Moharir Alok, Yamaguchi Yoshikazu, Aldrink Jennifer H, Martinez Andrea, Arce-Villalobos Mauricio, Yemele Kitio Sibelle Aurelie, Rice-Weimer Julie, Tobias Joseph D
From the Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, Ohio.
Department of Anesthesiology & Pain Medicine, The Ohio State University, Columbus, Ohio.
Anesth Analg. 2024 Dec 1;139(6):1294-1299. doi: 10.1213/ANE.0000000000007155. Epub 2024 Nov 15.
Minimally invasive thoracic surgical techniques require effective lung isolation using one-lung ventilation (OLV). Verification of lung isolation may be confirmed by auscultation, visual confirmation using fiberoptic bronchoscopy (FOB), or more recently, point-of-care ultrasound (POCUS). The aim of this study was to prospectively compare lung ultrasound with clinical auscultation to confirm OLV before thoracic surgery in pediatric patients.
This prospectively blinded feasibility study included 40 patients ranging in age from 0 to 20 years. After confirmation of lung separation by the primary anesthesia team using FOB, the sonographer and the auscultator, both blinded to the laterality of surgery and lung separation, entered the operating room. The sonographer evaluated for pleural lung sliding and the auscultator listened for breath sounds. Successful lung separation was definitively confirmed by direct visualization of lung collapse during the operation.
In confirming effective single-lung ventilation, lung ultrasound had a diagnostic accuracy of 95% (95% confidence interval [CI], 82.7%-98.5%). In contrast, auscultation could only reliably confirm lung isolation with 68% accuracy (95% CI, 51.5%-80.4%). The McNemar test showed a statistically significant difference between the use of lung ultrasound and auscultation ( P < .001). The median time to perform ultrasonography was 67 seconds (interquartile range [IQR], 46-142) and the median time to perform auscultation was 21 seconds (IQR, 10-32).
Based on the initial results of our feasibility trial, lung ultrasound proved to be a fast and reliable method to verify single-lung ventilation in pediatric patients presenting for thoracic surgery with a high degree of diagnostic accuracy.
微创胸外科技术需要通过单肺通气（OLV）实现有效的肺隔离。肺隔离的确认可通过听诊、使用纤维支气管镜（FOB）进行视觉确认，或最近通过床旁超声（POCUS）来完成。本研究的目的是前瞻性地比较肺部超声与临床听诊，以在小儿患者胸外科手术前确认OLV。
这项前瞻性双盲可行性研究纳入了40例年龄在0至20岁之间的患者。在主麻醉团队使用FOB确认肺分离后，超声检查医师和听诊者进入手术室，二者均不知手术侧别和肺分离情况。超声检查医师评估胸膜肺滑动情况，听诊者听诊呼吸音。术中通过直接观察肺萎陷明确确认成功的肺分离。
在确认有效的单肺通气方面，肺部超声的诊断准确率为95%（95%置信区间[CI]，82.7%-98.5%）。相比之下，听诊仅能以68%的准确率可靠地确认肺隔离（95%CI，51.5%-80.4%）。McNemar检验显示，肺部超声和听诊的使用之间存在统计学显著差异（P<.00!）。进行超声检查的中位时间为67秒（四分位间距[IQR]，46-142），进行听诊的中位时间为21秒（IQR，10-32）。
基于我们可行性试验的初步结果，肺部超声被证明是一种快速且可靠的方法，用于在接受胸外科手术的小儿患者中验证单肺通气，具有高度的诊断准确性。
