Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
Division of Cardiothoracic and Vascular Anaesthesiology, Department of Anaesthesiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, India.
J Cardiothorac Vasc Anesth. 2022 Nov;36(11):4039-4044. doi: 10.1053/j.jvca.2022.06.035. Epub 2022 Jul 1.
The primary objective was to study the degree of agreement between the chest ultrasound (CUS) studies and chest x-ray (CXR) studies in postoperative pediatric cardiac surgical patients regarding the diagnosis of thoracic abnormalities, and also to compare the diagnostic performance of CUS in reference to CXR for the detection of thoracic abnormalities. The secondary objective was to compare the necessity for interventions done on the basis of CUS and CXR findings in the postoperative setting.
A prospective observational study.
At a postoperative pediatric cardiac surgical intensive care unit in a tertiary-care center.
One hundred sixty patients between the age of 2 months to 18 years undergoing elective cardiac surgery for various congenital heart diseases.
After obtaining permission from the institutional ethics committee, 160 pediatric cardiac surgical patients were studied prospectively in the postoperative period. On the day of surgery (postoperative day [POD] 0), bedside CXR was done in the immediate postoperative period. After bedside CXR, CUS examination was performed and then interpreted by the principal investigator. The CXR was interpreted by the surgical team. Provisional diagnosis was made by the principal investigator and surgical team. Any intervention required was decided based on CXR or CUS findings or both. The procedure was repeated in the morning of POD 1.
The degree of agreement between CUS studies and CXR studies in detecting abnormalities was evaluated by Cohen's kappa (k) statistics. The diagnostic performance of CUS was compared with that of CXR using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy. Overall, kappa analysis (k) showed substantial agreement between the findings of the CUS and CXR studies (k = 0.749). The diagnostic performance of CUS, as compared with CXR, was found to have a sensitivity of 96.9%, specificity of 84.75%, PPV of 73.4%, NPV of 98.43%, and diagnostic accuracy of 88.44%. In 94 abnormal findings, the interventions were done based on CUS or CXR findings or both. Overall, there was a substantial agreement (k = 0.787) between CUS and CXR regarding the necessity for interventions.
The degree of agreement between CUS and CXR studies was substantial for atelectasis, interstitial edema, and diaphragmatic weakness. The degree of agreement between CUS and CXR studies was almost perfect for pneumothorax and fair for pleural effusion. More CUS studies detected intrathoracic pathologies than CXR studies. The CUS also detected abnormalities earlier than CXR and was found to be useful for the early institution of intervention therapy in patients with interstitial edema and atelectasis. It would be reasonable to conclude that CUS may be considered in some instances as an alternative to CXR.
本研究旨在探讨术后儿科心脏外科患者的胸部超声（CUS）与胸部 X 线（CXR）检查在诊断胸部异常方面的一致性程度，并比较 CUS 与 CXR 在检测胸部异常方面的诊断性能。次要目的是比较基于 CUS 和 CXR 检查结果在术后进行干预的必要性。
前瞻性观察性研究。
在一家三级医疗中心的术后儿科心脏外科重症监护病房。
160 名年龄在 2 个月至 18 岁之间的患者，因各种先天性心脏病接受择期心脏手术。
在获得机构伦理委员会的许可后，前瞻性研究了 160 名儿科心脏外科患者的术后情况。手术当天（术后第 0 天），立即在术后进行床边 CXR。在床边 CXR 之后，进行 CUS 检查，由主要研究者进行解释。CXR 由手术团队进行解释。主要研究者和手术团队做出临时诊断。根据 CXR 或 CUS 检查结果或两者，决定是否需要进行任何干预。在术后第 1 天早上重复该程序。
通过 Cohen's kappa（k）统计评估 CUS 研究与 CXR 研究在检测异常方面的一致性程度。使用敏感性、特异性、阳性预测值（PPV）、阴性预测值（NPV）和诊断准确性比较 CUS 与 CXR 的诊断性能。总体而言，kappa 分析（k）显示 CUS 和 CXR 研究结果之间存在高度一致（k=0.749）。与 CXR 相比，CUS 的诊断性能表现为敏感性 96.9%、特异性 84.75%、PPV 73.4%、NPV 98.43%和诊断准确性 88.44%。在 94 个异常发现中，干预措施是基于 CUS 或 CXR 检查结果或两者决定的。总体而言，CUS 和 CXR 关于干预必要性的一致性程度为高度一致（k=0.787）。
CUS 与 CXR 研究在肺不张、间质水肿和膈肌无力方面的一致性程度较高。CUS 与 CXR 研究在气胸方面的一致性程度几乎为完美，在胸腔积液方面的一致性程度为良好。更多的 CUS 研究检测到了胸腔内的病理变化，而不是 CXR 研究。CUS 还比 CXR 更早地发现异常，并且在间质水肿和肺不张患者中早期进行干预治疗方面具有一定的作用。因此，我们可以合理地得出结论，在某些情况下，CUS 可以作为 CXR 的替代方法。
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