“Lung Ultrasound Versus Clinical Assessment for Early Detection of Postoperative Pulmonary Complications: A Prospective Paired Diagnostic-Accuracy Study in the ICU”

Background: Postoperative pulmonary complications (PPCs) significantly contribute to morbidity, prolonged intensive care unit (ICU) stay, and healthcare costs after major surgery. Conventional clinical assessment (CA) often lacks sensitivity for early detection. Point-of-care lung ultrasound (LUS) offers a rapid, bedside, radiation-free diagnostic alternative, but its comparative accuracy in the immediate postoperative ICU period remains incompletely defined. Aim: To compare the diagnostic accuracy and timeliness of point-of-care LUS versus standard clinical assessment for early detection of PPCs in postoperative ICU patients. Methods: This prospective paired diagnostic-accuracy study included 200 adult postoperative ICU patients. Each patient underwent paired LUS and CA assessments at 6, 24, 48, and 72 hours after ICU admission, in randomized order. An independent blinded adjudication panel established the reference diagnosis of PPCs. Primary outcomes were sensitivity, specificity, and area under the receiver operating characteristic curve (AUC). Secondary outcomes included time to diagnosis, interobserver agreement, and clinical management impact. Results: PPCs occurred in 44% of patients. LUS demonstrated significantly higher sensitivity than CA (0.89 vs 0.62; P < 0.001), with comparable specificity (0.91 vs 0.88). Diagnostic discrimination was superior for LUS (AUC 0.94 vs 0.76; P < 0.001). Median time to PPC detection was shorter with LUS (12 h vs 28 h; P < 0.001). Interobserver agreement was excellent for LUS (κ = 0.84) compared with moderate agreement for CA (κ = 0.58). Earlier detection by LUS was associated with earlier therapeutic interventions and reduced imaging utilization. Conclusion: Point-of-care LUS enables earlier and more accurate detection of PPCs than conventional clinical assessment. Integrating LUS into routine postoperative ICU surveillance may improve diagnostic efficiency and optimize patient management.