Repeated Monitoring With Transthoracic Echocardiography and Lung Ultrasound After Cardiac Surgery: Feasibility and Impact on Diagnosis
Section snippets
Methods
This prospective observational study received ethics approval from the King Saud University Health System (Riyadh, Saudi Arabia) and the Melbourne Health Human Ethics Committee (Australia). Patients presenting for cardiac surgery between July 2011 and August 2012 at The King Fahad Cardiac Center of King Saud University were screened for inclusion (convenience sampling) by research personnel. Inclusion criteria included patients older than 18 and informed consent from the patient or legal
Statistical Analysis
The sample size calculation was based on reported data from TTE performed on emergency noncardiac surgery patients,21 in which assessment for concordance between clinical and ultrasound assessment of the hemodynamic state was 50%. A sample size of 77 pairs will have 80% power to detect a difference in proportions of 10% when the proportion of discordant pairs is expected to be 12% using McNemar’s test, with a significance of p<0.05. To account for patient exclusions and an expected 12% rate of
Results
Of the 275 patients who underwent cardiac surgery over the study period, 91 were recruited when researchers were available for recruitment and data were complete in all patients. Patient characteristics are shown in Table 2. Comparison of the diagnosis of cardiac and respiratory abnormalities between clinical assessment and ultrasound over the 3 time points (T1-the day after surgery, T2-after extubation and removal of drains, and T3-prior to discharge) are shown in Table 3, Table 4, Table 5.
Discussion
This study demonstrated proof of concept that TTE and LU result in a change in diagnosis in a high proportion of patients when performed after cardiac surgery at repeated intervals, providing utility as routine monitors for complications, rather than to provide diagnosis for persistent shock, as previously has been reported. It also was shown that LU provided additional diagnostic value to TTE, which can be performed conveniently at the same time.
Feasibility of TTE performed on patients after
Acknowledgments
This project was supported by National Science, Technology and Innovation. Plan, King Abdulaziz City for Science and Technology, Kingdom of Saudi Arabia (Grant number 11-MED 1932-02). The funding body had no involvement in study design; in the collection, analysis and interpretation of data; in the writing of the report; and in the decision to submit the article for publication. The authors are grateful for Drs. Fakhr Al Ayoubi, KN Asfena and Mr. Nabeel Rabea, RN who managed, recorded the data,
References (30)
- et al.
Major complications related to the use of transesophageal echocardiography in cardiac surgery
J Cardiothorac Vasc Anesth
(2009) - et al.
Elimination of daily routine chest radiographs does not change on-demand radiography practice in post-cardiothoracic surgery patients
J Thorac Cardiovasc Surg
(2007) - et al.
Transthoracic echocardiography to identify or exclude cardiac cause of shock
Chest
(2004) - et al.
Diagnostic accuracy and therapeutic impact of transthoracic and transesophageal echocardiography in mechanically ventilated patients in the ICU
Chest
(1994) - et al.
Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes
J Criti Care
(2014) - et al.
Inadequate visualization and reporting of ventricular function from transthoracic echocardiography after cardiac surgery
J Cardiothorac Vasc Anesth
(2010) - et al.
Relevance of lung ultrasound in the diagnosis of acute respiratory failure: The BLUE protocol
Chest
(2008) Ultrasound-guided haemodynamic state assessment
Best Pract Res Clin Anaesthesiol
(2009)- et al.
Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice
J Am Soc Echocardiograph
(2009) - et al.
Recommendations for evaluation of the severity of native valvular regurgitation with two-dimensional and Doppler echocardiography
J Am Soc Echocardiograph
(2003)