Point of Care Ultrasound to Identify Diaphragmatic Dysfunction after Thoracic Surgery

Area of Science:

• Thoracic Surgery
• Pulmonary Medicine
• Diagnostic Ultrasound

Background:

• Postoperative diaphragmatic dysfunction (PDD) after thoracic surgery is often underestimated.
• Lack of reproducible bedside diagnostic methods hinders accurate assessment.
• Point-of-care ultrasound (POCUS) offers a potential solution for bedside evaluation.

Purpose of the Study:

• To compare the incidence of PDD between video-assisted thoracoscopic surgery (VATS) and thoracotomy.
• To assess the association between PDD and postoperative pulmonary complications (PPCs).
• To evaluate the utility of POCUS in assessing diaphragmatic function post-thoracic surgery.

Main Methods:

• Prospective observational cohort study comparing VATS and thoracotomy patients.
• Diaphragmatic function assessed using POCUS (diaphragmatic excursion < 10 mm indicates dysfunction).
• Ultrasound evaluations performed preoperatively and at 2 and 24 hours postoperatively; PPCs monitored for 7 days.

Main Results:

• Higher incidence of PDD at 24 hours postoperatively in the thoracotomy group (83%) versus VATS group (55%).
• PDD on postoperative day 1 was significantly associated with increased PPCs (OR=5.5).
• Lower rates of atelectasis observed in the VATS group compared to the thoracotomy group (13% vs. 46%).

Conclusions:

• POCUS is a viable tool for evaluating diaphragmatic function in the postoperative thoracic surgery setting.
• VATS is associated with a lower incidence of PDD compared to thoracotomy.
• PDD is a significant risk factor for developing PPCs after thoracic surgery.