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Background <p>Postoperative pulmonary complications increase morbidity and mortality after coronary artery bypass grafting (CABG). Lung ultrasound detection of B-lines is an established method to quantify pulmonary congestion, and while B-lines have been studied as predictive markers in heart failure and general critical care settings, their role in predicting outcomes specifically for post-CABG patients remains inadequately defined. This study aimed to evaluate the association between B-lines detected on postoperative lung ultrasound and 30-day mortality and hospital length of stay in patients undergoing isolated CABG.</p> Methods <p>This prospective cohort study was conducted in a single-center intensive care unit between 2023 and 2024. A total of 148 adult patients scheduled for elective CABG were enrolled. Lung ultrasound was performed on postoperative days 1 (POD1) and 3 (POD3) using a standardized 8-zone protocol to quantify B-lines. The primary outcomes were all-cause 30-day mortality, assessed via hospital records and telephone follow-up, and total hospital length of stay. Univariate and multivariate logistic and linear regression analyses were used to identify predictors.</p> Results <p>The mean patient age was 60.15 ± 9.8&#xa0;years, and 57% were male. Within 30&#xa0;days, 22 patients (15%) died. In the multivariate logistic regression, the number of B-lines on POD1 was an independent predictor of 30-day mortality (Adjusted Odds Ratio: 1.090, 95% CI: 1.018–1.167, p = 0.013), indicating a 9% increase in the odds of death for each additional B-line. In contrast, the B-line count on POD3 was not significantly associated with mortality. B-line counts on both days were also not associated with hospital length of stay. Instead, higher body mass index (β = 0.22, p = 0.022) and a history of smoking (β = 2.20, p = 0.020) were independently associated with longer hospitalization.</p> Conclusions <p>Early postoperative pulmonary congestion, as quantified by B-lines on POD1 lung ultrasound, is an independent predictor of 30-day mortality after CABG. Routine bedside lung ultrasound on the first day after surgery can serve as a non-invasive tool to stratify high-risk patients, potentially allowing for earlier intervention to optimize fluid status and improve outcomes.</p>

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B‑lines on lung ultrasound: a non‑invasive marker for short‑term outcomes after coronary artery bypass grafting

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年8月1日

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  • Nima Mohamadi Afrakoti,
  • Mahan Khani,
  • Sina Hemmati,
  • Ali Ebrahiminasab,
  • Reza Atef Yekta,
  • Samaneh Hajy Molla Rabi,
  • Elham Pagard,
  • Mojtaba Marashi

摘要

Background

Postoperative pulmonary complications increase morbidity and mortality after coronary artery bypass grafting (CABG). Lung ultrasound detection of B-lines is an established method to quantify pulmonary congestion, and while B-lines have been studied as predictive markers in heart failure and general critical care settings, their role in predicting outcomes specifically for post-CABG patients remains inadequately defined. This study aimed to evaluate the association between B-lines detected on postoperative lung ultrasound and 30-day mortality and hospital length of stay in patients undergoing isolated CABG.

Methods

This prospective cohort study was conducted in a single-center intensive care unit between 2023 and 2024. A total of 148 adult patients scheduled for elective CABG were enrolled. Lung ultrasound was performed on postoperative days 1 (POD1) and 3 (POD3) using a standardized 8-zone protocol to quantify B-lines. The primary outcomes were all-cause 30-day mortality, assessed via hospital records and telephone follow-up, and total hospital length of stay. Univariate and multivariate logistic and linear regression analyses were used to identify predictors.

Results

The mean patient age was 60.15 ± 9.8 years, and 57% were male. Within 30 days, 22 patients (15%) died. In the multivariate logistic regression, the number of B-lines on POD1 was an independent predictor of 30-day mortality (Adjusted Odds Ratio: 1.090, 95% CI: 1.018–1.167, p = 0.013), indicating a 9% increase in the odds of death for each additional B-line. In contrast, the B-line count on POD3 was not significantly associated with mortality. B-line counts on both days were also not associated with hospital length of stay. Instead, higher body mass index (β = 0.22, p = 0.022) and a history of smoking (β = 2.20, p = 0.020) were independently associated with longer hospitalization.

Conclusions

Early postoperative pulmonary congestion, as quantified by B-lines on POD1 lung ultrasound, is an independent predictor of 30-day mortality after CABG. Routine bedside lung ultrasound on the first day after surgery can serve as a non-invasive tool to stratify high-risk patients, potentially allowing for earlier intervention to optimize fluid status and improve outcomes.