Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure

Lung ultrasound in children with asthma exacerbations: a systematic review and meta-analysis

INTRODUCTION

Lung ultrasound (LUS) is a noninvasive radiation-free imaging tool used to evaluate respiratory conditions, particularly in children and adolescents with asthma exacerbations. However, its role in diagnosing and managing asthma exacerbations remains unclear. We aimed to demonstrate LUS findings in pediatric asthma exacerbations, focusing on patterns such as B-lines, consolidation, and pleural abnormalities.

METHODS

A systematic review was conducted following the Preferred reporting items for systematic reviews and meta-analyses guidelines. Databases such as MEDLINE/PubMed and EMBASE were reviewed. The eligibility criterion was observational studies on LUS for pediatric asthma exacerbations. Bias risk was assessed using a validated tool. Data were analyzed both qualitatively and quantitatively, with findings summarized and meta-analysis conducted.

RESULTS

Five studies involving 192 participants were included in the analysis. The LUS findings included B-lines, consolidation, and pleural abnormalities. Meta-analysis revealed that 52.0% (95% confidence interval: 23.0-80.3) of the cases demonstrated positive LUS findings.

CONCLUSIONS

LUS exhibited potential for diagnosing asthma exacerbations, particularly in identifying B-lines, consolidation, and pleural abnormalities. However, variability in detection rates was observed across different studies, which might be due to the differences in study populations and criteria. Despite these limitations, LUS can be a valuable tool for managing asthma exacerbations.

PROTOCOL REGISTRATION

www.crd.york.ac.uk/Prospero identifier CRD42021244729.

Acute Respiratory Failure in Children: A Clinical Update on Diagnosis

Acute respiratory failure (ARF) is a sudden failure of the respiratory system to ensure adequate gas exchanges. Numerous clinical conditions may cause ARF, including pneumonia, obstructive lung diseases (e.g., asthma), restrictive diseases such as neuromuscular diseases (e.g., spinal muscular atrophy and muscular dystrophy), and albeit rarely, interstitial lung diseases. Children, especially infants, may be more vulnerable to ARF than adults due to anatomical and physiological features of the respiratory system. Assessing respiratory impairment in the pediatric population is particularly challenging as children frequently present difficulties in reporting symptoms and due to compliance and cooperation in diagnostic tests. The evaluation of clinical and anamnestic aspects represents the cornerstone of ARF diagnosis: first level exams (e.g., arterial blood gas analysis) confirm and evaluate the severity of the ARF and second level exams help to uncover the underlying cause. Prompt management is critical, with supplemental oxygen, mechanical ventilation, and the treatment of the underlying problem. The aim of this review is to provide a comprehensive summary of the current state of the art in diagnosing pediatric ARF, with a focus on pathophysiology, novel imaging applications, and new perspectives, such as biomarkers and artificial intelligence.

Respiratory Syncytial Virus: A Systematic Review and Meta-Analysis of Tomographic Findings (2000-2022)

Human respiratory syncytial virus (RSV) is a main cause of medical referrals and hospitalizations in all infants, particularly among newborns. Nevertheless, relatively limited evidence on chest tomography (CT) findings has been collected. According to the PRISMA statement, Pubmed, Embase, and medRxiv were searched for eligible observational studies published up to 31 December 2022. Cases were categorized in children and adolescents (age < 18 years), adults and elderly (age ≥ 18 years), and immunocompromised patients, and then pooled in a random-effects model. Heterogeneity was assessed using the I2 statistics, while reporting bias was assessed by means of funnel plots and regression analysis. A total of 10 studies (217 RSV cases) were retrieved (children, 37.3%; immunocompromised, 41.0%; adults, 21.7%). The most common features were signs of organizing pneumonia (33.65%, 95% confidence interval [95% CI] 22.39-47.27), followed by septal thickening (33.19%, 95% CI 21.76-47.03), ground glass opacities (GGOs; 28.03%, 95% CI 14.69-46.82), and tree-in-bud (TIB, 27.44%, 95% CI 15.04-44.68). Interestingly, up to 16.23% (95% CI 8.17-29.69) showed normal findings, while the large majority (76.06%, 95% CI 64.81-84.56) were characterized by bilateral involvement. Studies were highly heterogeneous without substantial reporting bias. Assuming children and adolescents as reference groups, healthy adults were characterized by a higher risk ratio [RR] for septal thickening (RR 3.878, 95% CI 1.253-12.000), nodular lesions (RR 20.197, 95% CI 1.286-317.082), and GGOs (RR 2.121, 95% CI 1.121-4.013). RSV cases are rarely assessed in terms of CT characteristics. Our study identified some specificities, suggesting that RSV infections evolve heterogeneous CT features in children/adolescents and adults, but the paucity of studies recommends a cautious appraisal.