Lung Ultrasound as a Predictor of fast track extubation in Pediatric Cardiac Surgery (Original Article)

Document Type : Original Article

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Department of Anesthesia, Kasr Alainy Faculty of Medicine, Cairo University, Cairo, Egypt

Abstract

Background: Fast-tracking in cardiac surgery refers to the early extubation,Lung ultrasound can detect pulmonary congestion by assessing extravascular lung water. This study aims to show if immediate postoperative lung ultrasound together with the measurement of arterial blood gas at the end of pediatric cardiac surgeries can predict extubation within the next 6 hours.
Method:: A prospective observational study, where forty-five pediatric patients underwent repair of congenital heart diseases with cardiopulmonary bypass. Patients were examined with arterial blood gases and lung ultrasound after induction of anesthesia and at the end of the surgery, and given a score according to the number of B lines in each region, the receiver operating characteristics (ROC) curve was used to assess the predictive value of lung ultrasound score (LUS) and PaO2/FiO2(PF) ratio to predict early extubation at the optimal cutoff points.
Results: Thirty two children (71%) were extubated early, and thirteen children (29%) experienced delayed extubation. The LUS showed good discriminative power for the prediction of early extubation (area under the ROC curve (AUC) 0.95 with sensitivity (93%) and specificity (89%) at cutoff point < 13. The PF ratio was less sensitive (87%) but more specific (100%) for the prediction of early extubation at a cutoff point > 230. The study showed a strong negative correlation between LUS and PF ratio (r = 0.76, p-value <0.001). We found an adequate interobserver agreement for LUS (weighted kappa 0.94)
Conclusions: Lung ultrasound is a simple, non-invasive, reproducible, and reliable tool for predicting early extubation .

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