Lung Ultrasound for the Postoperative Diagnosis of Pneumothorax in Children

Study Overview
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Brief Summary
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This study will be conducted to determine the advantages and limitations of sonography compared with chest radiography, in the detection of post procedure iatrogenic pneumothorax in patients underwent to Pectus Excavatum (PE) with Nuss repair.

Detailed Description
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The Nuss procedure is a minimally invasive technique for the repair of Pectus Excavatum (MIRPE). Residual pneumothorax (PNX) is reported in more than 50% after Nuss procedure. It is a consequence of the introduction of the scope and bar in the pleural space and is considered a minor complication due to the minimal clinical consequences. It is routine practice to confirm the diagnosis of PNX with a conventional chest X-Ray either in the operating room at the end of thoracic surgery or in the recovery room unit immediately after surgery.However, anterior pneumothorax can occur and chest-X ray could not be able to detected the PNX. Nowadays lung ultrasound (LUS) allows a bedside non-invasive evaluation of the patient(with a sensitivity and specificity of 92 and 99% respectively) without exposure to ionized radiation, can be performed more quickly than chest radiography and therefore can be repeated several times without additional risks. The use of LUS in pediatric age groups is more recent, but is becoming widely utilized both in neonatal and pediatric respiratory diseases. Bedside sonography for diagnosis of PNX has been well described in emergency and trauma medicine literature and it is resulted to be more sensitive and specific than portable anteroposterior chest radiography. Although there are few studies describing the use of ultrasound for the detection of surgical pneumothorax, none of them studied its use after Nuss Procedure.

Official Title
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Is Lung Ultrasound the Technique of Choice for the Diagnosis of Pneumothorax Following the Nuss Procedure for Pectus Excavatum?

Conditions
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Pectus Excavatum

Intervention / Treatment
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* Device: Lung ultrasound


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Patients following Nuss procedure for PE repair at Giannina Gaslini Institute Exclusion Criteria: absence of informed consent from parents poor quality of the pre-operatory acoustic window
Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Lung ultrasound<br>Every patient will receive a chest RX and lung US | Device: Lung ultrasound<br>* Lung ultrasound and chest RX<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Detection of PNX | Detection of residual PNX immediately after surgery for NUSS repair, either using lung ultrasound (LUS): sliding (Y/N), line B (Y/N), lung pulse (Y/N), lung point (Y/N) and Rx PNX=Y/N). | 60 minutes after the end of surgery | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lung ultrasound and operator, composite measurement | The diagnosis of PNX and no PNX has to be in agreement between operators (anesthesiologist and student) | Before surgery, 60 minutes after surgery and 24 hours after surgery | 
| Postoperative complications | Incidence of Postoperative Pulmonary Complication | 5 days after surgery |