Clinical Application Of Cardiopulmonary Combined Ultrasound In The Perioperative Period Of Children With Congenital Heart Diseas

Application of cardiopulmonary ultrasound in the diagnosis of cardiopulmonary complications in perioperative period of childrenObjective To explore the application value of cardiopulmonary ultrasound(CPUS)in the diagnosis and evaluation of perioperative cardiopulmonary complications in perioperative period of children with congenital heart disease(CHD).Methods Children with CHD who underwent surgical treatment in Fuwai Hospital from June 2019 to June 2021 were selected.Inclusion criteria:(1)Children aged from 1 month to 7 years with CHD;(2)underwent open-heart surgery;(3)transferred to intensive care unit(ICU)with the aid of endotracheal intubation and ventilator after surgery.Exclusion criteria:(1)Preoperative mechanical ventilation;(2)preoperative chest radiograph(CXR)or CT examination had the following abnormalities:pneumothorax,pneumonia,tracheal/bronchial stenosis,or severe thoracic malformation;(3)delayed chest closure or early postoperative secondary surgery;(4)ecmo support;(5)poor acoustical window;(6)lack of researchers to complete CPUS examinations during ICU treatment.The patients were examined in ICU on the day of surgery(POD0),the first day after surgery(POD1),and the second day after surgery(POD2),and the diagnostic result of CPUS,and left ventricular ejection fraction(LVEF),valve function,deformity correction,pulmonary artery pressure and score of lung ultrasound(LUS)were recorded.Clinical monitoring indicators,respiratory parameters,blood gas analysis and laboratory indicators were recorded.According to the clinical cardiopulmonary complications,the patients were divided into the complication group(80 cases)and the non-complication group(243 cases).Parameters between the two groups and the results of LUS and CXR were compared.To evaluate the diagnostic accuracy of CPUS in clinical cardiopulmonary complications and the predictive efficacy for early clinical outcome.Results There were no significant differences in gender,height,preoperative LVEF and surgical type between the two groups(all P>0.05).Age and body weight in the complication group were lower than those in the non-complication group,and CPB time,aorta blocking time,STAT score,total ventilator time and ICU stay were higher than those in the non-complication group(all P<0.05).Consistency analysis showed that LUS and CXR were significantly consistent in the diagnosis of pulmonary edema,pulmonary consolidation,pleural effusion,atelectasis and pneumothorax(all P<0.05),The positive rate of lung complications diagnosed by LUS on POD0 day was higher than that by CXR(P<0.05),and there was no statistical difference in the positive rate between POD1 and POD2 day(all P>0.05).Echocardiography diagnosed at POD0,POD1,POD2 day had an incidence of 18.0%,20.4%,26.8%of heart-related complications,with the highest incidence of left ventricular systolic function decline,pulmonary hypertension and residual ventricular septal defect.The accuracy rate of clinical cardiopulmonary complications diagnosed by CPUS was 68%,62%and 80%on POD0.POD1 and POD2,respectively,and pulmonary edema,cardiac insufficiency and pleural effusion were the most common.The POD0 day LUS score of the complications group(11.2±3.8)was higher than that of the non-complications group(5.4±3.1)(P<0.05).In multiple linear regression analysis.the traditional risk prediction model for predicting total ventilator time and ICU time based on age,STAT score and CPB time had statistical significance(all P<0.05),with adjusted R2=0.178 and 0.293.The adjusted R2 of LUS score in CPUS and diagnosis of cardiac complications included in the new risk prediction model was 0.423,0.500,both higher than the traditional prediction model(all P<0.05).Conclusion CPUS has high accuracy and feasibility in the diagnosis of cardiopulmonary complications in children after cardiac operation,and it is recommended to be a routine examination item in perioperative period for children with congenital heart disease.For the diagnosis of pulmonary complications,LUS has the advantages of high sensitivity and no radiation,and can be used as a supplementary examination for CXR,thus reducing the amount of radiation involved.The results of CPUS can improve the effectiveness of traditional risk factors in predicting early clinical outcomes,so as to detect cardiopulmonary complications early,guide treatment and improve the prognosis of children.Cardiopulmonary ultrasound for extubation outcome prediction in children after cardiac surgeryObjective To identify cardiopulmonary ultrasound diagnostic value in predicting extubation outcomes in children after cardiac surgery.Methods Eighty-three children who underwent cardiac surgical in Fuwai Hospital from January 2020 to July 2020 were included.Inclusion criteria:(1)children aged 3 months to 6 years with CHD;(2)underwent cardiac correction surgery by cardiopulmonary bypass surgery and general anesthesia;(3)postoperative invasive mechanical ventilation time>6 hours.Exclusion criteria:(1)preoperative mechanical ventilation status;(2)preoperative chest X-ray or CT examination included the following abnormalities:pneumothorax,pneumonia,tracheal or bronchial stenosis,severe thoracic malformation;(3)secondary or palliative cardiac surgery;(4)planned invasive and non-invasive ventilation sequential therapy;(5)delayed chest closure;(6)ecmo support before and after surgery;(7)poor acoustic window.Children meeting weaning criteria were examined by CPUS before the initiation of spontaneous breathing test.Lung ultrasound(LUS)score,left ventricular ejection fraction(LVEF),right ventricular area change fraction(FAC),pulmonary artery systolic pressure,and diaphragm movement were recorded.Clinical monitoring indicators,respiratory parameters blood gas analysis,and laboratory indicators were recorded.According to whether extubation was successful,they were divided into the offline success group(57 cases)and failure group(26 cases).Parameters between the two groups were compared to evaluate the predictive efficacy of ultrasonic indicators,traditional respiratory parameters and(NT-probBNP for weaning failure.Results There were no significant differences in gender,preoperative LVEF and RACHS-1 score between the two groups(all P>0.05).Children in the failure group had lower age and body weight,longer CPB and aortic crossclamp time(all P<0.05).The level of NT-probNP in failure group was higher(P<0.05).Oxygenation index and PaCO2 had no statistical difference between the two groups(all P>0.05).The respiratory ratetidal volume ratio(f/VT)in weaning failure group was higher(P<0.05).In terms of ultrasound indicators,the failure group had higher LUS scores,more children with LVEF<40%,FAC<35%,pulmonary hypertension or diaphragmatic dyskinesia(all P<0.05),but there were no significant differences in the number of LVEF,FAC and residual ventricular septal defect between the two groups(all P>0.05).In multivariate regression analysis,LUS score>12 points and EF<40%was the only independent predictor of extubation failure(OR=5.087,14.707,all p<0.05).Receiver operating characteristic curve showed that LUS score,NT-probNP and f/VT had certain diagnostic efficacy in predicting the outcome of extubation,and AUC were 0.765,0.672 and 0.643,respectively(all p<0.05).The combined LUS score and LVEF<40%showed higher diagnostic efficiency,with AUC of 0.838(CI 0.560,0.771),sensitivity and specificity of 94.74%and 73.08%(p<0.05).Conclusion CPUS can be used for risk assessment before ventilator withdrawal in children after heart surgery.The results show that LUS score>12 combined with LVEF<40%can predict extubation failure,and the prediction efficiency is higher than traditional parameters of NT-probNP and f/VT.The ultrasound scoring parameters provided by CPUS have strong clinical operability,and the routine application may reduce the adverse events of postoperative extubation failure in children with congenital heart disease,thus reducing the time of ventilator and ICU,and improving the prognosis of children.Application Value of Cardiopulmonary Ultrasound on Perioperative Rehabilitation of Pediatric Patients with Tetralogy of FallotObjective To investigate the application value of cardiopulmonary ultrasound(CPUS)on perioperative rehabilitation of pediatric patients with tetralogy of Fallot(TOF).Methods From February 2020 to September 2020,a total of 54 children who underwent primary repair of TOF in Fuwai Hospital,age ranged from 4 to 46 months,median age was 9(6,12)months,were included.Inclusion criteria:(1)children aged from 1 month to 7 years old with TOF;(2)underwent primary repair of TOF with general anesthesia and extracorporeal circulation.Exclusion criteria:(1)secondary or palliative surgery;(2)with complete endocardium pad defect,aortic arch dysplasia,unilateral pulmonary artery absence and other serious malformations;(3)postoperative ECMO assisted or delayed chest closure;(4)respiratory tract infection existed before surgery.Bedside CPUS were performed within 12 hours after returning to ICU,and left ventricular ejection fraction(LVEF),right ventricular area changes fraction(RV FAC),pulmonary ultrasound score,residual ventricular septal defect,valve regurgitation,and thoracoabdominal effusion were recorded.Clinical data and laboratory indexes were also collected.Baseline data,Mcgoon ratio,surgical method,extracorporeal circulation time(CBP),aorta blocking time(ACT),whether collateral pulmonary artery ligation or occlusion,postoperative complications,ventilator time,ICU time,etc.,were collected.Patients were divided into two groups:delayed recovery group(22 cases,41%)and normal recovery group(32 cases,59%),according to whether the postoperative mechanical ventilation time was more than 48 hours.Parameters between the two groups were compared,and statistically significant ultrasonic parameters were selected to develop CPUS scores,and their correlation with ventilator time and ICU time was evaluated,and risk stratification was performed for postoperative children.In addition,the children were divided into the group with(n=12)and without(n=42)MAPCAs,and the data between the two groups were compared,and the clinical experience in diagnosing residual MAPCAs by CPUS was summarized.Results There were no significant differences in age,gender,percutaneous oxygen saturation,McGoon ratio,preoperative LVEF,FAC and other baseline data between the two groups(all P>0.05).There were more transring patches in delayed recovery group than in normal recovery group(P<0.05).There were no significant differences in clinical monitoring and laboratory indicators between the two groups(all P>0.05).There were no significant differences in the left ventricular end diastolic diameter,peak pulmonary valve differential pressure and residual ventricular septal defect between the two groups(all P>0.05).LVEF and RV FAC in the delayed recovery group were lower than those in the normal recovery group,lung ultrasound score was higher than that in the normal recovery group(all P<0.05).The patients with moderate and severe pulmonary valve regurgitation and thoracoabdominal effusion in delayed recovery group w’ere more than those in normal recovery group(all P<0.05).The above differential ultrasound parameters were incorporated into the CPUS scoring system to score the children.The results showed that the CPUS score of delayed recovery group was higher than that of normal recovery group[(10.55±2.20)vs(8.53±2.31),P<0.05].The area under the ROC curve predicted by the CPUS score is 0.893,the optimal cut-off value is 6,the sensitivity is 68%,and the specificity is 91%.Kaplan-meier curve showed that the time of ventilator and ICU was longer in those with≥6 points compared with those with<6 points,and the difference was statistically significant(all P<0.05).There was no statistical difference in postoperative monitoring indexes between the group with or without MAPCAs(all P>0.05).The results of CPUS examination showed that the score of CPUS was higher in the group with MAPCAs(P<0.05).Conclusion CPUS can systematically evaluate the ventricular function and pulmonary exudation of children after TOF,and help identify residual pulmonary collateral arteries,so as to guide perioperative treatment and timely handle delayed recovery factors.The results showed that the patients with≥6 CPUS score could predict the prolonged duration of ventilator and ICU,perform risk stratification for postoperative children,timely detect residual pulmonary collateral arteries,and promote postoperative rapid recovery of children.