Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery
| Autor: | N. Tamburini, Savino Spadaro, F. Dalla Corte, Carlo Alberto Volta, E. De Camillis, R. Ragazzi, V. Alvisi, Salvatore Grasso, P. Maniscalco, Tania Stripoli, Alberto Fogagnolo, G. Cavallesco, M. Dres |
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| Jazyk: | angličtina |
| Rok vydání: | 2019 |
| Předmět: |
Male
medicine.medical_specialty Point-of-Care Systems Diaphragm MEDLINE Diaphragmatic breathing thoracotomy NO Cohort Studies 03 medical and health sciences Postoperative Complications 0302 clinical medicine Postoperative diaphragmatic dysfunction Risk Factors 030202 anesthesiology Humans Medicine Prospective Studies Prospective cohort study Aged Ultrasonography Thoracic Surgery Video-Assisted business.industry Point of care ultrasound ultrasound evaluation Reproducibility of Results thoracic surgery video-assisted thoracoscopic surgery Postoperative diaphragmatic dysfunction thoracic surgery postoperative pulmonary complications video-assisted thoracoscopic surgery thoracotomy ultrasound evaluation Anesthesiology and Pain Medicine 030228 respiratory system Cardiothoracic surgery Female Observational study postoperative pulmonary complications Radiology Diaphragmatic excursion business Cohort study |
| Popis: | Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Postoperative diaphragmatic dysfunction after thoracic surgery is underestimated due to the lack of reproducible bedside diagnostic methods. We used point of care ultrasound to assess diaphragmatic function bedside in patients undergoing video-assisted thoracoscopic or thoracotomic lung resection. Our main hypothesis was that the thoracoscopic approach may be associated with lower incidence of postoperative diaphragm dysfunction as compared to thoracotomy. Furthermore, we assessed the association between postoperative diaphragmatic dysfunction and postoperative pulmonary complications. Methods This was a prospective observational cohort study. Two cohorts of patients were evaluated: those undergoing video-assisted thoracoscopic surgery versus those undergoing thoracotomy. Diaphragmatic dysfunction was defined as a diaphragmatic excursion less than 10 mm. The ultrasound evaluations were carried out before (preoperative) and after (i.e., 2 h and 24 h postoperatively) surgery. The occurrence of postoperative pulmonary complications was assessed up to 7 days after surgery. Results Among the 75 patients enrolled, the incidence of postoperative diaphragmatic dysfunction at 24 h was higher in the thoracotomy group as compared to video-assisted thoracoscopic surgery group (29 of 35, 83% vs. 22 of 40, 55%, respectively; odds ratio = 3.95 [95% CI, 1.5 to 10.3]; P = 0.005). Patients with diaphragmatic dysfunction on the first day after surgery had higher percentage of postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.001). Radiologically assessed atelectasis was 46% (16 of 35) in the thoracotomy group versus 13% (5 of 40) in the video-assisted thoracoscopic surgery group (P = 0.040). Univariate logistic regression analysis indicated postoperative diaphragmatic dysfunction as a risk factor for postoperative pulmonary complications (odds ratio = 5.5 [95% CI, 1.9 to 16.3]; P = 0.002). Conclusions Point of care ultrasound can be used to evaluate postoperative diaphragmatic function. On the first postoperative day, diaphragmatic dysfunction was less common after video-assisted than after the thoracotomic surgery and is associated with postoperative pulmonary complications. |
| Databáze: | OpenAIRE |
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