A prospective comparative study to evaluate the utility of lung ultrasonography to improve the accuracy of traditional clinical methods to confirm position of left sided double lumen tube in elective thoracic surgeries

Background and Aims: Traditional clinical methods like auscultation or inspection have been found to be inaccurate in confirmation of double-lumen tube (DLT) position. Lung ultrasonography (USG) reliably identifies the tidal movement (lung sliding) and the collapse of the lung (lung pulse). We intended to check whether the accuracy of clinical methods can be improved by the addition of USG in confirmation of left DLT (LDLT) position. Methods: A single centred, prospective, comparative study was conducted involving 70 patients undergoing thoracic surgeries requiring the use of LDLT. The patients were assigned to Group A - where LDLT position was assessed by using clinical methods alone, and Group B - where LDLT position was assessed by USG and clinical methods. The correct position was predicted when USG demonstrated the absence of lung sliding and the presence of lung pulse on the operative side, the presence of lung sliding on non-operative side, along with normal airway pressures and oxygenation. The final verification of LDLT position was done by direct observation of lung isolation by one surgeon who was blinded to the method of confirmation. Contingency tables were drawn to calculate sensitivity, specificity, positive predictive value, negative predictive value and accuracy of each method. Results: Compared to clinical methods alone, addition of lung USG improved sensitivity (75% vs. 88%), specificity (18% vs. 75%) and accuracy (57% vs. 85%) for correct prediction of LDLT position. Conclusion: USG is a useful addition to the armamentarium of anaesthesiologist for the confirmation of LDLT position

A single-arm prospective interventional study to assess the efficacy of continuous bronchial cuff pressure monitoring to detect the displacement of lung isolation devices in elective thoracic surgeries

Background and Aims: During proximal or distal migration of lung isolation device (LID), the bronchial cuff would move into a wider or narrower portion of the bronchus, leading to a decrease or increase in the cuff pressure, respectively. To test this hypothesis, we conducted a study to find out the efficacy of continuous bronchial cuff pressure (BCP) monitoring for detecting the displacement of LID. Methods: A single-arm interventional study was conducted including hundred adult patients undergoing elective thoracic surgeries using a left-sided LID. BCP was monitored in a continuous manner using a pressure transducer connected to the bronchial cuff of the LID. The position of the LID was assessed using a paediatric bronchoscope. Changes in the BCP were noted when the LID was moved intentionally in the left main bronchus (part 1) and during the surgery (part 2). Bronchoscopic confirmation was performed at the end of the surgery to note any uncaptured movement of the LID (part 3). Results: During part 1 of the study, BCP consistently decreased on the proximal movement and increased on the distal movement of the LID, although the magnitude of change was not constant. During part 2 of the study, sensitivity, specificity, positive predictive value, negative predictive value and accuracy of continuous BCP monitoring to detect the dislodgement of LIDs (n = 41) during the surgery were 97.6%, 40%, 76.9%, 88.9% and 78.7%, respectively. Conclusion: Continuous BCP monitoring is a useful and sensitive method for monitoring the position of left-sided LIDs in limited-resource settings

Incidence of acute kidney injury and its associated risk factors in patients undergoing elective oesophagectomy surgeries at a tertiary care cancer institute – A pilot prospective observational study

Background and Aims: Acute kidney injury (AKI) is a significant postoperative complication. Multiple perioperative factors are implicated in the causation of AKI in the postoperative period in patients with oesophageal cancer. The study aimed to find out the incidence, causes and effects of AKI following oesophagectomy surgery. Methods: A prospective observational study was conducted in consecutive adult patients undergoing elective oesophagectomy at a tertiary cancer care hospital. Patients with preoperative chronic renal insufficiency (serum creatinine >1.5 mg/dl), AKI in the past and a history of renal replacement therapy were excluded. Serum creatinine values were measured on postoperative days 1, 3, 5, the day of discharge or day 15 and on the day of first follow-up or day 28, following oesophagectomy surgery. The incidence of AKI was measured using the ‘Kidney Disease Improving Global Outcome’ (KDIGO) criteria. Results: The incidence of AKI was 14.7% [95% confidence interval (CI) 9.9%, 20.7%] (i.e., 27/183) in patients who underwent elective oesophagectomy. AKI was associated with prolonged hospital stay [median- 13 days (interquartile range {IQR} 11–21.5) versus 9 days (IQR 8–12), P < 0.001] and increased in-hospital mortality (14.8% versus 1.3%, P 0.004, odds ratio = 13.2, 95% CI 2.3, 77.3). After multivariate analysis, age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI. Conclusion: The incidence of AKI was 14.7% after elective oesophagectomy. AKI was associated with prolonged hospital stay and in-hospital mortality. Higher age, anastomotic leak and use of vasopressors in the postoperative period were independent predictors of AKI