Title : Ultrasound diagnostics of pulmonary oedema in patients after lung transplantation
Abstract:
Relevance and Aim of the Study: Lung transplantation is the only treatment for the terminal stage of lung diseases. In the early postoperative period, an important task is monitoring the condition of the lung graft. Ultrasound imaging has several advantages over other instrumental diagnostic methods for the early detection of postoperative complications associated with graft dysfunction. Our aim was to evaluate the feasibility of using ultrasound to examine lung grafts in the early postoperative period for diagnosing pulmonary complications in patients after lung transplantation.
Materials and Methods: As part of a prospective study, 38 lung ultrasounds were performed on 9 patients after lung transplantation. Sonography was conducted using a four-point protocol on the first and third postoperative days. The results of ultrasound examination were compared with the patient's fluid balance, oxygenation and ventilation parameters, and chest CT scans.
Results and Discussion: A statistically significant correlation was identified between the number of B-lines and the fluid balance (r=0.78; p<0.001), between PEEP levels and B-lines (r=0.87; p<0.001), and between B-lines and FiO2 levels (r=0.81; p<0.001). The median number of B-lines observed on the first postoperative day was 4.27, with 100% of patients having a positive fluid balance. On the third postoperative day, the median number of B-lines was 2.0, and 67% of patients had a negative fluid balance. Additionally, in patients with signs of lung graft dysfunction, ultrasound revealed varying degrees of atelectasis, subpleural consolidations, and pleural effusions, which allowed for rapid optimization of intensive care tactics and increased treatment efficacy.
Conclusion: Ultrasound findings in the diagnostics of lung grafts show a significant correlation with PEEP, FiO2, and fluid balance indicators. Ultrasound of lung grafts is an accurate (AUC=0.9±0.05 with 95% CI [0.72–1.0]; p<0.004), non-invasive, safe, and accessible method for assessing extrapulmonary fluid, atelectasis, pleural effusions, and consolidations. Sonography can be utilized for the rapid ultrasound diagnostics of pathological processes in lung grafts.
