P-224THE USE OF TRANSTHORACIC ULTRASOUND FOR THE ASSESSMENT OF LUNG EXPANSION COMBINED WITH DIGITAL AIR LEAK MEASUREMENT IN THORACIC SURGERY PATIENTS

• Published in: Interactive cardiovascular and thoracic surgery Vol. 17; no. suppl_1; p. S58
• Main Authors: Chavarin, Abraham, Mier, J.M., Fibla, J.J., Izquierdo-Vidal, C., Molins, L.
• Format: Journal Article
• Language: English
• Published: Oxford University Press 01.07.2013
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt288.224

Objectives To evaluate the use of transthoracic lung ultrasound (LU) in post-thoracic surgery patients paired with digital air leak measurement for the assessment of lung expansion and/or residual pneumothorax, as a possible substitute to chest radiographs. Methods We included 55 surgically placed chest drains, 32 non-pulmonary and 23 pulmonary surgery cases. Transthoracic LU evaluation of the anterior and anterolateral chest wall was performed 20 minutes after chest drain placement, the presence or absence of lung sliding was recorded, and a digital air leak measurement was taken. A cut-off point of 20 ml/min air leak value was set for chest drain removal. Digital chest radiograph was obtained and reported in all cases. Results Lung sliding was present in 46 cases, and an air leak value of 20 ml/min or less was reported in 49 cases, 83.63% and 89.09% respectively. When compared, LU vs digital air leak measurement of <20 ml/min, LU has a sensitivity and specificity of 91.84% and 83.33% respectively for the diagnosis of full lung expansion, with a positive predictive value (PPV) of 97.83% and a negative predictive value (NPV) of 55.56%. In non-pulmonary surgery cases, a 100% agreement (Cohen's kappa 1.0) between LU and chest radiograph, and LU vs digital chest drain measurements was obtained. In pulmonary surgery, sensitivity is 76.47% and PPV is 92.86%. Conclusions The observation of lung sliding in a transthoracic LU evaluation when paired with a digital air leak value of 20 ml/min or less, can safely exclude pneumothorax in post-thoracic surgery patients and no further radiographic exploration is warranted, especially in non-pulmonary surgery cases. However, in pulmonary surgery cases, resection volume and site have to be taken into consideration, as the surgical absence of pulmonary tissue will result in absent lung sliding, even in cases with low air leak values. Disclosure All authors have declared no conflicts of interest.