after lung-resecting surgery in two prospective trials (register ID DRKS00014557 and DRKS00020216). The ultrasound examiners and radiologists were blinded towards the corresponding findings. We performed posthoc subgroup analyses to determine the influence of various patient or surgery related conditions on the sensitivity and specificity of ultrasound in the detection of pneumothorax. Results We performed 340 examinations in 208 patients. The covariates were age, gender, body mass index, smoking status, severity of chronic obstructive pulmonary disease, previous ipsilateral operation or irradiation, thoracotomy, postoperative skin emphysema, indwelling chest tube and X-ray in supine position. In univariate analysis, an indwelling chest-tube was associated with a higher sensitivity (58%, p = 0.04), and a postoperative subcutaneous emphysema with a lower specificity (73% vs. 88%, p = 0.02). None of the other subgroups differed in sensitivity or specificity from the total population . Conclusions Most of the patient- or surgery related conditions usually considered unfavourable for lung ultrasound did not impair the sensitivity or specificity of lung ultrasound. Further studies should not excluce patients with these conditions, but test the accuracy under routine conditions. Trial registration DRKS, DRKS00014557, registered 06/09/2018, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00014557 and DRKS00020216, registered 03/12/2019, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00020216 Supplementary Information The online version contains supplementary material available at 10.1186/s13019-021-01454-6.
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Affiliation(s)
- Thomas Galetin
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany.
| | - Julika Merres
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Mark Schieren
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Benjamin Marks
- Department of Radiology, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Yves Haffke
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Jerome Defosse
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Frank Wappler
- Department of Anaesthesiology and Intensive Care Medicine, University Witten/Herdecke, Medical Centre Cologne-Merheim, Cologne, Germany
| | - Aris Koryllos
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
| | - Erich Stoelben
- Lungclinic, Thoracic Surgery, University Witten/Herdecke, Medical Centre Cologne-Merheim, Ostmerheimer Str. 200, 51109, Cologne, Germany
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Bosch L, Mathe O, Robin JJ, Serres I, Labaste F, Masquère P, Grigoli M, Brouchet L, Conil JM, Minville V. Assessment of lung ultrasound for early detection of respiratory complications in thoracic surgery. Braz J Anesthesiol 2021; 72:128-134. [PMID: 33762193 PMCID: PMC9373259 DOI: 10.1016/j.bjane.2021.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 09/15/2020] [Accepted: 01/21/2021] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES To assess lung ultrasound for the diagnosis and monitoring of respiratory complications in thoracic surgery. METHODS Prospective observational study in a University hospital, single institution. Adult patients scheduled for pulmonary resection surgery excluding pneumonectomy. An ultrasound follow-up was performed from the day before the surgery to the third day after surgery with calculation of B-line and lung score (reaeration and loss of aeration scores). Respiratory complications were collected throughout the hospitalization period. RESULTS Fifty-six patients were included. Eighteen patients presented a respiratory complication (32%), and they presented significantly higher BMI and ASA scores. Patients operated by videothoracoscopy were less at risk of complications. At day 3, a reaeration score ≤ 2 on the ventilated side or ≤ -2 on the operated side, and a B-line score>6 on the operated side were in favor of a complication. CONCLUSION Lung ultrasound can help in the diagnosis of respiratory complications following pulmonary resection surgery.
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Affiliation(s)
- Laetitia Bosch
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - Olivier Mathe
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - Jean-Jacques Robin
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - Isabelle Serres
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - François Labaste
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France; Université Paul Sabatier, I2MC, Inserm U1048, Toulouse, France
| | - Pierre Masquère
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - Maxime Grigoli
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - Laurent Brouchet
- Toulouse University Teaching Hospital, Department of Thoracic Surgery, Toulouse, France
| | - Jean-Marie Conil
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France
| | - Vincent Minville
- Toulouse University Teaching Hospital, Anesthesiology and Critical Care Unit, Toulouse, France; Université Paul Sabatier, I2MC, Inserm U1048, Toulouse, France.
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Malík M, Dzian A, Skaličanová M, Hamada Ĺ, Zeleňák K, Grendár M. Chest Ultrasound Can Reduce the Use of Roentgenograms in Postoperative Care After Thoracic Surgery. Ann Thorac Surg 2020; 112:897-904. [PMID: 33186604 DOI: 10.1016/j.athoracsur.2020.10.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 09/16/2020] [Accepted: 10/12/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Roentgenography remains the standard imaging modality after thoracic surgery. Trials from intensive medicine proved a high accuracy of ultrasound examination in the diagnosis of various conditions. The assumption was that ultrasound examination could reduce the number of roentgenograms after thoracic surgery. METHODS This prospective study compared ultrasound examinations performed by thoracic surgeons with roentgenograms in the diagnosis of pneumothorax and pleural effusion after noncardiac thoracic surgery. Patients received 2 ultrasound scans, the first on the day of surgery and the second before chest tube removal. RESULTS A total of 297 patients underwent 545 examinations; 336 ultrasound scans (61.6%) showed neither pneumothorax nor pleural effusion. Pneumothorax was detected on 69 roentgenograms and 51 ultrasound scans. Both modalities showed positive results in 32 cases and negative results in 395 cases (Cohen's κ, 53.4%). Ultrasound missed 37 clinically irrelevant pneumothoraces. Roentgenograms missed 19 pneumothoraces; 15 of them were clinically irrelevant. Sensitivity and specificity were 59.4% and 95.9% in the first examination and 50.0% and 94.8% in the second examination, respectively. Pleural effusion was detected on 169 roentgenograms and 117 ultrasound scans. Both modalities showed positive results in 88 cases and negative results in 336 cases (Cohen's κ, 49.6%). Ultrasound scans missed 81 pleural effusions; except for 5 cases, the clinical decisions would not have changed. Roentgenograms missed 29 clinically irrelevant pleural effusions. Sensitivity and specificity were 44.4% and 92.6% in the first examination and 60.9% and 91.3% in the second examination, respectively. CONCLUSIONS Given high specificities, a large share of results without pneumothorax and pleural effusion, and mismatch analysis, we could reduce the number of roentgenograms by 61.6% by using ultrasound as a primary imaging modality.
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Affiliation(s)
- Marek Malík
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Anton Dzian
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia.
| | - Michaela Skaličanová
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Ĺuboš Hamada
- Department of Thoracic Surgery, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Martin, Slovakia
| | - Kamil Zeleňák
- Department of Radiology, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava and University Hospital in Martin, Slovakia, Martin, Slovakia
| | - Marián Grendár
- Biomedical Centre Martin, Jessenius Faculty of Medicine in Martin, Comenius University in Bratislava, Martin, Slovakia
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Sensitivity of lung ultrasound for the detection of pneumothorax one day after pulmonary resection—a prospective observational study. Eur Surg 2020. [DOI: 10.1007/s10353-020-00676-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Summary
Background
Chest X‑ray (CXR) after thoracic surgery contributes to patient discomfort and costs and is of limited therapeutic value. Lung ultrasound (LU) for pneumothorax may be an alternative to CXR, but diagnostic accuracy data are heterogeneous and biased by insufficient sonographic technique and patient selection. Reported sensitivities range from 0.21 to 1.0. We evaluated the sensitivity of LU on the first day after thoracic surgery under routine conditions.
Methods
We performed a prospective observational study (trial-ID DRKS00014557). Consecutive patients undergoing lung resection received standardized LU in addition to routine CXR on the first postoperative day. Ultrasound examiner and radiologist were blinded to corresponding X‑ray and ultrasound findings. CXR was used as reference to determine diagnostic test performance of ultrasound. The conformity of sonography- and routine-based therapeutic decisions was evaluated.
Results
A total of 68 patients were examined. The mean duration of ultrasound was 145 ± 64 s. CXR identified 23 patients with pneumothorax with a mean apex-to-cupola size of 1.5 ± 1.0 cm. Ultrasound detected 18 patients with pneumothorax. The computed sensitivity of LU was 0.48 (95% confidence interval [0.36; 0.60]). Specificity was between 0.81 and 1.0, the negative predictive value 0.76 [0.66; 0.86]. The sensitivity of CXR was 0.56 [0.44; 0.68]. Air leakage via chest tube correlated weakly with CXR (spearman’s rho = 0.26) and moderately with LU (rho = 0.43). The conformity between sonographically based recommendations and the actual therapy based on routine diagnostics was 96%.
Conclusions
Sensitivity of ultrasound for pneumothorax detection nearly reached CXR and resulted in equally safe patient management. Our data can serve as a pilot study for upcoming larger-scaled controlled trials.
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10
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Bhakhri K, Coonar A. Editorial of current practise in the use of chest ultrasound in thoracic surgery. J Thorac Dis 2020; 11:5706-5707. [PMID: 32030307 DOI: 10.21037/jtd.2019.12.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kunal Bhakhri
- Senior Thoracic Registrar, Royal Papworth Hospital, Hitchin, UK
| | - Aman Coonar
- Consultant Thoracic Surgeon, Royal Papworth Hospital, Hitchin, UK
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11
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Chiappetta M, Zanfrini E, Petracca Ciavarella L, Meacci E, Margaritora S. Is chest ultrasonography an essential tool for the modern thoracic surgeon? J Thorac Dis 2019; 11:S2028-S2029. [PMID: 31632817 DOI: 10.21037/jtd.2019.08.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Marco Chiappetta
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Edoardo Zanfrini
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Leonardo Petracca Ciavarella
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Elisa Meacci
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Margaritora
- Universita Cattolica delSacro Cuore, Rome, Italy.,Thoracic Surgery, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Rome, Italy
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12
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Touw HR, Schuitemaker AE, Daams F, van der Peet DL, Bronkhorst EM, Schober P, Boer C, Tuinman PR. Routine lung ultrasound to detect postoperative pulmonary complications following major abdominal surgery: a prospective observational feasibility study. Ultrasound J 2019; 11:20. [PMID: 31523784 PMCID: PMC6745303 DOI: 10.1186/s13089-019-0135-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2019] [Accepted: 08/16/2019] [Indexed: 12/28/2022] Open
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.
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Affiliation(s)
- H R Touw
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands. .,Department of Intensive Care Medicine, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - A E Schuitemaker
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - F Daams
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - D L van der Peet
- Department of Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - E M Bronkhorst
- Department of Health Evidence, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
| | - P Schober
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - C Boer
- Department of Anaesthesiology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - P R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Cardiovascular Sciences, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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13
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Scanagatta P, Rolli L. Post-operative lung ultrasonography in daily routine thoracic surgery: can we trust its results? J Thorac Dis 2019; 11:42-44. [PMID: 30863566 DOI: 10.21037/jtd.2018.12.96] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Paolo Scanagatta
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Luigi Rolli
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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14
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Sensitivity of Lung Ultrasound for Postsurgical Pneumothorax. Ann Thorac Surg 2019; 108:960-961. [PMID: 30872097 DOI: 10.1016/j.athoracsur.2019.01.074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/25/2019] [Indexed: 11/23/2022]
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15
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Patella M, Mongelli F, Cafarotti S. The importance of asking the right questions: the role of chest ultrasound in thoracic surgery. J Thorac Dis 2019; 11:S359-S362. [PMID: 30997221 DOI: 10.21037/jtd.2018.12.81] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
- Miriam Patella
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Francesco Mongelli
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
| | - Stefano Cafarotti
- Department of Thoracic Surgery, San Giovanni Hospital, Bellinzona, Switzerland
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16
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Nooitgedacht J, Haaksma M, Touw HRW, Tuinman PR. Perioperative care with an ultrasound device is as Michael Jordan with Scotty Pippen: at its best! J Thorac Dis 2018; 10:6436-6441. [PMID: 30746184 DOI: 10.21037/jtd.2018.12.82] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jip Nooitgedacht
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Mark Haaksma
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Hugo R W Touw
- Department of Intensive Care Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Pieter R Tuinman
- Department of Intensive Care Medicine, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Amsterdam Leiden Intensive Care Focused Echography (ALIFE)
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17
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Chiappetta M, Meacci E, Cesario A, Smargiassi A, Inchingolo R, Petracca Ciavarella L, Lopatriello S, Contegiacomo A, Congedo MT, Margaritora S. Postoperative chest ultrasound findings and effectiveness after thoracic surgery: A pilot study. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:1960-1967. [PMID: 29980450 DOI: 10.1016/j.ultrasmedbio.2018.05.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/01/2018] [Accepted: 05/08/2018] [Indexed: 06/08/2023]
Abstract
The aim of this study was to analyze the information from post-operative chest ultrasound (CU) to evaluate the possibility to use this method instead of chest X-ray (CXR) after thoracic surgery. Patients who underwent thoracic surgery were evaluated with CU blinded to CXR after surgery, deciding if it was useful or CU was exhaustive. Twenty-four patients were enrolled prospectively. The CU allowed a further discrimination of the lung abnormalities, discriminating between atelectasis, infections or hematoma. CXR was required in only 5 cases due to the presence of massive subcutaneous emphysema or absence of lung point. In the remaining 19 cases, CU was considered exhaustive and effective. In particular, CU was considered exhaustive in 67% of cases after open surgery and in 85% of cases after video-assisted thoracic surgery. In conclusion, CU appears to be effective in post-operative management after thoracic surgery and it can increase the diagnostic accuracy reducing any unnecessary X-ray exposure.
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Affiliation(s)
- Marco Chiappetta
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy.
| | - Elisa Meacci
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Alfredo Cesario
- Clinical Governance, Università Cattolica del sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Andrea Smargiassi
- Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Riccardo Inchingolo
- Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Leonardo Petracca Ciavarella
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Stefania Lopatriello
- Pulmonary Medicine Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Andrea Contegiacomo
- Department of Radiology, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Maria Teresa Congedo
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
| | - Stefano Margaritora
- Thoracic Surgery, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario A. Gemelli, Rome, Italy
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18
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Chiappetta M, Meacci E, Congedo MT, Nachira D, Margaritora S. Is Post-Operative Lung Ultrasonography Effective in Lung Abnormalities Analysis? Ann Thorac Surg 2018; 106:937. [PMID: 29626462 DOI: 10.1016/j.athoracsur.2018.02.078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Accepted: 02/26/2018] [Indexed: 10/17/2022]
Affiliation(s)
- Marco Chiappetta
- Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, I.R.C.C.S. Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy.
| | - Elisa Meacci
- Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, I.R.C.C.S. Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Maria Teresa Congedo
- Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, I.R.C.C.S. Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Dania Nachira
- Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, I.R.C.C.S. Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy
| | - Stefano Margaritora
- Department of Thoracic Surgery, Università Cattolica del Sacro Cuore, I.R.C.C.S. Fondazione Policlinico Universitario A. Gemelli, Largo A. Gemelli 8, 00168 Rome, Italy
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Leuzzi G, Facciolo F, Pastorino U, Rocco G. Methods for the postoperative management of the thoracic oncology patients: lessons from the clinic. Expert Rev Respir Med 2015; 9:751-67. [DOI: 10.1586/17476348.2015.1109453] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Tahiri M, Khereba M, Thiffault V, Ferraro P, Duranceau A, Martin J, Liberman M. Preoperative assessment of chest wall invasion in non-small cell lung cancer using surgeon-performed ultrasound. Ann Thorac Surg 2014; 98:984-9. [PMID: 25038014 DOI: 10.1016/j.athoracsur.2014.04.111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2014] [Revised: 04/13/2014] [Accepted: 04/22/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chest wall invasion in operable lung cancer upgrades the stage and can affect operative planning. Diagnosing chest wall invasion preoperatively is important in patient consent, in the choice of operative incision placement, and can be helpful in choosing an operative approach (open vs thoracoscopic). The objectives of this study were to determine the diagnostic accuracy of preoperative, surgeon-performed ultrasound (US) in assessing tumoral chest wall invasion (T3) in non-small cell lung cancer (NSCLC) patients and to compare its accuracy vs preoperative computed tomography (CT). METHODS This study was a prospective clinical trial (ClinicalTrials.gov: NCT01206894) that prospectively enrolled patients between September 2010 and January 2013. Eligible patients included those with NSCLC abutting the parietal pleura or invading the chest wall on preoperative CT scan of the chest and who were planned for surgical resection. Criteria for chest wall invasion on US included (1) disruption of the parietal pleura, (2) invasion of the ribs, or (3) impairment of pleural movement with respiration. The US chest wall examination was performed by the thoracic surgical team immediately before the surgical intervention. Sensitivity and specificity for CT scan and US in assessing chest wall invasion were calculated using definitive chest wall invasion on final pathologic analysis as the gold standard for chest wall invasion. RESULTS During a 28-month period, 28 patients (15 men and 13 women) patients were prospectively enrolled. Mean age was 62 ± 11 years, and mean body mass index was 25.3 ± 4.5 kg/m(2). The average time for surgeon-performed US assessment looking for chest wall invasion was 5.3 ± 5 minutes. The sensitivity of US in evaluating chest wall invasion was 90.9% and the specificity was 85.7%. CT scan was associated with a sensitivity of 61.5% and a specificity of 84.6%. The positive and negative predictive values of surgeon-performed US for tumoral chest wall invasion were 83.3% and 92.3%, respectively, compared with 80% and 68.8% for CT scan. CONCLUSIONS Surgeon-performed preoperative chest wall US can reliably diagnose tumoral chest wall invasion in patients with NSCLC. CT scan has poor sensitivity in predicting chest wall invasion preoperatively. Surgeon-performed US can be considered as a complementary adjunct to preoperative imaging in patients with pulmonary lesions abutting the chest wall to improve preoperative diagnosis, staging, and operative planning.
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Affiliation(s)
- Mehdi Tahiri
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada
| | - Mohamed Khereba
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada
| | - Vicky Thiffault
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada
| | - Pasquale Ferraro
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada
| | - André Duranceau
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada
| | - Jocelyne Martin
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada
| | - Moishe Liberman
- Division of Thoracic Surgery, Department of Surgery, and Centre Hospitalier de l'Université de Montreal Endoscopic Tracheobronchial and Oesophageal Center (C.E.T.O.C.), University of Montreal, Montreal, Quebec, Canada.
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21
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Scanagatta P, Girelli L. eComment. Chest sonography could reduce routine chest radiographs after pulmonary surgery. Interact Cardiovasc Thorac Surg 2013; 17:999. [PMID: 24243949 DOI: 10.1093/icvts/ivt417] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paolo Scanagatta
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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22
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Biegler N, McBeth PB, Tiruta C, Hamilton DR, Xiao Z, Crawford I, Tevez-Molina M, Miletic N, Ball CG, Pian L, Kirkpatrick AW. The feasibility of nurse practitioner-performed, telementored lung telesonography with remote physician guidance - 'a remote virtual mentor'. Crit Ultrasound J 2013; 5:5. [PMID: 23805869 PMCID: PMC3735420 DOI: 10.1186/2036-7902-5-5] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 06/12/2013] [Indexed: 01/01/2023] Open
Abstract
Background Point-of-care ultrasound (POC-US) use is increasingly common as equipment costs decrease and availability increases. Despite the utility of POC-US in trained hands, there are many situations wherein patients could benefit from the added safety of POC-US guidance, yet trained users are unavailable. We therefore hypothesized that currently available and economic ‘off-the-shelf’ technologies could facilitate remote mentoring of a nurse practitioner (NP) to assess for recurrent pneumothoraces (PTXs) after chest tube removal. Methods The simple remote telementored ultrasound system consisted of a handheld ultrasound machine, head-mounted video camera, microphone, and software on a laptop computer. The video output of the handheld ultrasound machine and a macroscopic view of the NP's hands were displayed to a remote trauma surgeon mentor. The mentor instructed the NP on probe position and US machine settings and provided real-time guidance and image interpretation via encrypted video conferencing software using an Internet service provider. Thirteen pleural exams after chest tube removal were conducted. Results Thirteen patients (26 lung fields) were examined. The remote exam was possible in all cases with good connectivity including one trans-Atlantic interpretation. Compared to the subsequent upright chest radiograph, there were 4 true-positive remotely diagnosed PTXs, 2 false-negative diagnoses, and 20 true-negative diagnoses for 66% sensitivity, 100% specificity, and 92% accuracy for remotely guided chest examination. Conclusions Remotely guiding a NP to perform thoracic ultrasound examinations after tube thoracostomy removal can be simply and effectively performed over encrypted commercial software using low-cost hardware. As informatics constantly improves, mentored remote examinations may further empower clinical care providers in austere settings.
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Affiliation(s)
- Nancy Biegler
- Regional Trauma Services, Foothills Medical Centre, Calgary, Alberta T2N 2T9, Canada.
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23
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Current World Literature. Curr Opin Anaesthesiol 2013; 26:98-104. [DOI: 10.1097/aco.0b013e32835cb4f0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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