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Łyźniak P, Świętoń D, Szurowska E. Lung ultrasound in a nutshell. Lines, signs, some applications, and misconceptions from a radiologist's point of view. Part 2. Pol J Radiol 2024; 89:e211-e224. [PMID: 38783909 PMCID: PMC11112417 DOI: 10.5114/pjr.2024.139286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/11/2024] [Indexed: 05/25/2024] Open
Abstract
In recent years, lung ultrasound (LUS) has developed rapidly, and it is gaining growing popularity in various scenarios. There are constant attempts to introduce it to new fields. In addition, knowledge regarding lung and LUS has been augmented by the recent COVID-19 pandemics. In the first part of this review we discuss lines, signs and pheno-mena, profiles, some applications, and misconceptions. An aim of the second part of the review is mainly to discuss some advanced applications of LUS, including lung elastography, lung spectroscopy, colour and spectral Doppler, contrast-enhanced ultrasound of lung, speckled tracking of pleura, quantification of pulmonary oedema, predicting success of talc pleurodesis, asthma exacerbations, detecting chest wall invasion by tumours, lung biopsy, estimating pleural effusion volume, and predicting mechanical ventilatory weaning outcome. For this purpose, we reviewed literature concerning LUS.
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Affiliation(s)
- Piotr Łyźniak
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Dominik Świętoń
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
| | - Edyta Szurowska
- 2 Department of Radiology, University Clinical Centre in Gdańsk, Gdańsk, Poland
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2
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Scheier E, Shoseyov D. Pleural line slope in point of care ultrasound assessment of paediatric wheeze may reflect respiratory effort. Acta Paediatr 2024; 113:795-801. [PMID: 38088477 DOI: 10.1111/apa.17057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 03/12/2024]
Abstract
AIM Asthma scoring systems rely on physical examination findings. Point of care ultrasound may provide an objective means to document improvement in the work of breathing in paediatric lower airway obstruction. METHODS Thirty children with wheeze on physical examination (cases) and 15 children presenting with abdominal pain (controls) were studied. Using point-of-care ultrasound, m-mode tracing of lung was recorded above the right hemidiaphragm at the midclavicular line. Pleural line slope and excursion were measured before and after treatment. RESULTS Twenty patients had a final slope measurement under 20°, and only three were admitted-one for hypoxia that resolved prior to ascending to the ward and another for poor compliance. Average decrease in pleural line slope after treatment was 43% and average decrease in pleural line excursion was 32%. Of the 10 children admitted, 8 had measurements over 25°. The correlation coefficient between pleural slope and pleural excursion was 0.67. All controls had a horizontal m-mode tracing at the pleural line. CONCLUSION Oscillation of the m-mode line at the pleura is seen in children with lower airway obstruction and is absent in controls. There appears to be a correlation between beta-agonist therapy and decreased pleural line slope and excursion.
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Affiliation(s)
- Eric Scheier
- Pediatric Emergency, Kaplan Medical Center, Rehovot, Israel
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - David Shoseyov
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
- Pediatric Pulmonology, Kaplan Medical Center, Rehovot, Israel
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DeSanti RL, Gill KG, Swanson JO, Kory PD, Schmidt J, Cowan EA, Lasarev MR, Al-Subu AM. Comparison of chest radiograph and lung ultrasound in children with acute respiratory failure. J Ultrasound 2023; 26:861-870. [PMID: 37747593 PMCID: PMC10632347 DOI: 10.1007/s40477-023-00827-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 08/17/2023] [Indexed: 09/26/2023] Open
Abstract
PURPOSE Chest x-ray (CXR) is the standard imaging used to evaluate children in acute respiratory distress and failure. Our objective was to compare the lung-imaging techniques of CXR and lung ultrasound (LUS) in the evaluation of children with acute respiratory failure (ARF) to quantify agreement and to determine which technique identified a higher frequency of pulmonary abnormalities. METHODS This was a secondary analysis of a prospective observational study evaluating the sensitivity and specificity of LUS in children with ARF from 12/2018 to 02/2020 completed at the University of Wisconsin-Madison (USA). Children > 37.0 weeks corrected gestational age and ≤ 18 years of age admitted to the PICU with ARF were evaluated with LUS. We compared CXR and LUS completed within 6 h of each other. Kappa statistics (k) adjusted for maximum attainable agreement (k/kmax) were used to quantify agreement between imaging techniques and descriptive statistics were used to describe the frequency of abnormalities. RESULTS Eighty-eight children had LUS completed, 32 with concomitant imaging completed within 6 h are included. There was fair agreement between LUS and CXR derived diagnoses with 58% agreement (k/kmax = 0.36). Evaluation of imaging patterns included: normal, 57% agreement (k = 0.032); interstitial pattern, 47% agreement (k = 0.003); and consolidation, 65% agreement (k = 0.29). CXR identified more imaging abnormalities than LUS. CONCLUSIONS There is fair agreement between CXR and LUS-derived diagnoses in children with ARF. Given this, clinicians should consider the benefits and limitations of specific imaging modalities when evaluating children with ARF. Additional studies are necessary to further define the role of LUS in pediatric ARF given the small sample size of our study.
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Affiliation(s)
- Ryan L DeSanti
- Department of Pediatrics, Drexel College of Medicine, St Christopher's Hospital for Children, Philadelphia, PA, USA.
- Department of Critical Care Medicine, St Christopher's Hospital for Children, 160 East Erie Avenue, Third Floor Suite, Office A3-20k, Philadelphia, PA, 19143, USA.
| | - Kara G Gill
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Jonathan O Swanson
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Pierre D Kory
- Department of Medicine, Advocate Aurora Health Care, St Luke's Medical Center, Milwaukee, WI, USA
| | - Jessica Schmidt
- Department of Emergency Medicine, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Eileen A Cowan
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Michael R Lasarev
- Department of Biostatistics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | - Awni M Al-Subu
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
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Hernández-Villarroel AC, Ruiz-García A, Manzanaro C, Echevarría-Zubero R, Bote-Gascón P, Gonzalez-Bertolin I, Sainz T, Calvo C, Bueno-Campaña M. Lung Ultrasound: A Useful Prognostic Tool in the Management of Bronchiolitis in the Emergency Department. J Pers Med 2023; 13:1624. [PMID: 38138851 PMCID: PMC10745017 DOI: 10.3390/jpm13121624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/01/2023] [Accepted: 11/13/2023] [Indexed: 12/24/2023] Open
Abstract
Lung ultrasound, a non-invasive bedside technique for assessing paediatric patients with acute respiratory diseases, is becoming increasingly widespread. The aim of this prospective, observational cohort study was to evaluate the effectiveness of a clinical ultrasound score in assessing infants with acute bronchiolitis in the emergency department and its ability to accurately identify patients at a higher risk of clinical deterioration. Infants under 6 months of age with clinical symptoms compatible with acute bronchiolitis were enrolled and underwent clinical and lung ultrasound evaluations. The study included 50 patients, the median age of which was 2.2 months (IQR: 1-5), and the primary outcome was respiratory support. Infants requiring invasive or non-invasive ventilation showed higher scores (5 points [IQR: 3.5-5.5] vs. 2.5 [IQR: 1.5-4]). The outcome had an AUC of 0.85 (95%CI: 0.7-0.98), with a sensitivity of 87%, specificity of 64%, and negative predictive value of 96.4% for a score <3.5 points. Children who scored ≥3.5 points were more likely to require respiratory support within the next 24 h (estimated event-free survival of 82.9% compared to 100%, log-rank test p-value = 0.02). The results suggest that integrating lung ultrasound findings into clinical scores when evaluating infants with acute bronchiolitis could be a promising tool for improving prognosis.
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Affiliation(s)
- Aiza C. Hernández-Villarroel
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Alicia Ruiz-García
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Carlos Manzanaro
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Regina Echevarría-Zubero
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
| | - Patricia Bote-Gascón
- Paediatric Emergency Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (P.B.-G.); (I.G.-B.)
| | - Isabel Gonzalez-Bertolin
- Paediatric Emergency Department, Hospital Universitario La Paz, 28046 Madrid, Spain; (P.B.-G.); (I.G.-B.)
| | - Talía Sainz
- Department of Paediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz, 28046 Madrid, Spain; (T.S.); (C.C.)
- IdiPAZ Research Institute, Translational Research Network for Paediatric Infectious Diseases (RITIP), 28029 Madrid, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
- Department of Paediatrics, Autonomous University of Madrid, 28029 Madrid, Spain
| | - Cristina Calvo
- Department of Paediatrics, Tropical and Infectious Diseases, Hospital Universitario La Paz, 28046 Madrid, Spain; (T.S.); (C.C.)
- IdiPAZ Research Institute, Translational Research Network for Paediatric Infectious Diseases (RITIP), 28029 Madrid, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
- Department of Paediatrics, Autonomous University of Madrid, 28029 Madrid, Spain
| | - Mercedes Bueno-Campaña
- Department of Paediatrics and Neonatology, Hospital Universitario Fundación Alcorcón, 28922 Madrid, Spain; (A.C.H.-V.); (A.R.-G.); (C.M.)
- IdiPAZ Research Institute, Translational Research Network for Paediatric Infectious Diseases (RITIP), 28029 Madrid, Spain
- Centre for Biomedical Research in Infectious Diseases (CIBERINFEC), 28029 Madrid, Spain
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Bloise S, Marcellino A, Sanseviero M, Martucci V, Testa A, Leone R, Del Giudice E, Frasacco B, Gizzone P, Proietti Ciolli C, Ventriglia F, Lubrano R. Point-of-Care Thoracic Ultrasound in Children: New Advances in Pediatric Emergency Setting. Diagnostics (Basel) 2023; 13:diagnostics13101765. [PMID: 37238249 DOI: 10.3390/diagnostics13101765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 05/10/2023] [Accepted: 05/11/2023] [Indexed: 05/28/2023] Open
Abstract
Point-of-care thoracic ultrasound at the patient's bedside has increased significantly recently, especially in pediatric settings. Its low cost, rapidity, simplicity, and repeatability make it a practical examination to guide diagnosis and treatment choices, especially in pediatric emergency departments. The fields of application of this innovative imaging method are many and include primarily the study of lungs but also that of the heart, diaphragm, and vessels. This manuscript aims to describe the most important evidence for using thoracic ultrasound in the pediatric emergency setting.
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Affiliation(s)
- Silvia Bloise
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Alessia Marcellino
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Mariateresa Sanseviero
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Vanessa Martucci
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Alessia Testa
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Rita Leone
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Emanuela Del Giudice
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Beatrice Frasacco
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Pietro Gizzone
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Claudia Proietti Ciolli
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Flavia Ventriglia
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
| | - Riccardo Lubrano
- UOC di Pediatria e Neonatologia Ospedale Santa Maria Goretti-Polo Pontino, Dipartimento Materno Infantile e di Scienze Urologiche, Sapienza Università di Roma, 00185 Roma, Italy
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Aydin O, Birbilen AZ, User IR, Turer OB, Teksam O. Lung ultrasound findings in children with foreign body aspiration. JOURNAL OF CLINICAL ULTRASOUND : JCU 2023; 51:447-451. [PMID: 36054370 DOI: 10.1002/jcu.23306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/07/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Foreign body aspiration (FBA) has a wide clinical spectrum, patients may be asymptomatic or present with cardiopulmonary arrest. Radiological imaging methods are used in addition to history and physical examination findings for certain diagnosis. Lung ultrasonography (LUS), whose usage area is increasing year by year, can be included in these. This study aimed to investigate ultrasonography findings in FBA and hypothesized that LUS may have a standard place in FBA diagnosis. METHODS Patients who administered to the pediatric emergency department between August 2019-August 2021, considered according to the clinical findings and physical examination possible FBA, and who undergone rigid bronchoscopy by pediatric surgery were included in the study. RESULTS Thirty-two patients were included in the study. According to the results of bronchoscopy, FBA was detected in 25 patients. The most common finding in radiography was hyperinflation on one side, while LUS findings were confluent-B lines in eight patients, barcode-sign in five patients, pleural line abnormalities in two patients, and pleural consolidation in two patients. CONCLUSION This study is the first study aiming to evaluate LUS findings in FBA to the best of our knowledge. The B-lines, barcode sign, pleural line abnormalities and consolidation are seen findings in LUS of the patients with FBA. Although it is far from replacing chest radiography in these patients, it is possible to say that it has an equivalent value with chest radiography.
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Affiliation(s)
- Orkun Aydin
- Division of Pediatric Emergency, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Ziya Birbilen
- Division of Pediatric Emergency, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Idil Rana User
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozlem Boybeyi Turer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ozlem Teksam
- Division of Pediatric Emergency, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Giorno EP, Foronda FK, De Paulis M, Bou Gohsn DN, Couto TB, Sa FV, Fraga AM, Farhat SC, Preto-Zamperlini M, Schvartsman C. Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress. Am J Emerg Med 2023; 68:112-118. [PMID: 36966586 DOI: 10.1016/j.ajem.2023.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/23/2023] [Accepted: 02/26/2023] [Indexed: 03/06/2023] Open
Abstract
PURPOSE Respiratory distress due to lower respiratory illnesses is a leading cause of death in children. Early recognition of high-risk populations is critical for the allocation of adequate resources. Our goal was to assess whether the lung ultrasound (US) score obtained at admission in children with respiratory distress predicts the need for escalated care. METHODS This prospective study included 0-18-year-old patients with respiratory distress admitted to three emergency departments in the state of Sao Paulo, Brazil, between July 2019 and September 2021. The enrolled patients underwent lung US performed by a pediatric emergency physician within two hours of arrival. Lung ultrasound scores ranging from 0 to 36 were computed. The primary outcome was the need for high-flow nasal cannula (HFNC), noninvasive ventilation (NIV), or mechanical ventilation within 24 h. RESULTS A total of 103 patients were included. The diagnoses included wheezing (33%), bronchiolitis (27%), pneumonia (16%), asthma (9%), and miscellaneous (16%). Thirty-five patients (34%) required escalated care and had a higher lung ultrasound score: median 13 (0-34) vs 2 (0-21), p < 0.0001; area under the curve (AUC): 0.81 (95% confidence interval [CI]: 0.71-0.90). The best cut-off score derived from Youden's index was seven (sensitivity: 71.4%; specificity: 79.4%; odds ratio (OR): 9.6 [95% CI: 3.8-24.7]). A lung US score above 12 was highly specific and had a positive likelihood ratio of 8.74 (95% CI:3.21-23.86). CONCLUSION An elevated lung US score measured in the first assessment of children with any type of respiratory distress was predictive of severity as defined by the need for escalated care with HFNC, NIV, or mechanical ventilation.
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Marzook N, Gagnon F, Deragon A, Zielinski D, Shapiro AJ, Lands LC, Dubrovsky AS. Lung ultrasound findings in asymptomatic healthy children with asthma. Pediatr Pulmonol 2022; 57:2474-2480. [PMID: 35794853 DOI: 10.1002/ppul.26061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 06/13/2022] [Accepted: 07/03/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) has been shown to be an effective tool to rapidly diagnose certain causes of pediatric respiratory distress. However, very little is known about LUS findings in pediatric asthma. OBJECTIVES The primary objective of this study was to characterize LUS findings in a cohort of pediatric patients with a definitive diagnosis of asthma, outside of an asthma exacerbation. METHODS Eligible patients, aged 6-17 years old and diagnosed with asthma, underwent LUS during an outpatient visit. LUS was conducted using a six-zone scanning protocol. Presence of a LUS artifact was defined by one or more of the following: ≥3 B-lines per intercostal space, pulmonary consolidation, and/or pleural abnormality. Images were interpreted by an expert sonographer blinded to patient clinical characteristics. RESULTS Fifty-two patients were included. 10/52 (19.2%) patients demonstrated the presence of LUS artifacts: 8 with ≥3 B-lines, 1 with consolidation >1 cm, and 7 with subpleural consolidations <1 cm, 1 with a pleural line abnormality. Artifacts were seen in the right anterior and lateral zones in 60% of participants and were limited to 1-2 intercostal space(s) within one lung zone in all participants. No association was found between presence of LUS artifacts and asthma control or severity. CONCLUSION To our knowledge, this is the first report of LUS findings in outpatient pediatric asthma. LUS artifacts in asthmatic children can be seen outside of acute exacerbations. Such baseline findings need to be taken into consideration when using LUS for the acute evaluation of a pediatric patient with asthma.
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Affiliation(s)
- Noah Marzook
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Francois Gagnon
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | - David Zielinski
- Pediatric Respirology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Adam J Shapiro
- Pediatric Respirology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Larry C Lands
- Pediatric Respirology, Montreal Children's Hospital, McGill University Health Center Research Institute, Montreal, Quebec, Canada
| | - Alexander S Dubrovsky
- Department of Pediatrics, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada.,UP Centre for Pediatric Emergencies, Montreal, Quebec, Canada
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Gagnon F, Marzook N, Deragon A, Lands LC, Zielinski D, Shapiro AJ, Rampakakis E, Dubrovsky AS. Characterizing pediatric lung ultrasound findings during a chemically induced bronchospasm. Pediatr Pulmonol 2022; 57:1475-1482. [PMID: 35355448 DOI: 10.1002/ppul.25907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/20/2022] [Accepted: 03/27/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Lung ultrasound (LUS) has been shown to be a useful clinical tool in pediatrics, but very little is known about the LUS findings of asthma in children. OBJECTIVES The primary objective was to characterize LUS findings of pediatric patients before and after a chemically induced bronchospasm. The secondary objective was to evaluate the effect of bronchodilators on LUS findings. METHODS Eligible children 6-17 years old presenting for a methacholine challenge test (MCT) in a pediatric respiratory clinic were recruited. Patients with viral symptoms were excluded. A six-zone LUS protocol was performed before and after the MCT, and after bronchodilator administration; video recordings were analysed by an expert blinded to the patient characteristics and MCT results. RESULTS Forty-four patients were included in the study. Five patients had positive LUS findings at baseline. Nine patients out of 29 (31%) had new-onset positive LUS following a reactive MCT. There was a significant association between having a chemically induced bronchospasm and a positive LUS post-MCT (odds ratio [95% confidence interval]: 5.3 [1.0-27.7]; p = 0.05). Among patients who developed positive LUS findings post-MCT, four out of nine returned to having a negative LUS postbronchodilator administration. CONCLUSIONS This is the first known report of an association between LUS findings and bronchospasm in pediatric patients. It is also the first documentation of resolution of LUS findings postbronchodilator administration. Most LUS findings observed were small and limited to a few intercostal spaces. Further research is required to quantify these findings and evaluate the effect of salbutamol on LUS.
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Affiliation(s)
- Francois Gagnon
- McGill University Health Center, Division of General Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Noah Marzook
- McGill University Health Center, Division of General Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Alexandre Deragon
- Division of Pediatric Emergency Medicine, Children's Hospital of Eastern Ontario, Ontario, Ottawa, Canada
| | - Larry C Lands
- Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - David Zielinski
- Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Adam J Shapiro
- Department of Respirology, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | - Emmanouil Rampakakis
- McGill University Health Center, Division of General Pediatrics, Montreal Children's Hospital, Montreal, Quebec, Canada
| | - Alexander S Dubrovsky
- Pediatric Emergency Medicine, Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
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DeSanti RL, Cowan EA, Kory PD, Lasarev MR, Schmidt J, Al-Subu AM. The Inter-Rater Reliability of Pediatric Point-of-Care Lung Ultrasound Interpretation in Children With Acute Respiratory Failure. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2022; 41:1159-1167. [PMID: 34378821 PMCID: PMC8831657 DOI: 10.1002/jum.15805] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/07/2021] [Accepted: 07/18/2021] [Indexed: 05/03/2023]
Abstract
OBJECTIVES Use of point-of-care lung ultrasound (POC-LUS) has increased significantly in pediatrics yet it remains under-studied in the pediatric intensive care unit (PICU). No studies explicitly evaluate the reliability of POC-LUS artifact interpretation among critically ill children with acute respiratory failure (ARF) in the PICU. We thus designed this study to determine the inter-rater reliability of POC-LUS interpretation in pediatric ARF among pediatric intensivists trained in POC-LUS and an expert intensivist. METHODS We compared the interpretation of lung sliding, pleural line characteristics, ultrasound artifacts, and POC-LUS diagnoses among pediatric intensivists and an expert intensivist in a cohort of children admitted to the PICU for ARF. Kappa statistics (k) adjusted for maximum attainable agreement (k/kmax ) were used to quantify chance-correct agreement between the pediatric intensivist and expert physician. RESULTS We enrolled 88 patients, evaluating 3 zones per hemithorax (anterior, lateral, and posterior) for lung sliding, pleural line characteristics, ultrasound artifacts, and diagnosis. There was moderate agreement between the PICU intensivist and expert-derived diagnoses with 56% observed agreement (k/kmax = 0.46, 95% confidence interval [CI] 0.31-0.65). Agreement in identification of lung sliding (k = 0.19, 95% CI -0.17 to 0.56) and pleural line characteristics (k = 0.24, 95% CI 0.08-0.40) was slight and fair, respectively, while agreement in the interpretation of ultrasound artifacts ranged from moderate to substantial. CONCLUSIONS Evidence supporting the evaluation of neonatal and adult patients with POC-LUS should not be extrapolated to critically ill pediatric patients. This study adds to the evidence supporting use of POC-LUS in the PICU by demonstrating moderate agreement between PICU intensivist and expert-derived POC-LUS diagnoses.
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Affiliation(s)
- Ryan L DeSanti
- Department of Pediatrics, Drexel College of Medicine, St Christopher’s Hospital for Children, Philadelphia, PA, USA
| | - Eileen A Cowan
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Pierre D Kory
- Department of Medicine, Advocate Aurora Health Care, St Luke’s Medical Center, Milwaukee, Wisconsin, USA
| | - Michael R Lasarev
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jessica Schmidt
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Awni M Al-Subu
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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11
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Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure. J Ultrasound 2022; 25:929-937. [PMID: 35397743 PMCID: PMC8994848 DOI: 10.1007/s40477-022-00675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 03/05/2022] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To describe point-of-care lung ultrasound (POC-LUS) artifact findings in children admitted to the pediatric intensive care unit (PICU) for acute respiratory failure (ARF). METHODS This is a secondary analysis of a prospective observational study completed in a 21-bed PICU. Children > 37 weeks gestational age and ≤ 18 years were enrolled from December 2018 to February 2020. POC-LUS was completed and interpreted by separate physicians blinded to all clinical information. POC-LUS was evaluated for the presence of lung sliding, pleural line characteristics, ultrasound artifacts, and the ultrasound diagnosis. RESULTS Eighty-seven subjects were included. A-lines were the most frequent artifact, occurring in 58% of lung zones (163/281) in those with bronchiolitis, 39% of lung zones (64/164) in those with pneumonia, and 81% of lung zones (48/59) in those with status asthmaticus. Sub-pleural consolidation was second most common, occurring in 28% (80/281), 30% (50/164), and 12% (7/59) of those with bronchiolitis, pneumonia, and status asthmaticus, respectively. The pattern a priori defined as bronchiolitis, pneumonia, and status asthmaticus was demonstrated in 31% (15/48), 10% (3/29), and 40% (4/10) of subjects with bronchiolitis, pneumonia, and status asthmaticus, respectively. CONCLUSION We found significant heterogeneity and overlap of POC-LUS artifacts across the most common etiologies of ARF in children admitted to the PICU. We have described the POC-LUS artifact findings in pediatric ARF to support clinicians using POC-LUS and to guide future pediatric POC-LUS studies. Determining the optimal role of POC-LUS as an adjunct in the care of pediatric patients requires further study.
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12
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Niedbalski PJ, Choi J, Hall CS, Castro M. Imaging in Asthma Management. Semin Respir Crit Care Med 2022; 43:613-626. [PMID: 35211923 DOI: 10.1055/s-0042-1743289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Asthma is a heterogeneous disease characterized by chronic airway inflammation that affects more than 300 million people worldwide. Clinically, asthma has a widely variable presentation and is defined based on a history of respiratory symptoms alongside airflow limitation. Imaging is not needed to confirm a diagnosis of asthma, and thus the use of imaging in asthma has historically been limited to excluding alternative diagnoses. However, significant advances continue to be made in novel imaging methodologies, which have been increasingly used to better understand respiratory impairment in asthma. As a disease primarily impacting the airways, asthma is best understood by imaging methods with the ability to elucidate airway impairment. Techniques such as computed tomography, magnetic resonance imaging with gaseous contrast agents, and positron emission tomography enable assessment of the small airways. Others, such as optical coherence tomography and endobronchial ultrasound enable high-resolution imaging of the large airways accessible to bronchoscopy. These imaging techniques are providing new insights in the pathophysiology and treatments of asthma and are poised to impact the clinical management of asthma.
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Affiliation(s)
- Peter J Niedbalski
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Jiwoong Choi
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Chase S Hall
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
| | - Mario Castro
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas
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13
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De Rose C, Miceli Sopo S, Valentini P, Morello R, Biasucci D, Buonsenso D. Potential Application of Lung Ultrasound in Children with Severe Uncontrolled Asthma: Preliminary Hypothesis Based on a Case Series. MEDICINES 2022; 9:medicines9020011. [PMID: 35200755 PMCID: PMC8877587 DOI: 10.3390/medicines9020011] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/26/2022] [Accepted: 01/27/2022] [Indexed: 11/16/2022]
Abstract
In recent years, lung ultrasound (LUS) has been increasingly used for the diagnosis of respiratory diseases in both adult and pediatric patients. However, asthma is a field in which the use of LUS is not yet well defined, or is in development. In the following case series, we describe clinical, laboratory, and radiological results, as well as detailed lung ultrasound findings of six children with asthma: some of them with acute asthma attack and with inadequately controlled allergic asthma or childhood asthma; others with acute asthma and allergic or infantile asthma adequately controlled by preventive therapy. Finally, we describe the clinical, laboratory, and imaging parameters of a child with severe allergic asthma in the absence of exacerbation. In these cases, albeit at different times, LUS played an important role in both the initial diagnostic process and follow-up. It also showed different ultrasound features depending on the severity of the individual asthma based on the type of asthmatic phenotype and control of it.
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Affiliation(s)
- Cristina De Rose
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
- Correspondence: ; Tel.: +32-7661-4543 or +39-06-3015-4390; Fax: +39-06-338-3211
| | - Stefano Miceli Sopo
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
| | - Daniele Biasucci
- Department of Anesthesia and Intensive Care, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Rome, Italy;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Policlinic Gemelli Universitary Foundation IRCCS, Catholic University of Sacre Hearth, 00168 Rome, Italy; (S.M.S.); (P.V.); (R.M.); (D.B.)
- Department of Basic Biotechnological Sciences, Intensive and Perioperative Clinics, Catholic University of Sacre Hearth, 00168 Rome, Italy
- Global Health Research Institute, Institute of Hygiene, Catholic University of Sacre Hearth, 00168 Rome, Italy
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14
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Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, Morello R, Supino MC, Villani A, Valentini P, Buonsenso D. Ten Years of Pediatric Lung Ultrasound: A Narrative Review. Front Physiol 2022; 12:721951. [PMID: 35069230 PMCID: PMC8770918 DOI: 10.3389/fphys.2021.721951] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 11/17/2021] [Indexed: 12/04/2022] Open
Abstract
Lung diseases are the most common conditions in newborns, infants, and children and are also the primary cause of death in children younger than 5 years old. Traditionally, the lung was not thought to be a target for an ultrasound due to its inability to penetrate the gas-filled anatomical structures. With the deepening of knowledge on ultrasound in recent years, it is now known that the affected lung produces ultrasound artifacts resulting from the abnormal tissue/gas/tissue interface when ultrasound sound waves penetrate lung tissue. Over the years, the application of lung ultrasound (LUS) has changed and its main indications in the pediatric population have expanded. This review analyzed the studies on lung ultrasound in pediatrics, published from 2010 to 2020, with the aim of highlighting the usefulness of LUS in pediatrics. It also described the normal and abnormal appearances of the pediatric lung on ultrasound as well as the benefits, limitations, and possible future challenges of this modality.
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Affiliation(s)
- Anna Maria Musolino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eugenio Pitaro
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Rita De Santis
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- General Pediatric and Infectious Disease Unit, Internal Care Department, Bambino Gesù Children’s Hospital, Rome, Italy
| | - Piero Valentini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Dipartimento di Scienze Biotecnologiche di Base, Cliniche Intensivologiche e Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy
- Global Health Research Institute, Istituto di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy
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15
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Attanasi M, Sferrazza Papa S, Porreca A, Sferrazza Papa GF, Di Filippo P, Piloni F, Dodi G, Sansone F, Di Pillo S, Chiarelli F. Use of lung ultrasound in school-aged children with wheezing. Front Pediatr 2022; 10:926252. [PMID: 36699291 PMCID: PMC9869023 DOI: 10.3389/fped.2022.926252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is limited information available on fast and safe bedside tools that could help clinicians establish whether the pathological process underlying cases of wheezing is due to asthmatic exacerbation, asthmatic bronchitis, or pneumonia. The study's aim was to characterize Lung Ultrasound (LUS) in school-aged children with wheezing and evaluate its use for their follow-up treatment. MATERIALS AND METHODS We carried out a cross-sectional study involving 68 consecutive outpatients (mean age 9.9 years) with wheezing and suggestive signs of an acute respiratory infection. An expert sonographer, blinded to all subject characteristics, clinical course, and the study pediatrician's diagnosis, performed an LUS after spirometry and before BDT. The severity of acute respiratory symptoms was determined using the Pediatric Respiratory Assessment Measure (PRAM) score. RESULTS The LUS was positive in 38.2% (26/68) of patients [12 (46.1%) with multiple B-lines, 24 (92.3%) with consolidation, and 22 (84.6%) with pleural abnormalities]. In patients with pneumonia, asthmatic bronchitis, and asthma, the percentages of those patients with a positive LUS were 100%, 57.7%, and 0%, respectively. Of note, patients with a positive LUS were associated with an increased need for hospital admission (30.8% vs. 2.4%, p = 0.001), administration of oxygen therapy (14.6% vs. 0%, p = 0.009), oral corticosteroids (84.6% vs. 19.0%, p < 0.001), and antibiotics (88.5% vs. 11.9%, p < 0.001); and a higher median value of PRAM score (4.0 (2.0-7.0) vs. 2.0 (1.0-5.0); p < 0.001). CONCLUSIONS Our findings would suggest the use of LUS as a safe and cheap tool used by clinicians to define the diagnosis of school-aged children with wheezing of unknown causes.
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Affiliation(s)
- Marina Attanasi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Simone Sferrazza Papa
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Annamaria Porreca
- Department of Economic Studies, University of Chieti-Pescara, Chieti, Italy
| | - Giuseppe F Sferrazza Papa
- Department of Health Sciences, Università degli Studi di Milano, Milan, Italy.,Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, Milan, Italy
| | - Paola Di Filippo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesca Piloni
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Giulia Dodi
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Sansone
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Sabrina Di Pillo
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
| | - Francesco Chiarelli
- Department of Pediatrics, Pediatric Allergy and Pulmonology Unit, University of Chieti-Pescara, Chieti, Italy
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16
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Hassanzad M, Kiani A, Abedini A, Ghaffaripour H, Emami H, Alizadeh N, Zoghi G, Hashemi S, Velayati AA. Lung ultrasound for the diagnosis of cystic fibrosis pulmonary exacerbation. BMC Pulm Med 2021; 21:353. [PMID: 34743707 PMCID: PMC8572653 DOI: 10.1186/s12890-021-01728-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 11/03/2021] [Indexed: 01/03/2023] Open
Abstract
Background High-resolution computed tomography (HRCT) is the gold standard for the evaluation of cystic fibrosis (CF) lung disease; however, lung ultrasound (LUS) is being increasingly used for the assessment of lung in these patients due to its lower cost, availability, and lack of irradiation. We aimed to determine the diagnostic performance of LUS for the evaluation of CF pulmonary exacerbation. Methods This cross-sectional study included patients with CF pulmonary exacerbation admitted to Masih Daneshvari Hospital, Tehran, Iran, from March 21, 2020 to March 20, 2021. Age, gender, and body mass index (BMI) of the patients were recorded. All patients underwent chest X-ray (CXR), HRCT, and LUS on admission. Pleural thickening, atelectasis, air bronchogram, B-line, and consolidation were noted in LUS and then compared with the corresponding findings in CXR and HRCT. Taking HRCT findings as reference, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy (DA) of LUS and CXR for the detection of each pulmonary abnormality were determined. Results Of the 30 patients included in this study, with a mean age of 19.62 ± 5.53 years, 14 (46.7%) were male. Of the 15 patients aged 2–20 years, BMI was below the 5th percentile in 10 (66.7%), within the 5–10 percentiles in 1 (6.7%), 10–25 percentiles in 3 (20%), and 25-50 percentiles in 1 (6.7%). The mean BMI for 15 patients > 20 years was 18.03 ± 2.53 kg/m2. LUS had better diagnostic performance compared to CXR for the detection of air bronchogram, consolidation, and pleural thickening (area under the receiver operating characteristic curve [AUROC]: 0.966 vs. 0.483, 0.900 vs. 0.575, and 0.656 vs. 0.531, respectively). Also, LUS was 100% and 96.7% specific for the diagnosis of pleural effusion and atelectasis, respectively. Conclusions LUS appears to be superior to CXR and comparable with HRCT for the evaluation of CF pulmonary exacerbation, especially in terms of air bronchogram and consolidation detection. LUS can be used to lengthen the HRCT evaluation intervals in this regard or utilized along with HRCT for better evaluation of CF pulmonary exacerbation.
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Affiliation(s)
- Maryam Hassanzad
- Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Arda Kiani
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atefeh Abedini
- Chronic Respiratory Diseases Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hoseinali Ghaffaripour
- Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Habib Emami
- Tobacco Prevention and Control Research Center, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Niloufar Alizadeh
- Department of Biostatistics, National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ghazal Zoghi
- Endocrinology and Metabolism Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - Saeed Hashemi
- Pediatric Respiratory Diseases Research Center (PRDRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Akbar Velayati
- Mycobacteriology Research Center (MRC), National Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Sansone F, Attanasi M, Di Filippo P, Sferrazza Papa GF, Di Pillo S, Chiarelli F. Usefulness of Lung Ultrasound in Paediatric Respiratory Diseases. Diagnostics (Basel) 2021; 11:1783. [PMID: 34679481 PMCID: PMC8534634 DOI: 10.3390/diagnostics11101783] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 09/22/2021] [Accepted: 09/24/2021] [Indexed: 01/02/2023] Open
Abstract
Respiratory infection diseases are among the major causes of morbidity and mortality in children. Diagnosis is focused on clinical presentation, yet signs and symptoms are not specific and there is a need for new non-radiating diagnostic tools. Among these, lung ultrasound (LUS) has recently been included in point-of-care protocols showing interesting results. In comparison to other imaging techniques, such as chest X-ray and computed tomography, ultrasonography does not use ionizing radiations. Therefore, it is particularly suitable for clinical follow-up of paediatric patients. LUS requires only 5-10 min and allows physicians to make quick decisions about the patient's management. Nowadays, LUS has become an early diagnostic tool to detect pneumonia during the COVID-19 pandemic. In this narrative review, we show the most recent scientific literature about advantages and limits of LUS performance in children. Furthermore, we discuss the major paediatric indications separately, with a paragraph fully dedicated to COVID-19. Finally, we mention potential future perspectives about LUS application in paediatric respiratory diseases.
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Affiliation(s)
- Francesco Sansone
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Marina Attanasi
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Paola Di Filippo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Giuseppe Francesco Sferrazza Papa
- Dipartimento di Scienze della Salute, Università degli Studi di Milano, 20146 Milan, Italy;
- Department of Neurorehabilitation Sciences, Casa di Cura del Policlinico, 20144 Milan, Italy
| | - Sabrina Di Pillo
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
| | - Francesco Chiarelli
- Paediatric Allergy and Pulmonology Unit, Department of Paediatrics, University of Chieti-Pescara, 66100 Chieti, Italy; (F.S.); (M.A.); (P.D.F.); (S.D.P.)
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18
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DeSanti RL, Al-Subu AM, Cowan EA, Kamps NN, Lasarev MR, Schmidt J, Kory PD. Point-of-Care Lung Ultrasound to Diagnose the Etiology of Acute Respiratory Failure at Admission to the PICU. Pediatr Crit Care Med 2021; 22:722-732. [PMID: 33739956 DOI: 10.1097/pcc.0000000000002716] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Determine the sensitivity and specificity of point-of-care lung ultrasound in identifying the etiology of acute respiratory failure at admission to the PICU. DESIGN Prospective observational study. SETTING Tertiary PICU. PATIENTS Children older than 37 weeks gestational age and less than or equal to 18 years old admitted to the PICU with acute respiratory failure from December 2018 to February 2020. INTERVENTION Point-of-care lung ultrasound performed within 14 hours of admission to the PICU by physicians blinded to patient history and clinical course. Two physicians, blinded to all clinical information, independently interpreted the point-of-care lung ultrasound and then established a consensus diagnosis (ultrasound diagnosis). The ultrasound diagnosis was compared with an independent, standardized review of the medical record following hospital discharge (final diagnosis). MEASUREMENTS AND RESULTS Eighty-eight patients were enrolled in the study. Forty-eight patients had a final diagnosis of bronchiolitis/viral pneumonitis (55%), 29 had pneumonia (33%), 10 had status asthmaticus (11%), and one was excluded because of an inability to differentiate the final diagnosis. Point-of-care lung ultrasound correctly identified the etiology of acute respiratory failure in 56% of patients (49/87; 95% CI, 46-66%). It identified bronchiolitis/viral pneumonitis with 44% sensitivity (95% CI, 0.31-0.58) and 74% specificity (95% CI, 0.59-0.85), pneumonia with 76% sensitivity (95% CI, 0.58-0.88) and 67% specificity (95% CI 0.54-0.78), and status asthmaticus with 60% sensitivity (95% CI, 0.31-0.83) and 88% specificity (95% CI, 0.79-0.94). CONCLUSIONS In contrast to literature demonstrating high utility differentiating the cause of acute respiratory failure in adults, blinded point-of-care lung ultrasound demonstrates moderate sensitivity and specificity in identifying the etiology of pediatric acute respiratory failure at admission to the PICU among children with bronchiolitis, pneumonia, and status asthmaticus.
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Affiliation(s)
- Ryan L DeSanti
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Awni M Al-Subu
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Eileen A Cowan
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Nicole N Kamps
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Michael R Lasarev
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Jessica Schmidt
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Pierre D Kory
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI
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19
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Quarato CMI, Mirijello A, Maggi MM, Borelli C, Russo R, Lacedonia D, Foschino Barbaro MP, Scioscia G, Tondo P, Rea G, Simeone A, Feragalli B, Massa V, Greco A, De Cosmo S, Sperandeo M. Lung Ultrasound in the Diagnosis of COVID-19 Pneumonia: Not Always and Not Only What Is COVID-19 "Glitters". Front Med (Lausanne) 2021; 8:707602. [PMID: 34350201 PMCID: PMC8328224 DOI: 10.3389/fmed.2021.707602] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/15/2021] [Indexed: 12/21/2022] Open
Abstract
Background: In the current coronavirus disease-2019 (COVID-19) pandemic, lung ultrasound (LUS) has been extensively employed to evaluate lung involvement and proposed as a useful screening tool for early diagnosis in the emergency department (ED), prehospitalization triage, and treatment monitoring of COVID-19 pneumonia. However, the actual effectiveness of LUS in characterizing lung involvement in COVID-19 is still unclear. Our aim was to evaluate LUS diagnostic performance in assessing or ruling out COVID-19 pneumonia when compared with chest CT (gold standard) in a population of SARS-CoV-2-infected patients. Methods: A total of 260 consecutive RT-PCR confirmed SARS-CoV-2-infected patients were included in the study. All the patients underwent both chest CT scan and concurrent LUS at admission, within the first 6-12 h of hospital stay. Results: Chest CT scan was considered positive when showing a "typical" or "indeterminate" pattern for COVID-19, according to the RSNA classification system. Disease prevalence for COVID-19 pneumonia was 90.77%. LUS demonstrated a sensitivity of 56.78% in detecting lung alteration. The concordance rate for the assessment of abnormalities by both methods increased in the case of peripheral distribution and middle-lower lung location of lesions and in cases of more severe lung involvement. A total of nine patients had a "false-positive" LUS examination. Alternative diagnosis included chronic heart disease (six cases), bronchiectasis (two cases), and subpleural emphysema (one case). LUS specificity was 62.50%. Collateral findings indicative of overlapping conditions at chest CT were recorded also in patients with COVID-19 pneumonia and appeared distributed with increasing frequency passing from the group with mild disease (17 cases) to that with severe disease (40 cases). Conclusions: LUS does not seem to be an adequate tool for screening purposes in the ED, due to the risk of missing some lesions and/or to underestimate the actual extent of the disease. Furthermore, the not specificity of LUS implies the possibility to erroneously classify pre-existing or overlapping conditions as COVID-19 pneumonia. It seems more safe to integrate a positive LUS examination with clinical, epidemiological, laboratory, and radiologic findings to suggest a "virosis." Viral testing confirmation is always required.
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Affiliation(s)
- Carla Maria Irene Quarato
- Institute of Respiratory Diseases, COVID-19 Center, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Antonio Mirijello
- Department of Internal Medicine, COVID-19 Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, Foggia, Italy
| | - Michele Maria Maggi
- Department of Emergency Medicine and Critical Care, Emergency Medicine Unit, COVID-19 Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Cristina Borelli
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Raffaele Russo
- Department of Emergency Medicine and Critical Care, Intensive Care Unit, COVID-19 Center, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo Della Sofferenza, Foggia, Italy
| | - Donato Lacedonia
- Institute of Respiratory Diseases, COVID-19 Center, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Maria Pia Foschino Barbaro
- Institute of Respiratory Diseases, COVID-19 Center, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Giulia Scioscia
- Institute of Respiratory Diseases, COVID-19 Center, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Pasquale Tondo
- Institute of Respiratory Diseases, COVID-19 Center, Policlinico Universitario "Riuniti" di Foggia, Foggia, Italy.,Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy
| | - Gaetano Rea
- Department of Radiology, "Vincenzo Monaldi" Hospital-Association of periOperative Registered Nurses (AORN) Ospedale Dei Colli, Naples, Italy
| | - Annalisa Simeone
- Department of Radiology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Casa Sollievo della Sofferenza, Foggia, Italy
| | - Beatrice Feragalli
- Department of Medical, Oral and Biotechnological Sciences - Radiology Unit "G. D'Annunzio, " University of Chieti-Pescara, Chieti, Italy
| | - Valentina Massa
- Department of Medical Sciences, Geriatric and COVID-19 Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, Foggia, Italy
| | - Antonio Greco
- Department of Medical Sciences, Geriatric and COVID-19 Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, Foggia, Italy
| | - Salvatore De Cosmo
- Department of Internal Medicine, COVID-19 Unit, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, Foggia, Italy
| | - Marco Sperandeo
- Department of Medical Sciences, Unit of Interventional and Diagnostic Ultrasound of Internal Medicine, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Fondazione Casa Sollievo della Sofferenza, Foggia, Italy.,Diagnostic and Interventional Lung Ultrasonology at the Bachelor in Medicine and Surgery and the Postgraduate School of Respiratory Disease, University of Foggia, Foggia, Italy
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20
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Lacedonia D, Scioscia G, Giardinelli A, Quarato CMI, Sassani EV, Foschino Barbaro MP, Maci F, Sperandeo M. The Role of Transthoracic Ultrasound in the Study of Interstitial Lung Diseases: High-Resolution Computed Tomography Versus Ultrasound Patterns: Our Preliminary Experience. Diagnostics (Basel) 2021; 11:439. [PMID: 33806439 PMCID: PMC8001146 DOI: 10.3390/diagnostics11030439] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/28/2021] [Accepted: 03/01/2021] [Indexed: 12/12/2022] Open
Abstract
Transthoracic ultrasound (TUS) is a readily available imaging tool that can provide a quick real-time evaluation. The aim of this preliminary study was to establish a complementary role for this imaging method in the approach of interstitial lung diseases (ILDs). TUS examination was performed in 43 consecutive patients with pulmonary fibrosis and TUS findings were compared with the corresponding high-resolution computed tomography (HRCT) scans. All patients showed a thickened hyperechoic pleural line, despite no difference between dominant HRCT patterns (ground glass, honeycombing, mixed pattern) being recorded (p > 0.05). However, pleural lines' thickening showed a significant difference between different HRCT degree of fibrosis (p < 0.001) and a negative correlation with functional parameters. The presence of >3 B-lines and subpleural nodules was also assessed in a large number of patients, although they did not demonstrate any particular association with a specific HRCT finding or fibrotic degree. Results allow us to suggest a complementary role for TUS in facilitating an early diagnosis of ILD or helping to detect a possible disease progression or eventual complications during routine clinical practice (with pleural line measurements and subpleural nodules), although HRCT remains the gold standard in the definition of ILD pattern, disease extent and follow-up.
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Affiliation(s)
- Donato Lacedonia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, Italy; (D.L.); (A.G.); (C.M.I.Q.); (M.P.F.B.); (F.M.)
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, Italy; (D.L.); (A.G.); (C.M.I.Q.); (M.P.F.B.); (F.M.)
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, Italy
| | - Angelamaria Giardinelli
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, Italy; (D.L.); (A.G.); (C.M.I.Q.); (M.P.F.B.); (F.M.)
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, Italy
| | - Carla Maria Irene Quarato
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, Italy; (D.L.); (A.G.); (C.M.I.Q.); (M.P.F.B.); (F.M.)
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, Italy
| | | | - Maria Pia Foschino Barbaro
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, Italy; (D.L.); (A.G.); (C.M.I.Q.); (M.P.F.B.); (F.M.)
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, Italy
| | - Federica Maci
- Department of Medical and Surgical Sciences, Institute of Respiratory Diseases, University of Foggia, 71122 Foggia, Italy; (D.L.); (A.G.); (C.M.I.Q.); (M.P.F.B.); (F.M.)
- Institute of Respiratory Diseases, Policlinico “Riuniti” di Foggia, 71122 Foggia, Italy
| | - Marco Sperandeo
- Unit of Interventional and Diagnostic Ultrasound, Department of Internal Medicine, IRCCS Fondazione “Casa Sollievo della Sofferenza”, 71013 San Giovanni Rotondo, Italy;
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21
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Fochi O, Bronco A, Nacoti M, Signori D, Gatti S, Sala F, Rozen T, Bonanomi E, Bellani G. Modified pediatric lung ultrasound score compared with computed tomography for assessment of lung aeration in children. Minerva Anestesiol 2021; 87:675-683. [PMID: 33594872 DOI: 10.23736/s0375-9393.21.15155-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Lung ultrasound can be used to assess lung density and aeration at the bedside. Few authors have investigated scores based on the ultrasonographic interstitial syndrome for this purpose, but none have compared them with the gold standard computed tomography in children. METHODS Children <10 kilograms undergoing a chest computed tomography for clinical purposes at a tertiary hospital Pediatric Intensive Care Unit were enrolled in the study. An ultrasound scan was performed shortly after computed tomography. Each hemithorax was divided in six zones, and each zone was scored: 1, no B lines; 2, <3 B lines; 3, >3 well separated B lines; 4, crowded, coalescent B lines; 5, white lung; 6, consolidation. The pediatric lung ultrasound score was obtained by adding all zones. Interobserver variation for two separate operators was calculated. RESULTS Ten children, median age 95 days (range 23-721) were enrolled. Mean pediatric lung ultrasound score had a significant correlation with lung density (r=0.68) and percentage of hypoaerated lung (r=0.51). Median density and percentage of hypoaerated lung increased along the ultrasound patterns values (P<0.05) although not all patterns were significantly different from adjacent ones in the pairwise comparison. Interobserver variability in scoring of ultrasonographic patterns was moderate. CONCLUSIONS The pediatric lung ultrasound score correlates with lung density and percentage of hypoaerated lung measured with computed tomography.
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Affiliation(s)
- Oliviero Fochi
- Department of Pediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy -
| | - Alfio Bronco
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Mirco Nacoti
- Department of Pediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Davide Signori
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Stefano Gatti
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Monza-Brianza, Italy
| | - Francesco Sala
- Department of Radiology, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Thomas Rozen
- Pediatric Intensive Care Unit, Royal Children's Hospital, Melbourne, Australia.,University of Melbourne, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia
| | - Ezio Bonanomi
- Department of Pediatric Anesthesia and Intensive Care, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Giacomo Bellani
- Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Monza-Brianza, Italy.,Faculty of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
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22
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Long B, Lentz S, Koyfman A, Gottlieb M. Evaluation and management of the critically ill adult asthmatic in the emergency department setting. Am J Emerg Med 2020; 44:441-451. [PMID: 32222313 DOI: 10.1016/j.ajem.2020.03.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/08/2020] [Accepted: 03/16/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Asthma is a common reason for presentation to the Emergency Department and is associated with significant morbidity and mortality. While patients may have a relatively benign course, there is a subset of patients who present in a critical state and require emergent management. OBJECTIVE This narrative review provides evidence-based recommendations for the assessment and management of patients with severe asthma. DISCUSSION It is important to consider a broad differential diagnosis for the cause and potential mimics of asthma exacerbation. Once the diagnosis is determined, the majority of the assessment is based upon the clinical examination. First line therapies for severe exacerbations include inhaled short-acting beta agonists, inhaled anticholinergics, intravenous steroids, and magnesium. Additional therapies for refractory cases include parenteral epinephrine or terbutaline, helium‑oxygen mixture, and consideration of ketamine. Intravenous fluids should be administered, as many of these patients are dehydrated and at risk for hypotension if they receive positive pressure ventilatory support. Noninvasive positive pressure ventilation may prevent the need for endotracheal intubation. If mechanical ventilation is required, it is important to avoid breath stacking by setting a low respiratory rate and allowing permissive hypercapnia. Patients with severe asthma exacerbations will require intensive care unit admission. CONCLUSIONS This review provides evidence-based recommendations for the assessment and management of severe asthma with a focus on the emergency clinician.
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Affiliation(s)
- Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, 3841 Roger Brooke Dr, Fort Sam Houston, TX 78234, United States.
| | - Skyler Lentz
- Division of Emergency Medicine, Department of Surgery, Larner College of Medicine, University of Vermont, Burlington, VT, United States
| | - Alex Koyfman
- The University of Texas Southwestern Medical Center, Department of Emergency Medicine, 5323 Harry Hines Boulevard, Dallas, TX 75390, United States
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, United States
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23
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Interrater reliability of pediatric point-of-care lung ultrasound findings. Am J Emerg Med 2020; 38:1-6. [DOI: 10.1016/j.ajem.2019.01.047] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 01/24/2019] [Accepted: 01/26/2019] [Indexed: 01/20/2023] Open
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24
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Le Conte P, Terzi N, Mortamet G, Abroug F, Carteaux G, Charasse C, Chauvin A, Combes X, Dauger S, Demoule A, Desmettre T, Ehrmann S, Gaillard-Le Roux B, Hamel V, Jung B, Kepka S, L’Her E, Martinez M, Milési C, Morawiec É, Oberlin M, Plaisance P, Pouyau R, Raherison C, Ray P, Schmidt M, Thille AW, Truchot J, Valdenaire G, Vaux J, Viglino D, Voiriot G, Vrignaud B, Jean S, Mariotte E, Claret PG. Management of severe asthma exacerbation: guidelines from the Société Française de Médecine d'Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies. Ann Intensive Care 2019; 9:115. [PMID: 31602529 PMCID: PMC6787133 DOI: 10.1186/s13613-019-0584-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 09/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe asthma exacerbation (SAE) in adult and pediatric patients. RESULTS The guidelines were related to 5 areas: diagnosis, pharmacological treatment, oxygen therapy and ventilation, patients triage, specific considerations regarding pregnant women. The literature analysis and formulation of the guidelines were conducted according to the Grade of Recommendation Assessment, Development and Evaluation methodology. An extensive literature research was conducted based on publications indexed in PubMed™ and Cochrane™ databases. Of the 21 formalized guidelines, 4 had a high level of evidence (GRADE 1+/-) and 7 a low level of evidence (GRADE 2+/-). The GRADE method was inapplicable to 10 guidelines, which resulted in expert opinions. A strong agreement was reached for all guidelines. CONCLUSION The conjunct work of 36 experts from 3 scientific societies resulted in 21 formalized recommendations to help improving the emergency and intensive care management of adult and pediatric patients with SAE.
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Affiliation(s)
- Philippe Le Conte
- Service d’Accueil des Urgences, CHU de Nantes, 5 allée de l’île gloriette, 44093 Nantes Cedex 1, France
- PHU3, Faculté de Médecine 1, rue Gaston Veil, 44035 Nantes, France
| | - Nicolas Terzi
- Service de Médecine Intensive Réanimation, CHU de Grenoble Alpes, 38000 Grenoble, France
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
| | - Guillaume Mortamet
- Service de Réanimation Pédiatrique, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Fekri Abroug
- Service de réanimation, CHU de Monastir, Monastir, Tunisia
| | | | - Céline Charasse
- Pediatric Emergency Department, CHU Pellegrin Enfants, Bordeaux, France
| | - Anthony Chauvin
- Service des Urgences, Hôpital Lariboisière, APHP, Paris, France
| | - Xavier Combes
- Service des Urgences, CHU de la Réunion, Saint-Denis, France
| | - Stéphane Dauger
- Pediatric Intensive Care Unit, Robert Debré Hospital, APHP, Paris, France
| | - Alexandre Demoule
- Groupe Hospitalier Pitié-Salpêtrière Charles Foix, Service de Pneumologie, Médecine Intensive et Réanimation (Département R3S), AP-HP, INSERM, UMRS1158 neurophysiologie respiratoire expérimentale et clinique, Sorbonne Université, Paris, France
| | | | - Stephan Ehrmann
- Médecine Intensive Réanimation, INSERM CIC 1415, réseau CRICS-TriggerSEP, CHRU de Tours and Centre d’Etude des Pathologies Respiratoires, INSERM U1100, faculté de médecine, Université de Tours, Tours, France
| | | | - Valérie Hamel
- Service des Urgences, CHU de Toulouse, Toulouse, France
| | - Boris Jung
- Service de MIR, CHU de Montpelliers, Montpellier, France
| | - Sabrina Kepka
- Service des Urgences, CHU de Strasbourg, Strasbourg, France
| | - Erwan L’Her
- Service de MIR, CHRU de Brest, Brest, France
| | - Mikaël Martinez
- Pôle Urgences, centre hospitalier du Forez, 42605 Montbrison, France
- Réseau d’urgence Ligérien Ardèche Nord (REULIAN), centre hospitalier Le Corbusier, 42700 Firminy, France
| | - Christophe Milési
- Département de Pédiatrie Néonatale et Réanimations, CHU de Montpellier, Montpellier, France
| | - Élise Morawiec
- Service de Pneumologie et Réanimation, GH Pitié-Salpêtrière, APHP, Paris, France
| | - Mathieu Oberlin
- Service des Urgences, centre hospitalier de Cahors, Cahors, France
| | | | - Robin Pouyau
- Pediatric Intensive Care Unit, Women‐Mothers and Children’s University Hospital, Lyon, France
| | | | - Patrick Ray
- Service des Urgences, CHU de Dijon, faculté de médecine de Dijon, Dijon, France
| | - Mathieu Schmidt
- INSERM, UMRS_1166-ICAN, Institute of Cardiometabolism and Nutrition, Pitié–Salpêtrière Hospital, Medical Intensive Care Unit, Sorbonne Universités, 75651 Paris Cedex 13, France
| | - Arnaud W. Thille
- CHU de Poitiers, Médecine Intensive Réanimation, Poitiers, France
| | | | | | - Julien Vaux
- SAMU 94, CHU Henri Mondor, AP-HP, Créteil, France
| | - Damien Viglino
- INSERM, U1042, University of Grenoble-Alpes, HP2, 38000 Grenoble, France
- Service des Urgences Adultes, CHU de Grenoble Alpes, 38000 Grenoble, France
| | - Guillaume Voiriot
- Service de réanimation polyvalente, Hôpital Tenon, APHP, Paris, France
| | - Bénédicte Vrignaud
- Pediatric Emergency Department, Women and Children’, s University Hospital, Nantes, France
| | - Sandrine Jean
- Service de Réanimation Pédiatrique, APHP Hôpital Trousseau, 75012 Paris, France
| | - Eric Mariotte
- Service de Médecine Intensive Réanimation, APHP Hôpital Saint Louis, 75010 Paris, France
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Marini TJ, Castaneda B, Baran T, O'Connor TP, Garra B, Tamayo L, Zambrano M, Carlotto C, Trujillo L, Kaproth-Joslin KA. Lung Ultrasound Volume Sweep Imaging for Pneumonia Detection in Rural Areas: Piloting Training in Rural Peru. J Clin Imaging Sci 2019; 9:35. [PMID: 31538033 PMCID: PMC6737249 DOI: 10.25259/jcis_29_2019] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 05/21/2019] [Indexed: 01/19/2023] Open
Abstract
Objective: Pneumonia is the leading cause of pediatric mortality worldwide among children 0–5 years old. Lung ultrasound can be used to diagnose pneumonia in rural areas as it is a portable and relatively economic imaging modality with ~95% sensitivity and specificity for pneumonia in children. Lack of trained sonographers is the current limiting factor to its deployment in rural areas. In this study, we piloted training of a volume sweep imaging (VSI) ultrasound protocol for pneumonia detection in Peru with rural health workers. VSI may be taught to individuals with limited medical/ultrasound experience as it requires minimal anatomical knowledge and technical skill. In VSI, the target organ is imaged with a series of sweeps and arcs of the ultrasound probe in relation to external body landmarks. Methods: Rural health workers in Peru were trained on a VSI ultrasound protocol for pneumonia detection. Subjects were given a brief didactic session followed by hands-on practice with the protocol. Each attempt was timed and mistakes were recorded. Participants performed the protocol until they demonstrated two mistake-free attempts. Results: It took participants a median number of three attempts (range 1–6) to perform the VSI protocol correctly. Time to mastery took 51.4 ± 17.7 min. There were no significant differences among doctors, nurses, and technicians in total training time (P = 0.43) or number of attempts to success (P = 0.72). Trainee age was not found to be significantly correlated with training time (P = 0.50) or number of attempts to success (P = 0.40). Conclusion: Rural health workers learned a VSI protocol for pneumonia detection with relative ease in a short amount of time. Future studies should investigate the clinical efficacy of this VSI protocol for pneumonia detection. Key Message: A volume sweep imaging (VSI) protocol for pneumonia detection can be taught with minimal difficulty to rural health workers without prior ultrasound experience. No difference was found in training performance related to education level or age. VSI involves no significant knowledge of anatomy or technical skill.
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Affiliation(s)
- Thomas J Marini
- Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Benjamin Castaneda
- Department of Engineering, Pontifical Catholic University of Peru, Lima, Peru
| | - Timothy Baran
- Departments of Imaging Sciences, University of Rochester, Rochester, New York, United States
| | - Timothy P O'Connor
- Departments of Emergency Medicine, University of Rochester, Rochester, New York, United States
| | - Brian Garra
- Medical Imaging Ministries of the Americas, Clermont, Florida, United States
| | - Lorena Tamayo
- Medical Innovation and Technology, San Isidrio, Peru
| | - Maria Zambrano
- Touro College of Osteopathic Medicine, Middletown, New York, United States
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26
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Özkaya AK, Başkan Vuralkan F, Ardıç Ş. Point-of-care lung ultrasound in children with non-cardiac respiratory distress or tachypnea. Am J Emerg Med 2019; 37:2102-2106. [PMID: 31189496 DOI: 10.1016/j.ajem.2019.05.063] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 05/27/2019] [Accepted: 05/31/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the feasibility and diagnostic benefit of point-of-care ultrasound (PoCLUS) in children with non-cardiac respiratory distress or tachypnea. METHODS In this prospective observational study, children aged between 1 month and 18 years with respiratory distress, tachypnea, or both, at triage were included. Concordance and accuracy of the emergency department (ED) and ultrasound diagnoses, length of stay, and time elapsing until ED and ultrasound diagnoses were calculated. RESULTS One hundred forty-five patients were evaluated. The mean age of the children in the study was 67 ± 58 months. Seventy-nine patients (56%) were boys. Mean length of stay in the ED was 124.6 ± 76.5 min. Mean time to ultrasound diagnosis was 29.32 ± 15.71 min, compared to 46.75 ± 32.65 min for ED diagnosis, which was significantly longer (p < 0.001). Concordance between ultrasound and ED diagnoses was almost perfect for pneumonia, acute bronchiolitis, asthma and croup (0.8 < Ƙ < 1), and good for other non-pulmonary causes (0.6 < Ƙ < 0.8). Overall concordance for all diagnoses was also good (Ƙ = 0.76). Ultrasound diagnosis was more sensitive than ED diagnosis for pneumonia, acute bronchiolitis, and other non-pulmonary causes (81.4%-74.42%; 97.3%-86.49%; and 100%-95.83%, respectively). In addition, ultrasound diagnosis was more specific than ED diagnosis for pneumonia, acute bronchiolitis and other non-pulmonary causes (100%-97.35%; 99.07%-98.15%; and 93.39%-88.43%, respectively). However, ultrasound and ED diagnoses exhibited similar sensitivity and specificity values for asthma (97.22%-97.22%; and 99.08%-100%). CONCLUSION PoCLUS may constitute a beneficial and rational approach in the evaluation of children with increased work of breathing in the ED, and can also expedite the diagnostic process.
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Affiliation(s)
- Ahmet Kağan Özkaya
- Department of Pediatrics and Division of Pediatric Emergency, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey.
| | - Fevziye Başkan Vuralkan
- Department of Pediatrics, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Şenol Ardıç
- Department of Emergency Medicine, University of Health Science, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
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Abstract
PURPOSE OF REVIEW The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research. RECENT FINDINGS POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration. Rapidly evolving and upcoming applications include diagnosis of pneumonia and acute chest syndrome, identification of intra-abdominal injury via contrast-enhancement, guidance of resuscitation, monitoring of increased intracranial pressure and procedural guidance. SUMMARY POCUS is an effective and burgeoning method for both rapid diagnostics and guidance for interventions and procedures. It has clinical application for a variety of conditions that span PEM and PICU settings. Formal POCUS training is needed to standardize and expand use of this valuable technology by PICU and PEM providers alike.
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28
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Kantor DB, Hirshberg EL, McDonald MC, Griffin J, Buccigrosso T, Stenquist N, Smallwood CD, Nelson KA, Zurakowski D, Phipatanakul W, Hirschhorn JN. Fluid Balance Is Associated with Clinical Outcomes and Extravascular Lung Water in Children with Acute Asthma Exacerbation. Am J Respir Crit Care Med 2018; 197:1128-1135. [PMID: 29313715 PMCID: PMC6019929 DOI: 10.1164/rccm.201709-1860oc] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 01/08/2018] [Indexed: 11/16/2022] Open
Abstract
RATIONALE The effects of fluid administration during acute asthma exacerbation are likely unique in this patient population: highly negative inspiratory intrapleural pressure resulting from increased airway resistance may interact with excess fluid administration to favor the accumulation of extravascular lung water, leading to worse clinical outcomes. OBJECTIVES Investigate how fluid balance influences clinical outcomes in children hospitalized for asthma exacerbation. METHODS We analyzed the association between fluid overload and clinical outcomes in a retrospective cohort of children admitted to an urban children's hospital with acute asthma exacerbation. These findings were validated in two cohorts: a matched retrospective and a prospective observational cohort. Finally, ultrasound imaging was used to identify extravascular lung water and investigate the physiological basis for the inferential findings. MEASUREMENTS AND MAIN RESULTS In the retrospective cohort, peak fluid overload [(fluid input - output)/weight] is associated with longer hospital length of stay, longer treatment duration, and increased risk of supplemental oxygen use (P values < 0.001). Similar results were obtained in the validation cohorts. There was a strong interaction between fluid balance and intrapleural pressure: the combination of positive fluid balance and highly negative inspiratory intrapleural pressures is associated with signs of increased extravascular lung water (P < 0.001), longer length of stay (P = 0.01), longer treatment duration (P = 0.03), and increased risk of supplemental oxygen use (P = 0.02). CONCLUSIONS Excess volume administration leading to fluid overload in children with acute asthma exacerbation is associated with increased extravascular lung water and worse clinical outcomes.
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Affiliation(s)
- David B. Kantor
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine
- Department of Anaesthesia
| | - Eliotte L. Hirshberg
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Intermountain Medical Center, Murray, Utah
- Department of Pediatrics, Division of Pediatric Critical Care, University of Utah, Salt Lake City, Utah; and
| | | | - John Griffin
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine
| | | | - Nicole Stenquist
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine
| | - Craig D. Smallwood
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine
- Department of Anaesthesia
| | - Kyle A. Nelson
- Division of Pediatric Emergency Medicine
- Department of Pediatrics, and
| | - David Zurakowski
- Division of Critical Care Medicine, Department of Anesthesiology, Critical Care and Pain Medicine
- Department of Anaesthesia
| | | | - Joel N. Hirschhorn
- Division of Endocrinology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Genetics, Harvard Medical School, Boston, Massachusetts
- Program in Medical and Population Genetics, Broad Institute of Harvard and Massachusetts Institute of Technology, Cambridge, Massachusetts
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29
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Kou M, Hwang V, Ramkellawan N. Bronchiolitis: From Practice Guideline to Clinical Practice. Emerg Med Clin North Am 2018; 36:275-286. [PMID: 29622322 DOI: 10.1016/j.emc.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The American Academy of Pediatrics' clinical practice guideline in bronchiolitis was last updated in 2014 with recommendations to improve care for pediatric patients with bronchiolitis. As most treatments of bronchiolitis are supportive, the guideline minimizes the breadth of treatments previously used and cautions the use of tests and therapies that have a limited evidence base. Emergency physicians must be familiar with the guidelines in order to apply best practices appropriately.
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Affiliation(s)
- Maybelle Kou
- The Altieri PEM Fellowship, Inova Fairfax Medical Campus, The George Washington University School of Medicine, Virginia Commonwealth University School of Medicine, Inova Fairfax Campus, 3300 Gallows Road, Falls Church, VA 22042, USA.
| | - Vivian Hwang
- The Altieri PEM Fellowship, Inova Fairfax Medical Campus, The George Washington University School of Medicine, Virginia Commonwealth University School of Medicine, Inova Fairfax Campus, 3300 Gallows Road, Falls Church, VA 22042, USA
| | - Nadira Ramkellawan
- Pediatric Emergency Medicine Fellow, The Altieri PEM Fellowship, Inova Fairfax Medical Campus, 3300 Gallows Road, Falls Church, VA 22042, USA
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