Optimization of lung ultrasound in ultrafast-track anesthesia for non-cyanotic congenital heart disease surgery

Abstract

Objective: We aimed to explore the feasibility of lung ultrasound for perioperative assessment and the optimal effect of lung ultrasound in reducing lung complications during non-cyanotic congenital heart disease (CHD) surgery using ultrafast-track anesthesia.

Methods: Sixty patients were treated at Shenzhen Children's Hospital between 2019 and 2020. Of these, 30 patients in group N had an indication for extubation and ultrafast-track anesthesia after congenital heart surgery; the tracheal catheter was removed, and the patients were sent to the cardiac intensive care unit (CICU) for further monitoring and treatment. Another 30 patients were in group L and also had an indication for extubation and ultrafast-track anesthesia; in addition we compared lung ultrasound score (LUS) before and after surgery, when we found the cases that LUS ≥ 15, for whom targeted optimization treatment would be carried out. The tracheal catheter was removed after LUS <15 days before the patients were sent to the CICU. In all cases, the LUS and PaO2/FiO2 ratios (P/F) of both groups were recorded at the time of anesthesia induction (T₀), before extubation (T₁), and 5 min (T₂), 1 h (T₃), and 24 h (T₄) after extubation. The incidence of pulmonary complications, LUS, and P/F were compared between the two groups.

Results: There was great consistency between LUS and radiographic findings. Comparing the data of the two groups at T₂, T₃ and T₄, the P/F was higher and the LUS was lower in group L than in group N. The incidence of lung complications in group L (18 cases, 60 %) was lower than that in group N (26 cases, 86.7 %, χ2 = 5.46, P = 0.02); comparing LUS between T₀ and T₃, LUS decreased in a greater number of cases in group L (15, 50 %) than in group N (7 cases, 23.3 %, χ2 = 4.59, P = 0.032).

Conclusion: Lung ultrasonography can effectively help assess lung conditions. Optimization guided by lung ultrasound in ultrafast track anesthesia can significantly reduce postoperative lung complications.

Keywords: Lung ultrasound; Non-cyanotic congenital heart disease; Optimization; Ultrafast-track anesthesia.

Fig. 1

Schematic Diagram of Lung Ultrasound ALP Division. (A) (B) The surface of each lung is divided into 6 areas，and the bilateral lungs are divided into 12 regions.

Fig. 2

Lung ultrasound scoring: (A) Normal A -line LUS = 0, (B) Independent presence of a single B-lines, LUS = 1 point, (C) Independent presence of multiple B-lines, LUS = 1 point, (D) B-Line Fusion LUS = 2 points, (E) Bronchial inflation sign, or B-Line Fusion LUS = 2 points, (F) Pulmonary consolidation or atelectasis LUS = 3 points.

Fig. 3

(A) Before fiberoptic bronchoscope irrigation, there were many sticky secretions in the trachea, which are not easy to be sucked out，(B) Rinsed with saline to dilute the secretions, (C) The trachea was much cleaner after fiberoptic bronchoscope irrigation.

Fig. 4

(A) Before optimization of manual hyperinflation LUS = 3 points, (B) Under optimization of manual hyperinflation guided by ultrasound LUS = 2 points, (C) After optimization of manual hyperinflation LUS = 1 point, (D) Before optimization of endotracheal sputum aspiration LUS = 2 points, (E) After optimization of endotracheal sputum aspiration (A-line reappeared) LUS = 0.

Fig. 5

Spearman correlation analysis and scatter plot between LUS and OI at each time point of all cases (n = 60). (A) Anesthesia induction (T₀), (B) before extubation (T1), (C) 5min after extubation(T₂), (D) 1 h after extubation (T₃), (E) 24 h after extubation (T₄).

Fig. 6

ROC analysis of lung ultrasound score (LUS) to predict the occurrence of pulmonary complications.