Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2026
Comparative accuracy of lung ultrasound and chest radiography for pneumothorax detection after cardiac surgery: a feasibility pilot study.
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Erbetta Ignacio, Jerath Angela, Kaustov Lilia, Kiss Alexander, McCartney Colin J L, Cohen Gideon, Fremes Stephen, Garijo Jacobo Moreno
Аннотация
PURPOSE: Pneumothorax (PTX) is a common complication after chest tube removal in adult patients undergoing cardiac surgery, traditionally diagnosed via chest x-ray (CXR). Nevertheless, CXR has limitations, including radiation exposure, low sensitivity, and delays. Lung ultrasound (LUS) is a safer, faster, and potentially more accurate alternative, but its feasibility and diagnostic accuracy when performed by novices remains underexplored. In this pilot study, we sought to evaluate the feasibility and diagnostic accuracy of novice-performed LUS compared with CXR, using expert-performed LUS or senior-radiologist-reviewed CXR as the reference standard for PTX confirmation, given their high specificity.
METHODS: We conducted a single-centre prospective observational feasibility study enrolling adult patients undergoing cardiac surgery. Novice trainees performed LUS, which was compared with expert LUS or senior-radiologist-reviewed CXR. Primary outcomes included recruitment feasibility, protocol adherence, and image quality. Secondary outcomes assessed diagnostic accuracy, interrater reliability, and safety.
RESULTS: Of 506 patients screened, 60 were enrolled over 1 year. Recruitment feasibility was shown (12% enrolment). Protocol adherence was 98.3%, and image quality was sufficient in 96.7% of cases. Pneumothorax was diagnosed in 19/60 participants (31.7%) using the composite reference standard. Novice-performed LUS identified 18/19 PTX cases (94.7%), whereas senior-radiologist-reviewed CXR identified 13/19 PTX cases (68.4%). Novice-performed LUS showed a high negative predictive value (97.6%) in this feasibility cohort. Interrater reliability was high (κ = 0.97).
CONCLUSIONS: Novice-performed LUS was feasible, with high protocol adherence and image quality. Lung ultrasound showed high sensitivity and strong reliability for PTX detection in this feasibility pilot study. These findings support the need for larger, fully powered studies to evaluate diagnostic performance and clinical integration.
METHODS: We conducted a single-centre prospective observational feasibility study enrolling adult patients undergoing cardiac surgery. Novice trainees performed LUS, which was compared with expert LUS or senior-radiologist-reviewed CXR. Primary outcomes included recruitment feasibility, protocol adherence, and image quality. Secondary outcomes assessed diagnostic accuracy, interrater reliability, and safety.
RESULTS: Of 506 patients screened, 60 were enrolled over 1 year. Recruitment feasibility was shown (12% enrolment). Protocol adherence was 98.3%, and image quality was sufficient in 96.7% of cases. Pneumothorax was diagnosed in 19/60 participants (31.7%) using the composite reference standard. Novice-performed LUS identified 18/19 PTX cases (94.7%), whereas senior-radiologist-reviewed CXR identified 13/19 PTX cases (68.4%). Novice-performed LUS showed a high negative predictive value (97.6%) in this feasibility cohort. Interrater reliability was high (κ = 0.97).
CONCLUSIONS: Novice-performed LUS was feasible, with high protocol adherence and image quality. Lung ultrasound showed high sensitivity and strong reliability for PTX detection in this feasibility pilot study. These findings support the need for larger, fully powered studies to evaluate diagnostic performance and clinical integration.