Lung ultrasound versus chest radiography for the detection of early postoperative pulmonary complications in children undergoing cardiac surgery.

LUS and CXR showed equivalent detection of pulmonary congestion within 6 hours postoperatively.

• Both modalities detected pulmonary congestion at a rate of 63.3% at T1 (within 6 hours postoperatively).
• Agreement between LUS and CXR for pulmonary congestion at T1 was exact (p = 1.000).
• Diagnostic agreement was assessed using Cohen's kappa.
• Assessment was performed in 30 pediatric patients aged less than 4 years undergoing congenital heart surgery.

LUS detected pleural effusion at significantly higher rates than CXR at the early postoperative timepoint (T1).

• LUS detected pleural effusion in 40.0% of patients versus 6.7% by CXR at T1.
• This difference was statistically significant (p = 0.002).
• Higher LUS detection rates for pleural effusion were observed across all three postoperative timepoints.
• CXR has limited sensitivity for early parenchymal and pleural pathology per the authors.

LUS detected consolidation at a higher rate than CXR at T1, though this difference did not reach statistical significance.

• LUS detected consolidation in 56.7% of patients versus 33.3% by CXR at T1.
• The difference in consolidation detection did not reach statistical significance (p = 0.069).
• The study enrolled only 30 patients, limiting statistical power to detect differences.
• Higher LUS detection rates for consolidation were also observed across all three postoperative timepoints.

Extubation failure occurred in 16.7% of pediatric patients following congenital heart surgery.

• Extubation failure occurred in 5 out of 30 patients (16.7%).
• Extubation failure was associated with prolonged ICU stay, longer mechanical ventilation, and greater inotropic support (all p ≤ 0.040).
• Three assessment timepoints were used: within 6 hours postoperatively (T1), pre-extubation (T2), and post-extubation (T3).
• The study enrolled patients undergoing RACHS-1 categories 1–3 congenital heart surgery at a single tertiary center.

On multivariable logistic regression, longer inotropic support duration was associated with lower odds of successful extubation, while imaging variables were not significant predictors.

• Longer inotropic support duration was associated with lower odds of successful extubation (OR 0.52, p = 0.009) in exploratory multivariable logistic regression.
• Imaging variables (LUS and CXR findings) were not significant predictors of extubation outcome (all p > 0.27).
• The authors note these findings 'warrant cautious interpretation given the small sample.'
• The analysis was described as exploratory given the pilot nature of the study with n = 30.

Serial bedside LUS enabled dynamic longitudinal monitoring of pulmonary complication resolution over 11 postoperative days.

• LUS monitoring extended over approximately 11 postoperative days.
• The authors describe this longitudinal capability as going 'beyond what static CXR can provide.'
• Three standardized timepoints were used: within 6 hours postoperatively, pre-extubation, and post-extubation.
• A standardized 12-zone LUS protocol was employed for all assessments.

Postoperative pulmonary complications occur in up to 76% of children after cardiac surgery and are a major cause of morbidity.

• The authors report that pulmonary complications occur in up to 76% of children following congenital heart surgery.
• These complications prolong mechanical ventilation and ICU stay.
• The study enrolled patients aged less than 4 years, a population particularly vulnerable to postoperative pulmonary complications.
• The study was conducted at a single tertiary center from March 2024 to March 2025.