Anesth Pain Med.  2019 Apr;14(2):187-192. 10.17085/apm.2019.14.2.187.

Relationship between PaOâ‚‚/FiOâ‚‚ and number of regions with B-line on transthoracic lung ultrasound: a prospective, observational study

• Koh JC
• Hong JH
• Kweon TD
• Park JY
• Ko E
• Kim JY

• KMID: 2447967
• DOI: http://doi.org/10.17085/apm.2019.14.2.187

Abstract

BACKGROUND
Aeration of the lungs must be monitored during general anesthesia because of the possibility of postsurgical pulmonary complications. The aim of this study was to compare PaOâ‚‚/FiOâ‚‚ and the number of regions with B-line on transthoracic lung ultrasonography (TLU) between the postinduction and postsurgical periods.
METHODS
Twenty-six adult patients undergoing major abdominal surgery were enrolled. Arterial blood gas analysis and TLU were performed 30 min after the induction of anesthesia (postinduction) and after skin closure (postsurgical period) while patients were under mechanical ventilation. TLU was performed in 12 regions (anterior, lateral, and posterior in the upper and lower regions of both lungs). The number of regions with B-line was counted.
RESULTS
Compared with postinduction values, the number of regions with B-line on TLU was increased in the postsurgical period (0.3 ± 0.5 to 1.3 ± 1.2, P < 0.001); however, PaOâ‚‚/FiOâ‚‚ did not significantly differ (421.3 ± 95.8 to 425.2 ± 86.0, P = 0.765). The change in PaOâ‚‚/FiOâ‚‚ (postinduction-postsurgical period) was significantly higher in Group B than in Group A (P = 0.028).
CONCLUSIONS
Although the number of regions with B-line on TLU was increased in the postsurgical period, lung oxygenation did not differ, based on the main assessment in this study. In contrast, patients with an increased number of regions with B-line tended to show a reduction in PaOâ‚‚/FiOâ‚‚ during the postsurgical period. Further study seems necessary to establish the number of regions with B-line on TLU as a tool for evaluation of perioperative oxygenation.

Keyword

Anesthesiology; Lung; Prospective studies; Pulmonary atelectasis; Pulmonary ventilation; Ultrasonography

MeSH Terms

Adult
Anesthesia
Anesthesia, General
Anesthesiology
Blood Gas Analysis
Humans
Lung*
Observational Study*
Oxygen
Prospective Studies*
Pulmonary Atelectasis
Pulmonary Ventilation
Respiration, Artificial
Skin
Ultrasonography*
Oxygen

Figure

• 

  Fig. 1 The thorax was divided into 6 regions in each lung. Anterior and posterior axillary lines were used to divide anterior, lateral, and posterior regions; a line crossing the nipple was used to divide upper and lower regions.

• 

  Fig. 2 A-line and B-line on transthoracic ultrasound. (A) Repetitive, horizontal reverberation artifacts generated by air within the lungs, separated by regular intervals (A-line, white arrow). (B) Vertical, laser-like lines that erase normal A-lines (B-line, white arrow heads).

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