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

Pulmonary complications are a major cause of morbidity following congenital heart surgery in children. This pilot study evaluated detection rates of point-of-care lung ultrasound (LUS) compared with chest X-ray (CXR) for early identification of postoperative pulmonary complications in pediatric cardiac surgery patients. This prospective observational pilot study enrolled 30 pediatric patients (aged < 4 years) undergoing congenital heart surgery (RACHS-1 categories 1-3) at a single tertiary center (March 2024-March 2025). LUS using a standardized 12-zone protocol was compared with bedside CXR at three assessment timepoints: within 6 h postoperatively (T1), pre-extubation (T2), and post-extubation (T3). Diagnostic agreement was assessed by Cohen's kappa. Clinical outcomes were analyzed using multivariable logistic regression. LUS and CXR showed equivalent detection of pulmonary congestion at T1 (63.3%; p = 1.000). LUS detected higher rates of pleural effusion (40.0% vs. 6.7%; p = 0.002) and consolidation (56.7% vs. 33.3%; p = 0.069) at T1. Extubation failure occurred in 16.7% (n = 5) and was associated with prolonged ICU stay, longer ventilation, and greater inotropic support (all p ≤ 0.040). On multivariable logistic regression, longer inotropic support duration was associated with lower odds of successful extubation (exploratory analysis, OR 0.52, p = 0.009); imaging variables were not significant (all p > 0.27); findings warrant cautious interpretation given the small sample.

conclusionIn this pilot cohort, LUS demonstrated higher detection rates for early postoperative pleural effusion and consolidation compared with CXR, supporting its role as a complementary bedside tool. Extubation outcomes were primarily driven by hemodynamic factors. Larger prospective studies are needed to confirm these preliminary findings. WHAT IS KNOWN: • Postoperative pulmonary complications occur in up to 76% of children after cardiac surgery and prolong mechanical ventilation and ICU stay. • Chest X-ray is the standard bedside imaging tool but has limited sensitivity for early parenchymal and pleural pathology. WHAT IS NEW: • Lung ultrasound detected pleural effusion and consolidation at higher rates than CXR across all three postoperative timepoints. • Serial bedside LUS enabled dynamic longitudinal monitoring of complication resolution over 11 postoperative days, beyond what static CXR can provide.