Does daily chest ultrasound in the postoperative period contribute to an enhanced recovery after surgery pathway for patients undergoing general thoracic surgery?

Feasibility and efficacy of lung ultrasound to investigate pulmonary complications in patients who developed postoperative Hypoxaemia-a prospective study

Background

Postoperative pulmonary complications (PPCs) and hypoxaemia are associated with morbidity and mortality. We aimed to evaluate the feasibility and efficacy of lung ultrasound (LUS) to diagnose PPCs in patients suffering from hypoxaemia after general anaesthesia and compare the results to those of thoracic computed tomography (CT).

Methods

Adult patients who received general anaesthesia and suffered from hypoxaemia in the postanaesthesia care unit (PACU) were analysed. Hypoxaemia was defined as an oxygen saturation measured by pulse oximetry (SPO₂) less than 92% for more than 30 s under ambient air conditions. LUS was performed by two trained anaesthesiologists once hypoxaemia occurred. After LUS examination, each patient was transported to the radiology department for thoracic CT scan within 1 h before returning to the ward.

Results

From January 2019 to May 2019, 113 patients (61 men) undergoing abdominal surgery (45 patients, 39.8%), video-assisted thoracic surgery (31 patients, 27.4%), major orthopaedic surgery (17 patients, 15.0%), neurosurgery (10 patients, 8.8%) or other surgery (10 patients, 8.8%) were included. CT diagnosed 327 of 1356 lung zones as atelectasis, while LUS revealed atelectasis in 311 of the CT-confirmed zones. Pneumothorax was detected by CT scan in 75 quadrants, 72 of which were detected by LUS. Pleural effusion was diagnosed in 144 zones on CT scan, and LUS detected 131 of these zones. LUS was reliable in diagnosing atelectasis (sensitivity 98.0%, specificity 96.7% and diagnostic accuracy 97.2%), pneumothorax (sensitivity 90.0%, specificity 98.9% and diagnostic accuracy 96.7%) and pleural effusion (sensitivity 92.9%, specificity 96.0% and diagnostic accuracy 95.1%).

Conclusions

Lung ultrasound is feasible, efficient and accurate in diagnosing different aetiologies of postoperative hypoxia in healthy-weight patients in the PACU.

Trial registration

Current Controlled Trials NCT03802175, 2018/12/05, www.ClinicalTrials.gov

[Proper Selection of Enhanced Recovery after Surgery Programs between the Medical Service and Medical Intervence - Is It Time to Do?]

加速康复外科（enhanced recovery after surgery, ERAS）理念诞生与微创外科技术进步密切相关。ERAS发展过程中利用技术，又融入人文因素，使其高于技术，而丰富ERAS的内涵和外延。结合近年ERAS在外科各领域的进展，总结ERAS临床应用的现状与策略：一是微创技术进步使ERAS理念的临床应用成为必然；二是外科学理论与技术的发展，深入与扩大了ERAS的内涵与外延；三是ERAS临床应用需要我们更新观念；四是ERAS的临床实践需要在医疗服务和医疗干预之间合理选择；五是ERAS临床应用加减之间应用的现实问题与策略。从而深入理解ERAS的真正临床意义，更好地指导临床实践。