This chapter will focus on the use of ultrasound-based imaging techniques to monitor cardiorespiratory function and anatomy in patients undergoing thoracic surgery. The two primary applications discussed are echocardiography and lung ultrasound, both of which offer specific advantages over traditional perioperative monitoring tools.
Echocardiography is of special interest in thoracic anesthesia for its unique ability to monitor right ventricular function. In selected patients at risk for the development of right ventricular dysfunction, associated with lung disease or as a result of the surgical procedure, the use of intraoperative transesophageal echocardiography may assist in mitigating RV failure.
The diagnostic power of lung ultrasound has long been questioned as air is a strong reflector. However, pioneers in the field have shown that artefacts created by the interplay between lung tissue and ultrasound waves provide clinically relevant information about pulmonary and pleural function, and that specific lung disease states can be diagnosed through pattern recognition. In fact, lung ultrasound when used in combination with echocardiography offers incremental value in the perioperative assessment of patients undergoing thoracic surgery.
It is not yet clear whether the perioperative use of these techniques will affect surgical outcome. At present, there is a large practice variability with regard to the use of ultrasound in routine practice which appears to depend primarily on the individual anesthesiologist’s knowledge and experience with the technology. The growing interest has created a large need for training in the anesthesia community. Ideally, ultrasound training should be integrated in the basic curriculum of every anesthesiologists. In particular, anesthesiologists involved in the perioperative care of patients undergoing thoracic surgery should be encouraged to acquire the skills and knowledge necessary to perform a standardized basic echocardiography and lung ultrasound exam.
Ultrasound Echocardiography Lung ultrasonography Thoracic anesthesia Thoracic surgery Hemodynamic monitoring Cardiac function Right ventricle Perioperative care
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Lung sliding 1 (M4V 236 kb)
Lung pulse (M4V 234 kb)
Lung point 1 (M4V 247 kb)
Konstadt SN, Thys D, Mindich BP, Kaplan JA, Goldman M. Validation of quantitative intraoperative transesophageal echocardiography. Anesthesiology. 1986;65(4):418–21.PubMedCrossRefGoogle Scholar
Jensen MB, Sloth E. Echocardiography for cardiopulmonary optimization in the intensive care unit: should we expand its use? Acta Anaesthesiol Scand. 2004;48(9):1069–70.PubMedCrossRefGoogle Scholar
Lichtenstein DA, Menu Y. A bedside ultrasound sign ruling out pneumothorax in the critically ill: lung sliding. Chest. 1995;108(5):1345–8.PubMedCrossRefGoogle Scholar
Reusz G, Csomos A. The role of ultrasound guidance for vascular access. Curr Opin Anaesthesiol. 2015;28(6):710–6.PubMedGoogle Scholar
Barrington MJ, Uda Y. Did ultrasound fulfill the promise of safety in regional anesthesia? Curr Opin Anaesthesiol. 2018;31(5):649–55.PubMedCrossRefGoogle Scholar
Thys DM. Practice guidelines for perioperative transesophageal echocardiography. An updated report by the American Society of Anesthesiologists and the Society of Cardiovascular Anesthesiologists Task Force on Transesophageal Echocardiography. Anesthesiology. 2010;112(5):1084–96.Google Scholar
Mahmood F, Matyal R, Skubas N, Montealegre-Gallegos M, Swaminathan M, Denault A, et al. Perioperative ultrasound training in anesthesiology: a call to action. Anesth Analg. 2016;122(6):1794–804.PubMedCrossRefGoogle Scholar
Reeves ST, Finley AC, Skubas NJ, Swaminathan M, Whitley WS, Glas KE, et al. Basic perioperative transesophageal echocardiography examination: a consensus statement of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. Anesth Analg. 2013;117(3):543–58.PubMedCrossRefGoogle Scholar
Wink J, de Wilde RBP, Wouters PF, van Dorp ELA, Veering BT, Versteegh MIM, et al. Thoracic epidural anesthesia reduces right ventricular systolic function with maintained ventricular-pulmonary coupling. Circulation. 2016;134(16):1163–75.PubMedCrossRefGoogle Scholar
Evans A, Dwarakanath S, Hogue C, Brady M, Poppers J, Miller S, et al. Intraoperative echocardiography for patients undergoing lung transplantation. Anesth Analg. 2014;118(4):725–30.PubMedPubMedCentralCrossRefGoogle Scholar
Ashes C, Roscoe A. Transesophageal echocardiography in thoracic anesthesia: pulmonary hypertension and right ventricular function. Curr Opin Anaesthesiol. 2015;28(1):38–44.PubMedCrossRefGoogle Scholar
Sullivan B, Puskas F, Fernandez-Bustamante A. Transesophageal echocardiography in noncardiac thoracic surgery. Anesthesiol Clin. 2012;30(4):657–69.PubMedCrossRefGoogle Scholar
Kratz T, Holz S, Steinfeldt T, Exner M, dell’Orto MC, Kratz C, et al. Feasibility and impact of focused intraoperative transthoracic echocardiography on management in thoracic surgery patients: an observational study. J Cardiothorac Vasc Anesth. 2018;32(2):848–52.PubMedCrossRefGoogle Scholar
Lichtenstein D, van Hooland S, Elbers P, Malbrain MLNG. Ten good reasons to practice ultrasound in critical care. Anaesthesiol Intens Ther. 2014;46(5):323–35.CrossRefGoogle Scholar
Via G, Storti E, Gulati G, Neri L, Mojoli F, Braschi A. Lung ultrasound in the ICU: from diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol. 2012;78(11):1282–96.PubMedGoogle Scholar
Diaz-Gomez JL, Ripoll JG, Ratzlaff RA, Tavazzi G, Via G, Mookadam F, et al. Perioperative lung ultrasound for the cardiothoracic anesthesiologist: emerging importance and clinical applications. J Cardiothorac Vasc Anesth. 2017;31(2):610–25.CrossRefGoogle Scholar
Lichtenstein DA, Mezière GA. The BLUE-points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure. Crit Ultrasound J. 2011;3(2):109–10.CrossRefGoogle Scholar
Lichtenstein DA, Mezière GA, Lagoueyte J-F, Biderman P, Goldstein I, Gepner A. A-lines and B-lines: lung ultrasound as a bedside tool for predicting pulmonary artery occlusion pressure in the critically ill. Chest. 2009;136(4):1014–20.PubMedCrossRefGoogle Scholar
Lichtenstein DA. BLUE-protocol and FALLS-protocol: two applications of lung ultrasound in the critically ill. Chest. 2015;147(6):1659–70.PubMedCrossRefGoogle Scholar
Lichtenstein D, Mézière G, Biderman P, Gepner A, Barré O. The comet-tail artifact. Am J Respir Crit Care Med. 2012;156(5):1640–6.CrossRefGoogle Scholar
Eibenberger KL, Dock WI, Ammann ME, Dorffner R, Hörmann MF, Grabenwöger F. Quantification of pleural effusions: sonography versus radiography. Radiology. 1994;191(3):681–4.PubMedCrossRefGoogle Scholar
Ponsonnard S, Gardet E, Bertin F, Marsaud JP, Fuzier R, Nathan N. Value of lung sonography to control of right-sided double lumen endotracheal tube location: 1AP2-1. Eur J Anaesthesiol. 2012;29:8.CrossRefGoogle Scholar
Lichtenstein DA, Lascols N, Prin S, Mézière G. The “lung pulse”: an early ultrasound sign of complete atelectasis. Intensive Care Med. 2003;29(12):2187–92.PubMedCrossRefGoogle Scholar
Saporito A, Piccolo Lo A, Franceschini D, Tomasetti R, Anselmi L. Thoracic ultrasound confirmation of correct lung exclusion before one-lung ventilation during thoracic surgery. J Ultrasound. 2013;16(4):195–9.PubMedPubMedCentralCrossRefGoogle Scholar
Bouhemad B, Brisson H, Le-Guen M, Arbelot C, Lu Q, Rouby J-J. Bedside ultrasound assessment of positive end-expiratory pressure-induced lung recruitment. Am J Respir Crit Care Med. 2011;183(3):341–7.PubMedCrossRefGoogle Scholar
Chavarín A, Mier JM, Fibla JJ, Izquierdo-Vidal C, Molins L. The use of transthoracic ultrasound for the assessment of lung expansion combined with digital air leak measurement in thoracic surgery patients. Interact Cardiovasc Thorac Surg. 2013;17:S58.CrossRefGoogle Scholar
Lichtenstein D, Hulot JS, Rabiller A, Tostivint I, Meziere G. Feasibility and safety of ultrasound-aided thoracentesis in mechanically ventilated patients. Intensive Care Med. 1999;25(9):955–8.PubMedCrossRefGoogle Scholar
Sengupta S. Post-operative pulmonary complications after thoracotomy. Ind J Anaesth. 2015;59(9):618–26.CrossRefGoogle Scholar
Dubé B-P, Dres M, Mayaux J, Demiri S, Similowski T, Demoule A. Ultrasound evaluation of diaphragm function in mechanically ventilated patients: comparison to phrenic stimulation and prognostic implications. Thorax. 2017;72(9):811–8.PubMedCrossRefGoogle Scholar