Thoracic Surgery, Ultrasonography
Conditions
Keywords
Thoracic surgery, Lung ultrasound, Chest X-ray, Nurse
Brief summary
This projects aim is to study the effects of substitute conventional chest x-ray with lung ultrasound for patients undergoing thoracic surgery. Participants in the study will be randomized to either ultrasound or routine chest x-ray as the primary method of diagnosis after having received surgery to their lungs.
Detailed description
Modern lung surgery involves a variety of procedures that expose patients to the risk of developing postoperative complications (PPC). In lung surgery such as resections or lobectomies where a part of the lung tissue is removed, so-called single-lung ventilation is used. Through this technique, the lung that is operated on collapses, while ventilation is directed to the lung that is not operated on. When the operation is over, the structures of the lung are sewn together and the collapsed lung is inflated again. At this stage, it is important to ensure that the expansion of the lung is adequate. It is also important for the continued expansion of the lung that there is no air leakage from the lung to the pleural cavity. Therefore, there is initially a drainage in the pleural cavity to prevent both bleeding and air leakage. Postoperatively, several X-ray examinations are performed before the patient is discharged to ensure adequate lung expansion. Lung ultrasound is a well-established method that is based on physical artifacts that arise in the interaction between ultrasound and various conditions in the lung tissue. The method is used in most of the questions that are usually asked even in chest X-rays and other conventional techniques but has the advantages of being both cost- and time-effective and does not involve the radiation dose that conventional X-rays involve. The study aims to investigate whether lung ultrasound can replace conventional chest X-rays in patients who have undergone lung surgery. The research subjects will be randomized to undergo postoperative lung ultrasound or conventional chest X-rays after lung surgery. Previous research has shown the possibility of abandoning X-ray radiation in favor of ultrasound in most scenarios. However, randomized studies are generally lacking, especially in this population.
Interventions
DIAGNOSTIC_TESTLung Ultrasound
Diagnostic ultrasound of pulmonary tissues such as pleura, plural spaces, and parenchyma.
Sponsors
Uppsala University Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Outcomes Assessor)
Masking description
Inter-rater variability will be masked.
Intervention model description
Case-Control
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Segmental, partial, or wedge resection lung surgery, or lobectomy. * Written informed consent * Available research team for measurements.
Exclusion criteria
* Pregnancy * Re-surgery due to complications related to the original surgery * Need for critical care or admittance to the ICU. * Patient or physician choice of withdrawal from the study
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reduction in chest x-ray | Through patient hospital stay, an average of five days | Reduction in chest x-ray in patients undergoing thoracic surgery when LUS is the primary method of investigation. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Re-insertion of chest tube | Through patient hospital stay, an average of five days | The need for re-insertion och chest tube because of clinical deterioration, and/or verified clinically relevant post-operative pulmonary complication |
| Delayed removal of chest tube | Through patient hospital stay, an average of five days | Number of patients in need of prolonged care with chest tube. |
| Time to chest tube removal | Through patient hospital stay, an average of five days | Time, in hours, to eventual removal of chest tube |
| Patient Satisfaction | Through patient hospital stay, an average of five days | Sub-group analysis of the patient experience and satisfaction for patients receiving both lung ultrasound and chest x-ray, measures through quantitative psychometric questionnaire with Likert-design consisting of a minimum value of 1 and a maximum of 5. Worse outcome is associated with low scores and vice versa. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Missed Care | Through patient hospital stay, an average of five days | The number of missed diagnoses of post-operative pulmonary complications based on results from chest x-ray in patients subjected to group crossover. |
| Inter-rater variability | Through patient hospital stay, an average of five days | Inter-observer agreement study of collected ultrasound images. |
Countries
Sweden
Outcome results
None listed