Top

Published in:

Open Access 01-12-2021 | Ultrasound | Research article

Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study

Authors: Thomas Galetin, Julika Merres, Mark Schieren, Benjamin Marks, Yves Haffke, Jerome Defosse, Frank Wappler, Aris Koryllos, Erich Stoelben

Published in: Journal of Cardiothoracic Surgery | Issue 1/2021

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

Available only for authorised users

Bjerregaard LS, Jensen K, Petersen RH, Hansen HJ. Routinely obtained chest X-rays after elective video-assisted thoracoscopic surgery can be omitted in most patients; a retrospective, observational study. Gen Thorac Cardiovasc Surg. 2015;63(8):465–71. https://doi.org/10.1007/s11748-015-0560-9.CrossRef

Cerfolio RJ, Bryant AS. Daily chest roentgenograms are unnecessary in nonhypoxic patients who have undergone pulmonary resection by thoracotomy. Ann Thorac Surg. 2011;92(2):440–3. https://doi.org/10.1016/j.athoracsur.2011.04.002.CrossRef

Furák J, Géczi T, Pécsy B, Morvay Z. Szükséges-e a naponkénti rutinmellkasröntgen tüdőresectio után? Bizonyítékalapú döntési taktika. Magy Seb. 2014;67(4):252–5. https://doi.org/10.1556/MaSeb.67.2014.4.2.CrossRef

Haddad L, Bubenheim M, Bernard A, Melki J, Peillon C, Baste J-M. The interest of performing "on-demand chest X-rays" after lung resection by minimally invasive surgery. Thorac Cardiovasc Surg. 2017;65(7):572–80. https://doi.org/10.1055/s-0037-1599793.CrossRef

Leschber G, May CJ, Simbrey-Chryselius N. Postoperatives Röntgenbild: Immer notwendig? Zentralbl Chir. 2014;139(Suppl 1):S43–9. https://doi.org/10.1055/s-0034-1383034.PubMed

Nagy P, Antony C, Hegedüs B, Kampe S, Ploenes T, Aigner C, et al. Routine-Röntgenaufnahmen des Thorax am OP-Tag nach thoraxchirurgischen Operationen: Nicht erforderlich! Zentralbl Chir. 2018;143(1):96–101. https://doi.org/10.1055/s-0043-117174.CrossRef

Reeb J, Falcoz P-E, Olland A, Massard G. Are daily routine chest radiographs necessary after pulmonary surgery in adult patients? Interact Cardiovasc Thorac Surg. 2013;17(6):995–8. https://doi.org/10.1093/icvts/ivt352.CrossRef

Nekolla EA, Schegerer AA, Griebel J, Brix G. Häufigkeit und Dosis diagnostischer und interventioneller Röntgenanwendungen: Trends zwischen 2007 und 2014. Radiologe. 2017;57(7):555–62. https://doi.org/10.1007/s00117-017-0242-y.CrossRef

Vezzani A, Manca T, Brusasco C, Santori G, Valentino M, Nicolini F, et al. Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation. J Cardiothorac Vasc Anesth. 2014;28(6):1527–32. https://doi.org/10.1053/j.jvca.2014.04.012.CrossRef

10.

Johnson B, Rylander M, Beres AL. Do X-rays after chest tube removal change patient management? J Pediatr Surg. 2017;52(5):813–5. https://doi.org/10.1016/j.jpedsurg.2017.01.047.CrossRef

11.

John MM, Bibi S. eComment. Daily routine chest radiographs after pulmonary surgery. Interact Cardiovasc Thorac Surg. 2013;17(6):998–9. https://doi.org/10.1093/icvts/ivt422.CrossRef

12.

Mets O, Spronk PE, Binnekade J, Stoker J, de Mol BAJM, Schultz MJ. Elimination of daily routine chest radiographs does not change on-demand radiography practice in post-cardiothoracic surgery patients. J Thorac Cardiovasc Surg. 2007;134(1):139–44. https://doi.org/10.1016/j.jtcvs.2007.02.029.CrossRef

13.

Alrajab S, Youssef AM, Akkus NI, Caldito G. Pleural ultrasonography versus chest radiography for the diagnosis of pneumothorax: review of the literature and meta-analysis. Crit Care. 2013;17(5):R208. https://doi.org/10.1186/cc13016.CrossRef

14.

Ding W, Shen Y, Yang J, He X, Zhang M. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011;140(4):859–66. https://doi.org/10.1378/chest.10-2946.CrossRef

15.

Wilkerson RG, Stone MB. Sensitivity of bedside ultrasound and supine anteroposterior chest radiographs for the identification of pneumothorax after blunt trauma. Acad Emerg Med. 2010;17(1):11–7. https://doi.org/10.1111/j.1553-2712.2009.00628.x.CrossRef

16.

Galetin T, Defosse J, Schieren M, Marks B, Lopez-Pastorini A, Koryllos A, et al. Sensitivity of chest ultrasound for postoperative pneumothorax in comparison to chest X-ray after lung resecting surgery. Eur J Cardio Thoracic Surg. 2019;57(5):846–53. https://doi.org/10.1093/ejcts/ezz332.CrossRef

17.

Galetin T, Schieren M, Marks B, Defosse J, Stoelben E. Sensitivity of lung ultrasound for the detection of pneumothorax one day after pulmonary resection—a prospective observational study. Eur Surg. 2020;53(1):23–8. https://doi.org/10.1007/s10353-020-00676-7.CrossRef

18.

Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659–70. https://doi.org/10.1378/chest.14-1313.CrossRef

19.

Lichtenstein DA. Lung ultrasound in the critically ill: the BLUE protocol. Cham: Springer; 2016. https://doi.org/10.1007/978-3-319-15371-1.CrossRef

20.

Staquet M, Rozencweig M, Lee YJ, Muggia FM. Methodology for the assessment of new dichotomous diagnostic tests. J Chronic Dis. 1981;34(12):599–610. https://doi.org/10.1016/0021-9681(81)90059-X.CrossRefPubMed

21.

Smargiassi A, Inchingolo R, Chiappetta M, Ciavarella LP, Lopatriello S, Corbo GM, et al. Agreement between chest ultrasonography and chest X-ray in patients who have undergone thoracic surgery: preliminary results. Multidiscip Respir Med. 2019;14(1):9. https://doi.org/10.1186/s40248-019-0171-x.CrossRef

22.

Soult MC, Collins JN, Novosel TJ, Weireter LJ, Britt LD. Thoracic ultrasound can predict safe removal of thoracostomy tubes. J Trauma Acute Care Surg. 2014;77(2):256–61. https://doi.org/10.1097/TA.0000000000000315.CrossRef

23.

Goudie E, Bah I, Khereba M, Ferraro P, Duranceau A, Martin J, et al. Prospective trial evaluating sonography after thoracic surgery in postoperative care and decision making. Eur J Cardiothorac Surg. 2012;41(5):1025–30. https://doi.org/10.1093/ejcts/ezr183.CrossRef

24.

Patella M, Saporito A, Puligheddu C, Mongelli F, La Regina D, Pini R, et al. Lung ultrasound to detect residual pneumothorax after chest drain removal in lung resections. Ann Thorac Surg. 2018;105(5):1537–42. https://doi.org/10.1016/j.athoracsur.2017.12.008.CrossRef

25.

Sperandeo M, Rotondo A, Guglielmi G, Catalano D, Feragalli B, Trovato GM. Transthoracic ultrasound in the assessment of pleural and pulmonary diseases: use and limitations. Radiol Med. 2014;119(10):729–40. https://doi.org/10.1007/s11547-014-0385-0.CrossRef

26.

Volpicelli G. Lung ultrasound in pneumothorax: the continuing need for appropriate use and correct interpretation. J Emerg Med. 2017;53(2):e25–6. https://doi.org/10.1016/j.jemermed.2017.03.048.CrossRef

27.

Ciwit BV. Castor Electronic Data Capture. Amsterdam: Castor; 2016.

28.

Team RC. R: a language and environment for statistical computing. Vienna: R-project; 2018. Available from: https://www.R-project.org/

29.

Doebler P. mada: Meta-Analysis of Diagnostic Accuracy; 2019; Available from: https://CRAN.R-project.org/package=mada.

30.

Teitler N. Examiner bias: influence of patient history on perceptual ratings of videostroboscopy. J Voice. 1995;9(1):95–105. https://doi.org/10.1016/S0892-1997(05)80227-9.CrossRef

31.

Sackett DL. Bias in analytic research. J Chronic Dis. 1979;32(1–2):51–63. https://doi.org/10.1016/0021-9681(79)90012-2.CrossRef

32.

Galetin T, Stoelben E. Sensitivity of lung ultrasound for postsurgical pneumothorax. Ann Thorac Surg. 2019;108(3):960–1. https://doi.org/10.1016/j.athoracsur.2019.01.074.CrossRef

33.

Lichtenstein DA, Lascols N, Prin S, Mezière G. The "lung pulse": an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29(12):2187–92. https://doi.org/10.1007/s00134-003-1930-9.CrossRef

34.

Yue Lee FC, Jenssen C, Dietrich CF. A common misunderstanding in lung ultrasound: the comet tail artefact. Med Ultrason. 2018;20(3):379–84. https://doi.org/10.11152/mu-1573.CrossRef

35.

Lichtenstein DA. Current misconceptions in lung ultrasound: a short guide for experts. Chest. 2019;156(1):21–5. https://doi.org/10.1016/j.chest.2019.02.332.CrossRef

36.

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(Suppl 3):S359–62. https://doi.org/10.21037/jtd.2018.12.81.CrossRef

37.

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):946–54. https://doi.org/10.1111/anae.14243.CrossRef

Title: Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study
Authors: Thomas Galetin
Julika Merres
Mark Schieren
Benjamin Marks
Yves Haffke
Jerome Defosse
Frank Wappler
Aris Koryllos
Erich Stoelben
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Ultrasound
Pneumothorax
Pneumothorax
Pneumothorax
Ultrasound
Thoracic Ultrasound
Lung Ultrasound
Published in: Journal of Cardiothoracic Surgery / Issue 1/2021
Electronic ISSN: 1749-8090
DOI: https://doi.org/10.1186/s13019-021-01454-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Most patient conditions do not a priori debilitate the sensitivity of thoracic ultrasound in thoracic surgery-a prospective comparative study

Abstract

Background

Methods

Results

Conclusions

Trial registration

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2021

Localization of subcentimeter pulmonary nodules using an indocyanine green near-infrared imaging system during uniportal video-assisted thoracoscopic surgery

Large papillary fibroelastoma of right atrium, an unusual case of respiratory distress in a young man

ACURATE neo™ aortic valve implantation via carotid artery access: first case report

Quality of life: modified triple-branched stent graft implantation versus frozen elephant trunk technique

Surgical techniques for aortic valve xenotransplantation

Preliminary study of the characteristics of rib fractures and their impact on pulmonary ventilatory function