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Gori L, Amendolea A, Buonsenso D, Salvadori S, Supino MC, Musolino AM, Adamoli P, Coco AD, Trobia GL, Biagi C, Lucherini M, Leonardi A, Limoli G, Giampietri M, Sciacca TV, Morello R, Tursi F, Soldati G. Prognostic Role of Lung Ultrasound in Children with Bronchiolitis: Multicentric Prospective Study. J Clin Med 2022; 11:jcm11144233. [PMID: 35887997 PMCID: PMC9316238 DOI: 10.3390/jcm11144233] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 02/06/2023] Open
Abstract
There is increasing recognition of the role of lung ultrasound (LUS) to assess bronchiolitis severity in children. However, available studies are limited to small, single-center cohorts. We aimed to assess a qualitative and quantitative LUS protocol to evaluate the course of bronchiolitis at diagnosis and during follow-up. This is a prospective, multicenter study. Children with bronchiolitis were stratified according to clinical severity and underwent four LUS evaluations at set intervals. LUS was classified according to four models: (1) positive/negative; (2) main LUS pattern (normal/interstitial/consolidative/mixed) (3) LUS score; (4) LUS score with cutoff. Two hundred and thirty-three children were enrolled. The baseline LUS was significantly associated with bronchiolitis severity, using both the qualitative (positive/negative LUS p < 0.001; consolidated/normal LUS pattern or mixed/normal LUS p < 0.001) and quantitative models (cutoff score > 9 p < 0.001; LUS mean score p < 0.001). During follow-up, all LUS results according to all LUS models improved (p < 0.001). Better cut off value was declared at a value of >9 points. Conclusions: Our study supports the role of a comprehensive qualitative and quantitative LUS protocol for the identification of severe cases of bronchiolitis and provides data on the evolution of lung aeration during follow-up.
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Affiliation(s)
- Laura Gori
- Pediatric Unit, Valle del Serchio General Hospital, 55051 Barga, Italy
- Correspondence: (L.G.); (D.B.); Tel.: +39-050-996690 (L.G.); +39-06-30154390 (D.B.)
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
- Correspondence: (L.G.); (D.B.); Tel.: +39-050-996690 (L.G.); +39-06-30154390 (D.B.)
| | | | - Maria Chiara Supino
- Department of Pediatric Emergency, Bambin Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (M.C.S.); (A.M.M.)
| | - Anna Maria Musolino
- Department of Pediatric Emergency, Bambin Gesù Children’s Hospital IRCCS, 00165 Rome, Italy; (M.C.S.); (A.M.M.)
| | - Paolo Adamoli
- Pediatric Unit, Moriggia Pelascini Hospital, Gravedona et Uniti, 22015 Como, Italy; (P.A.); (A.D.C.)
| | - Alfina Domenica Coco
- Pediatric Unit, Moriggia Pelascini Hospital, Gravedona et Uniti, 22015 Como, Italy; (P.A.); (A.D.C.)
| | - Gian Luca Trobia
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital, 95126 Catania, Italy; (G.L.T.); (T.V.S.)
| | - Carlotta Biagi
- Pediatric Emergency Unit, Sant’Orsola Hospital IRCCS, 40138 Bologna, Italy;
| | - Marco Lucherini
- Pediatric Unit, Nottola Hospital, Montepulciano, 53045 Siena, Italy;
| | - Alberto Leonardi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, University of Perugia, 06132 Perugia, Italy;
| | | | - Matteo Giampietri
- Department of Maternal and Child Health, Division of Neonatology and Neonatal Intensive Care Unit, S. Chiara Hospital, University of Pisa, 56100 Pisa, Italy;
| | - Tiziana Virginia Sciacca
- Pediatric and Pediatric Emergency Room Unit, Cannizzaro Emergency Hospital, 95126 Catania, Italy; (G.L.T.); (T.V.S.)
| | - Rosa Morello
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
| | - Francesco Tursi
- Pneumology Unit, Civil Hospital, Codogno, 26845 Lodi, Italy;
| | - Gino Soldati
- Diagnostic and Interventional Ultrasound Unit, Valle del Serchio General Hospital, Castelnuovo Garfagnana, 55032 Lucca, Italy;
| | - Ecobron Group
- Pediatric Unit and Pediatric Emergency Unit, Azienda Ospedaliera Universitaria Policlinico San Marco, University of Catania, 95121 Catania, Italy
- Pneumology Unit, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy
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Cipulli F, Vasques F, Duscio E, Romitti F, Quintel M, Gattinoni L. Atelectrauma or volutrauma: the dilemma. J Thorac Dis 2018; 10:1258-1264. [PMID: 29707275 DOI: 10.21037/jtd.2018.02.71] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Francesco Cipulli
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Francesco Vasques
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Eleonora Duscio
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Federica Romitti
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Luciano Gattinoni
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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Jabaudon M, Blondonnet R, Audard J, Fournet M, Godet T, Sapin V, Constantin JM. Recent directions in personalised acute respiratory distress syndrome medicine. Anaesth Crit Care Pain Med 2017; 37:251-258. [PMID: 28935455 DOI: 10.1016/j.accpm.2017.08.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2017] [Revised: 08/10/2017] [Accepted: 08/15/2017] [Indexed: 12/12/2022]
Abstract
Acute respiratory distress syndrome (ARDS) is heterogeneous by definition and patient response varies depending on underlying biology and their severity of illness. Although ARDS subtypes have been identified with different prognoses in past studies, the concept of phenotypes or endotypes does not extend to the clinical definition of ARDS. This has possibly hampered the development of therapeutic interventions that target select biological mechanisms of ARDS. Recently, a major advance may have been achieved as it may now be possible to identify ARDS subtypes that may confer different responses to therapy. The aim of personalised medicine is to identify, select, and test therapies that are most likely to be associated with a favourable outcome in a specific patient. Several promising approaches to ARDS subtypes capable of predicting therapeutic response, and not just prognosis, are highlighted in this perspective paper. An overview is also provided of current and future directions regarding the provision of personalised ARDS medicine. The importance of delivering the right care, at the right time, to the right patient, is emphasised.
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Affiliation(s)
- Matthieu Jabaudon
- Department of perioperative medicine, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS 6293, Inserm U1103, GReD, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France.
| | - Raiko Blondonnet
- Department of perioperative medicine, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS 6293, Inserm U1103, GReD, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Jules Audard
- Department of perioperative medicine, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS 6293, Inserm U1103, GReD, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Marianne Fournet
- Université Clermont Auvergne, CNRS 6293, Inserm U1103, GReD, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
| | - Thomas Godet
- Department of perioperative medicine, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France
| | - Vincent Sapin
- Université Clermont Auvergne, CNRS 6293, Inserm U1103, GReD, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France; Department of medical biochemistry and molecular biology, CHU de Clermont-Ferrand, 63000 Clermont-Ferrand, France
| | - Jean-Michel Constantin
- Department of perioperative medicine, CHU de Clermont-Ferrand, 58, rue Montalembert, 63000 Clermont-Ferrand, France; Université Clermont Auvergne, CNRS 6293, Inserm U1103, GReD, 1, place Lucie-Aubrac, 63003 Clermont-Ferrand cedex 1, France
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Gattinoni L, Collino F, Maiolo G, Rapetti F, Romitti F, Tonetti T, Vasques F, Quintel M. Positive end-expiratory pressure: how to set it at the individual level. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:288. [PMID: 28828363 DOI: 10.21037/atm.2017.06.64] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
The positive end-expiratory pressure (PEEP), since its introduction in the treatment of acute respiratory failure, up to the 1980s was uniquely aimed to provide a viable oxygenation. Since the first application, a large debate about the criteria for selecting the PEEP levels arose within the scientific community. Lung mechanics, oxygen transport, venous admixture thresholds were all proposed, leading to PEEP recommendations from 5 up to 25 cmH2O. Throughout this period, the main concern was the hemodynamics. This paradigm changed during the 1980s after the wide acceptance of atelectrauma as one of the leading causes of ventilator induced lung injury. Accordingly, the PEEP aim shifted from oxygenation to lung protection. In this framework, the prevention of lung opening and closing became an almost unquestioned dogma. Consequently, as PEEP keeps open the pulmonary units opened during the previous inspiratory phase, new methods were designed to identify the 'optimal' PEEP during the expiratory phase. The open lung approach requires that every collapsed unit potentially openable is opened and maintained open. The methods to assess the recruitment are based on imaging (computed tomography, electric impedance tomography, ultrasound) or mechanically-driven gas exchange modifications. All the latest assume that whatever change in respiratory system compliance is due to changes in lung compliance, which in turn is uniquely function of the recruitment. Comparative studies, however, showed that the only possible approach to measure the amount of collapsed tissue regaining inflation is the CT scan. In fact, all the other methods estimate as recruitment the gas entry in pulmonary units already open at lower PEEP, but increasing their compliance at higher PEEP. Since higher PEEP is usually more indicated (also for oxygenation) when the recruitability is higher, as occurs with increasing severity, a meaningful PEEP selection requires the assessment of recruitment. The Berlin definition may help in this assessment.
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Affiliation(s)
- Luciano Gattinoni
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Francesca Collino
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Giorgia Maiolo
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Francesca Rapetti
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Federica Romitti
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Tommaso Tonetti
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Francesco Vasques
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
| | - Michael Quintel
- Department of Anesthesiology, Emergency and Intensive Care Medicine, University of Göttingen, Göttingen, Germany
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Modelling mixing within the dead space of the lung improves predictions of functional residual capacity. Respir Physiol Neurobiol 2017; 242:12-18. [PMID: 28323205 DOI: 10.1016/j.resp.2017.03.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 03/09/2017] [Accepted: 03/13/2017] [Indexed: 11/24/2022]
Abstract
Routine estimation of functional residual capacity (FRC) in ventilated patients has been a long held goal, with many methods previously proposed, but none have been used in routine clinical practice. This paper proposes three models for determining FRC using the nitrous oxide concentration from the entire expired breath in order to improve the precision of the estimate. Of the three models proposed, a dead space with two mixing compartments provided the best results, reducing the mean limits of agreement with the FRC measured by whole body plethysmography by up to 41%. This moves away from traditional lung models, which do not account for mixing within the dead space. Compared to literature values for FRC, the results are similar to those obtained using helium dilution and better than the LUFU device (Dräger Medical, Lubeck, Germany), with significantly better limits of agreement compared to plethysmography.
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Bouhemad B, Le Neindre A. Intérêt de l’échographie thoracique dans l’évaluation de l’aération pulmonaire par le kinésithérapeute. Rev Mal Respir 2016. [DOI: 10.1016/j.rmr.2015.10.470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Liu J, Liu F, Liu Y, Wang HW, Feng ZC. Lung ultrasonography for the diagnosis of severe neonatal pneumonia. Chest 2014; 146:383-388. [PMID: 24833216 DOI: 10.1378/chest.13-2852] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Lung ultrasonography is useful for the diagnosis of pneumonia in children and adults. This study investigated the lung ultrasound findings in severe neonatal pneumonia. METHODS From September 2012 to October 2013, 80 neonates admitted to Bayi Children's Hospital, affiliated with the Beijing Military General Hospital, were divided into two groups: 40 neonates with severe pneumonia according to their medical history, clinical manifestations, and chest radiograph findings and 40 neonates with no lung disease (control group). All subjects underwent bedside lung ultrasound examination in a quiet state. A single expert physician performed all ultrasound examinations. Findings of pleural line abnormalities, B lines, lung consolidation, air bronchograms, bilateral white lung, interstitial syndrome, lung sliding, and lung pulse were compared between the groups. RESULTS The lung ultrasound findings associated with infectious pneumonia included large areas of lung consolidation with irregular margins and air bronchograms, pleural line abnormalities, and interstitial syndrome. A large area of lung consolidation with irregular margins had 100% sensitivity and 100% specificity for the diagnosis of neonatal pneumonia. CONCLUSIONS Lung ultrasonography is a reliable tool for diagnosing neonatal pneumonia. It is suitable for routine use in the neonatal ICU and may eventually replace chest radiography and CT scanning.
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Affiliation(s)
- Jing Liu
- Department of Neonatology & NICU of Bayi Children's Hospital, Beijing Military General Hospital, Beijing, China.
| | - Fang Liu
- Department of Neonatology & NICU of Bayi Children's Hospital, Beijing Military General Hospital, Beijing, China; Graduate School of Southern Medical University, Guangzhou City, China
| | - Ying Liu
- Department of Neonatology & NICU of Bayi Children's Hospital, Beijing Military General Hospital, Beijing, China; Graduate School of Anhui Medical University, Hefei City, China
| | - Hua-Wei Wang
- Department of Neonatology & NICU of Bayi Children's Hospital, Beijing Military General Hospital, Beijing, China; Graduate School of Anhui Medical University, Hefei City, China
| | - Zhi-Chun Feng
- Department of Neonatology & NICU of Bayi Children's Hospital, Beijing Military General Hospital, Beijing, China
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Chiumello D, Froio S, Bouhemad B, Camporota L, Coppola S. Clinical review: Lung imaging in acute respiratory distress syndrome patients--an update. Crit Care 2013; 17:243. [PMID: 24238477 PMCID: PMC4056355 DOI: 10.1186/cc13114] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Over the past 30 years lung imaging has greatly contributed to the current understanding of the pathophysiology and the management of acute respiratory distress syndrome (ARDS). In the past few years, in addition to chest X-ray and lung computed tomography, newer functional lung imaging techniques, such as lung ultrasound, positron emission tomography, electrical impedance tomography and magnetic resonance, have been gaining a role as diagnostic tools to optimize lung assessment and ventilator management in ARDS patients. Here we provide an updated clinical review of lung imaging in ARDS over the past few years to offer an overview of the literature on the available imaging techniques from a clinical perspective.
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Affiliation(s)
- Davide Chiumello
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Sara Froio
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
| | - Belaïd Bouhemad
- Multidisciplinary Critical Care Unit, La Pitié-Salpêtrière Hospital, University Pierre and Marie Curie Paris, Paris, France
| | - Luigi Camporota
- Guy’s and St Thomas’ NHS Foundation Trust, St Thomas’ Hospital, London, UK
| | - Silvia Coppola
- Dipartimento di Anestesia, Rianimazione (Intensiva e Subintensiva) e Terapia del Dolore, Fondazione IRCCS Ca’ Granda - Ospedale Maggiore Policlinico, Via F. Sforza 35, Milan, Italy
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