RED Protocol: Ultrasound for Intraoperative Detection of Pneumothorax and Hemothorax in Rib Remodeling Surgeries
In brief
In simulations, intraoperative ultrasound detected 96% of pneumothoraces
The ultrasound protocol detected 96% of simulated pneumothoraces and correctly ruled out the condition in all simulated cases without it. Among 113 patients undergoing ribcage remodeling, no pneumothorax or hemothorax occurred, so clinical accuracy could not be measured; prospective studies must show whether simulation results translate to real operations.
- Journal
- Aesthetic surgery journal (Q1)
- Published
- 29 October 2026
- Study design
- Prospective / inception cohort
- Evidence level
- Level 2, Moderate (CEBM 2b)
- Authors
- Hugo A Aguilar, Manuel Velasco, Luis F Reyes, Nicole G Echeverry, Alfredo E Hoyos, Silvia J Villabona, et al.
- PMID
- 42952427
- DOI
- 10.1093/asj/sjag245
Why clinicians should know about it
- Picked for Plastic and Reconstructive Surgery (top studies of the week, 1 November 2026): Aesthetic rib remodeling safety and intraoperative complication detection
Abstract
BACKGROUND: Ribcage remodeling procedures are increasingly used in aesthetic surgery to reduce waist circumference; however, they carry a potential risk of pneumothorax and hemothorax due to proximity to the lung parenchyma. Early intraoperative detection of these complications is critical but currently not standardized. OBJECTIVES: To evaluate the feasibility and diagnostic performance of the Rib Complication Evaluation and Detection (RED) protocol, an intraoperative ultrasound-based approach for detecting pneumothorax and hemothorax during ribcage remodeling procedures. METHODS: A retrospective observational study was conducted including 113 patients undergoing ribcage remodeling between 2023 and 2024. Due to the low incidence of pneumothorax, the protocol was additionally assessed using 250 high-fidelity simulation scenarios with the CAE Vimedix system. Ultrasound findings were standardized, and sensitivity, specificity, and predictive values were calculated. RESULTS: No cases of pneumothorax or hemothorax were identified in the clinical cohort. In simulation testing, the RED protocol demonstrated a sensitivity of 96% and specificity of 100% for pneumothorax detection, with a positive predictive value of 100% and a negative predictive value of 98%. The protocol successfully differentiated pneumothorax from other thoracic conditions. CONCLUSIONS: The RED protocol provides a structured and reproducible approach for intraoperative lung ultrasound in ribcage remodeling. While simulation was necessary due to the low prevalence of complications, the protocol is based on well-established sonographic signs. Its high negative predictive value suggests utility as a rule-out tool, enhancing intraoperative safety. Further prospective studies are needed to validate its performance in real clinical scenarios.
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.