Background: Although lung ultrasound (LUS) has been widely used in the critical care setting, its applications in perioperative management of different lung pathologies are still limited.
Objective: This randomized controlled study aimed to evaluate the benefits of perioperative LUS followed by LUS-guided recruitment maneuver in adults undergoing open heart surgery.
Methods: One hundred patients admitted for elective cardiac surgery were enrolled in this trial. They were divided into two groups; the control group (Group C) included 50 patients who underwent LUS without LUS guided interventions, and LUS group (Group L) included the remaining patients who underwent LUS followed by LUS-guided recruitment maneuver and other interventions according to the finding. 
Results: Baseline characteristics of the study population and perioperative variables showed no significant difference between the study groups. Postoperative pulmonary complications tended to be significantly higher in Group C (22% versus 6% in Group L – p = 0.021). the incidence of postoperative desaturation was significantly higher in the control group than in the intervention group. However, the incidence of intraoperative desaturation was similar between the control and intervention groups. Better aeration, B-line, and compliance scores were detected when LUS-guided recruitment was applied. Additionally, Group L expressed higher O₂ saturation in most of the recorded readings. There was a significant decline in the duration of postoperative mechanical ventilation and the need for respiratory support LUS-guided recruitment was applied.
Conclusions: Postoperative pulmonary outcomes showed a significant improvement in association with LUS-guided recruitment maneuvers and other interventions after adult cardiac surgery.