Lung Cancer, Lung Neoplasm, Lung Resection Surgery, Lung Ultrasound, Lung Ultrasound Score, One-lung Ventilation (OLV), Postoperative Pulmonary Complications (PPCs), Thoracic Surgery
Conditions
Keywords
thoracic surgery, lung ultrasound, lung aeration, lung ultrasound score, lung resection, lobectomy, one-lung ventilation, postoperative pulmonary complications, oxygenation, cytokines, NT-proBNP, diaphragmatic function
Brief summary
The purpose of this prospective observational study is to assess perioperative changes in lung aeration after lung resection surgery using lung ultrasound, and to explore their relationship with oxygenation, inflammatory biomarkers, cardiac stress markers and diaphragmatic function.
Detailed description
Postoperative pulmonary complications are common after lung resection surgery and are associated with worse clinical outcomes. Lung ultrasound (LUS) is a bedside, non-invasive and repeatable imaging technique that can detect regional changes in lung aeration. These changes may reflect postoperative loss of aeration related to one-lung ventilation, surgical manipulation, lung collapse and re-expansion, inflammatory response, diaphragmatic dysfunction or other perioperative mechanisms. This is a prospective, single-centre, observational pilot study including consecutive adult patients scheduled for elective lung resection surgery under one-lung ventilation. Lung ultrasound was performed at three predefined time points: before surgery (T1), 30 minutes after extubation (T2), and 24 hours after surgery (T3). Each hemithorax was divided into six regions: anterior, lateral and posterior areas, each subdivided into upper and lower zones. For each examination, the most pathological ultrasound finding in each area was recorded. A semiquantitative lung ultrasound score was calculated to assess lung aeration over time, both globally and separately for the operated and non-operated lung. Corrected LUSS values were used to compensate for the loss of areas after surgery. At the same predefined time points, oxygenation, NT-proBNP and plasma inflammatory biomarkers, including IL-6, IL-10 and TNF-α, were assessed. Bedside transthoracic echocardiography and diaphragmatic ultrasound were also performed as exploratory analyses to evaluate possible cardiovascular and diaphragmatic mechanisms associated with postoperative loss of lung aeration. The primary objective of the study is to assess perioperative changes in lung aeration after lung resection surgery using LUS. Secondary objectives are to describe the regional distribution of LUS findings, compare the operated and non-operated lung, assess the feasibility of repeated perioperative LUS examinations, and explore the relationship between LUS changes and oxygenation, inflammatory biomarkers, cardiac stress markers and diaphragmatic function.
Interventions
DIAGNOSTIC_TESTPerioperative lung ultrasound assessment
Lung ultrasound was performed at three predefined perioperative time points: before surgery, in the immediate postoperative period after extubation, and 24 hours after surgery. Each hemithorax was assessed in six regions, and lung aeration was evaluated using a semiquantitative lung ultrasound score.
Sponsors
Ana Broseta Lleó
Hospital General Universitario de Valencia
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Age \> 18 * ASA I-III * Non-small cell lung neoplasm * Elective lobectomy * Under one-lung ventilation
Exclusion criteria
* pregnancy * Diagnosed pulmonary fibrosis * Scheduled surgery limited to biopsy * Surgery that includes resection of the thoracic wall or the diaphragm * Predicted FEV1 \< 40% * Neoplasm metastasis * Obesity class II or more (BMI ≥ 35 kg/m\^2) * Risk of malnutrition CONUT score \> 1 * Hemoglobin \< 10 g/dl * Chronic kidney failure: glomerular filtration \< 60 ml/min/m\^2, nephrectomy, kidney transplantation * Treatment with corticosteroids or immunosuppressive agents 3 months before surgery * Transfusion of blood products during the previous 10 days * Heart failure (New York Heart Association Functional Class 3 or 4) during the week before surgery. * Heart valve diseases over stage B of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines 2014 * Previously documented elevated left atrial pressure or cardiac disease associated with elevated left-sided filling pressures.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in lung aeration after lung resection surgery assessed by lung ultrasound score | preoperative vs immediate postoperative period vs 24 hours after surgery | The lung ultrasound score is a semiquantitative score used to assess lung aeration. Higher values indicate greater loss of aeration. Changes will be assessed between the preoperative period, the immediate postoperative period after extubation, and 24 hours after surgery. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Regional distribution of lung ultrasound findings in the operated and non-operated lung | preoperative vs immediate postoperative period vs 24 hours after surgery | Description of lung ultrasound findings and lung aeration loss in each lung region at the predefined perioperative time points. |
| Changes in oxygenation after lung resection surgery | preoperative vs immediate postoperative vs 24 hours after surgery | Oxygenation will be assessed using the PaO₂/FiO₂ ratio at the predefined perioperative time points. |
| Changes in plasma inflammatory biomarkers after lung resection surgery | preoperative vs immediate postoperative vs 24 hours after surgery | Plasma IL-6, IL-10 and TNF-α concentrations, and the IL-6/IL-10 ratio, will be assessed at the predefined perioperative time points. |
| Changes in cardiac stress markers after lung resection surgery | preoperative vs immediate postoperative vs 24 hours after surgery | NT-proBNP values will be assessed at the predefined perioperative time points and explored in relation to lung ultrasound findings. |
| Changes in diaphragmatic function after lung resection surgery | preoperative vs immediate postoperative vs 24 hours after surgery | Diaphragmatic function will be assessed by ultrasound using diaphragmatic thickening fraction at the predefined perioperative time points. |
Countries
Spain
Contacts
PRINCIPAL_INVESTIGATORAna Broseta Lleó, Consultant
Hospital General Universitario de Valencia
Outcome results
None listed