Introduction

Monitoring and diagnostics in the critical care unit are gradually becoming more complicated and more accurate. This in turn increases the demand for medical training and ability to interpret data. In this setting, ultrasound is becoming an important diagnostic tool. The ultrasound modalities used are body surface scans and semi-invasive scans.

Body surface scans, like ultrasound, for venous access, assessment and drainage of pleural collections, urinary bladder scans, and transthoracic echocardiography (TTE) are practically devoid of direct complications. However, like all diagnostic imaging, they still carry risks of poor image acquisition and incorrect data interpretation. In contrast, the semi-invasive scans like transoesophageal echocardiography (TOE) offer better image quality but also carry risks of direct injury.

Ultrasound

Modern ultrasound machines are small, portable and provide excellent resolution and image quality if set up correctly. With training and experience, portable ultrasound in critical care is an important and often used tool. Many units want their own equipment to allow them to carry out bedside assessment on a 24-hour basis, and staff working in critical care should ensure they are trained in both use and interpretation. Particular uses include the following.

Introduction

Lung resection varies in the amount of lung resected and the approach, and ranges from segmentectomy or wedge resection to lobectomy or pneumonectomy. It may be performed using a minimally invasive technique (video-assisted thoracoscopic surgery [VATS]) or via a thoracotomy. Irrespective of the type of resection undertaken or approach chosen, the aim is to have the patient extubated, breathing spontaneously and able to cough and expectorate secretions with minimal discomfort as soon as possible after the procedure.

Thoracic surgical patients often have significant comorbid conditions. The association between smoking, emphysema, lung cancer and cardiovascular disease is widely accepted. The preponderance of comorbid disease, together with the extent of surgery and the surgical approach, predispose to numerous potentially serious complications.

The aim of preoperative assessment and optimization is to identify patients at risk of complications and to take measures to prevent such complications from arising. Good postoperative care aims not only to recognize and treat complications that have already occurred, but also to prevent the progression from minor to major complication.

Mortality

Mortality after lung resection has generally improved over the years with improved diagnostic and treatment strategies. The 30-day mortality rate for lung resection is between 4% and 5% and is inversely proportional to the experience of the surgical centre. Pneumonectomy carries a higher mortality risk compared with lobectomy, which in turn carries a higher mortality rate than wedge lung resections.