Newly Published
Perioperative Medicine  |   May 2019
Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery
Author Notes
  • From the Department of Morphology, Surgery and Experimental Medicine, Intensive Care Unit, Sant’Anna Hospital, Ferrara, Italy (S.S., A.F., F.D.C., N.T., P.M., G.C., V.A., E.D.C., R.R., C.A.V.), the Department of Emergency and Organ Transplant, Aldo Moro University of Bari, Bari, Italy (S.G., T.S.), and Sorbonne Universités, UPMC Université Paris 06, INSERM, UMRS1158 Neurophysiologie respiratoire expérimentale et clinique, Paris, France (M.D.).
  • Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).
    Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are available in both the HTML and PDF versions of this article. Links to the digital files are provided in the HTML text of this article on the Journal’s Web site (www.anesthesiology.org).×
  • Submitted for publication May 17, 2018. Accepted for publication April 4, 2019.
    Submitted for publication May 17, 2018. Accepted for publication April 4, 2019.×
  • Correspondence: Address correspondence to Dr. Spadaro: Department of Morphology, Surgery and Experimental Medicine, University of Ferrara, Anesthesia and Intensive Care Unit, Sant’Anna Hospital 8 Aldo Moro, 44125 Ferrara, Italy. savinospadaro@gmail.com. Information on purchasing reprints may be found at www.anesthesiology.org or on the masthead page at the beginning of this issue. Anesthesiology’s articles are made freely accessible to all readers, for personal use only, 6 months from the cover date of the issue.
Article Information
Perioperative Medicine / Respiratory System / Thoracic Anesthesia
Perioperative Medicine   |   May 2019
Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery
Anesthesiology Newly Published on May 22, 2019. doi:10.1097/ALN.0000000000002774
Anesthesiology Newly Published on May 22, 2019. doi:10.1097/ALN.0000000000002774
Abstract

Editor’s Perspective:

What We Already Know about This Topic:

  • Patients undergoing thoracic surgery are at high risk for postoperative pulmonary complications

  • The feasibility of using point of care ultrasound to diagnose diaphragmatic dysfunction is unclear

What This Manuscript Tells Us That Is New:

  • Point of care ultrasound can be used to detect diaphragmatic dysfunction after thoracic surgery

  • Diaphragmatic dysfunction may be associated with postoperative pulmonary complications

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.