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Musolino AM, Di Sarno L, Buonsenso D, Murciano M, Chiaretti A, Boccuzzi E, Mesturino MA, Villani A. Use of POCUS for the assessment of dehydration in pediatric patients-a narrative review. Eur J Pediatr 2024; 183:1091-1105. [PMID: 38133810 DOI: 10.1007/s00431-023-05394-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 12/13/2023] [Accepted: 12/15/2023] [Indexed: 12/23/2023]
Abstract
In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions and pleural and pericardial effusions, but less to evaluate fluid depletion. The main aim of this review is to analyze the current literature on the assessment of dehydration in pediatric patients by using POCUS. The size of the inferior vena cava (IVC) and its change in diameter in response to respiration have been investigated as a tool to screen for hypovolemia. A dilated IVC with decreased collapsibility (< 50%) is a sign of increased right atrial pressure. On the contrary, a collapsed IVC may be indicative of hypovolemia. The IVC collapsibility index (cIVC) reflects the decrease in the diameter upon inspiration. Altogether the IVC diameter and collapsibility index can be easily determined, but their role in children has not been fully demonstrated, and an estimation of volume status solely by assessing the IVC should thus be interpreted with caution. The inferior vena cava/abdominal aorta (IVC/AO) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS could be a valuable supplementary tool in the assessment of dehydration in several clinical scenarios, enabling rapid identification of life-threatening primary etiologies and helping physicians avoid inappropriate therapeutic interventions. Conclusion: POCUS can provide important information in the assessment of intravascular fluid status in emergency scenarios, but measurements may be confounded by a number of other clinical variables. The inclusion of lung and cardiac views may assist in better understanding the patient's physiology and etiology regarding volume status. What is Known: • In pediatric practice, POCUS (point-of-care ultrasound) has been mostly implemented to recognize lung conditions (like pneumonia and bronchiolitis) and pleural and pericardial effusions, but less to evaluate fluid depletion. • The size of the IVC (inferior vena cava) and its change in diameter in response to respiration have been studied as a possible screening tool to assess the volume status, predict fluid responsiveness, and assess potential intolerance to fluid loading. What is New: • The IVC diameter and collapsibility index can be easily assessed, but their role in predicting dehydration in pediatric age has not been fully demonstrated, and an estimation of volume status only by assessing the IVC should be interpreted carefully. • The IVC /AO(inferior vena cava/abdominal aorta) ratio may be a suitable parameter to assess the volume status in pediatric patients even though there is a need to define age-based thresholds. A combination of vascular, lung, and cardiac POCUS can be a valuable supplementary tool in the assessment of intravascular volume in several clinical scenarios.
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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
| | - Lorenzo Di Sarno
- 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.
- Centro di Salute Globale, Università Cattolica del Sacro Cuore, Roma, Italia.
| | - Manuel Murciano
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Antonio Chiaretti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Maria Alessia Mesturino
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Alberto Villani
- Pediatric Emergency Unit, Department of Emergency and General Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Camporesi A, Gemma M, Buonsenso D, Ferrario S, Mandelli A, Pessina M, Diotto V, Rota E, Raso I, Fiori L, Campari A, Izzo F. Lung Ultrasound Patterns in Multisystem Inflammatory Syndrome in Children (MIS-C)-Characteristics and Prognostic Value. Children (Basel) 2022; 9:children9070931. [PMID: 35883915 PMCID: PMC9322869 DOI: 10.3390/children9070931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Revised: 05/31/2022] [Accepted: 06/15/2022] [Indexed: 12/11/2022]
Abstract
Objective and design: Following COVID-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described, but data describing the LUS findings of MIS-C are limited. The aim of this retrospective observational study conducted between 1 March and 31 December 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. The secondary objective is to evaluate concordance of LUS with Chest X-ray (CXR). Methodology: Clinical and laboratory data were collected for all patients (age 0−18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, needed for respiratory support and inotrope administration, hospital, and PICU length of stay, were considered as outcomes and evaluated in the different LUS patterns. An agreement between LUS and CXR evaluation was assessed with Cohen’ k. Results: 24 children, who had a LUS examination upon admission, were enrolled. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. Conclusion: LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity; under this aspect, LUS can be used at admission to stratify risk of severe disease.
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Affiliation(s)
- Anna Camporesi
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
- Correspondence:
| | - Marco Gemma
- Department of NeuroAnesthesia and NeuroIntensive Care, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20154 Milano, Italy;
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario “A. Gemelli”, 00168 Roma, Italy;
| | - Stefania Ferrario
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Anna Mandelli
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Matteo Pessina
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Veronica Diotto
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Elena Rota
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
| | - Irene Raso
- Department of Pediatric Cardiology, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Laura Fiori
- Department of Pediatrics, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Alessandro Campari
- Department of Pediatric Radiology, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy;
| | - Francesca Izzo
- Department of Pediatric Anesthesia and Intensive Care, Children’s Hospital “Vittore Buzzi”, 20154 Milano, Italy; (S.F.); (A.M.); (M.P.); (V.D.); (E.R.); (F.I.)
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DeSanti RL, Cowan EA, Kory PD, Lasarev MR, Schmidt J, Al-Subu AM. Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure. J Ultrasound 2022. [PMID: 35397743 DOI: 10.1007/s40477-022-00675-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Rodriguez-Gonzalez M, Rodriguez-Campoy P, Estalella-Mendoza A, Castellano-Martinez A, Flores-Gonzalez JC. Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study. Tomography 2022; 8:142-157. [PMID: 35076624 PMCID: PMC8788562 DOI: 10.3390/tomography8010012] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/26/2021] [Accepted: 12/31/2021] [Indexed: 12/14/2022] Open
Abstract
We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants <12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients underwent clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 h of hospital admission. The existence of significant correlation between cardiac and respiratory parameters was the primary outcome. The association of different cardiopulmonary variables with the need of respiratory support higher than O2, the length of stay hospitalization, the PICU stay and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5–3) months; 62% males) hospitalized with acute bronchiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction (Tei index). Up to 36 (32%) infants required respiratory support during the hospitalization. This group presented with higher lung ultrasound score (p < 0.001) and increased values of NT-proBNP (p < 0.001), the Tei index (p < 0.001) and pulmonary artery pressures (p < 0.001). All the analyzed respiratory and cardiac variables showed moderate-to-strong correlations with the LOS of hospitalization and the time of respiratory support. Lung ultrasound and echocardiography showed a moderate-to-strong predictive accuracy for the need of respiratory support in the ROC analysis, with the AUC varying from 0.74 to 0.87. Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ultrasonography could be a useful tool to easily identify high-risk populations for complicated acute bronchiolitis hospitalization.
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Affiliation(s)
| | - Patricia Rodriguez-Campoy
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, 11010 Cadiz, Spain; (P.R.-C.); (A.E.-M.); (J.C.F.-G.)
| | - Ana Estalella-Mendoza
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, 11010 Cadiz, Spain; (P.R.-C.); (A.E.-M.); (J.C.F.-G.)
| | - Ana Castellano-Martinez
- Pediatric Nephrology Division, Puerta del Mar University Hospital, 11010 Cadiz, Spain
- Correspondence:
| | - Jose Carlos Flores-Gonzalez
- Pediatric Intensive Care Unit, Puerta del Mar University Hospital, 11010 Cadiz, Spain; (P.R.-C.); (A.E.-M.); (J.C.F.-G.)
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Musolino AM, Boccuzzi E, Buonsenso D, Supino MC, Mesturino MA, Pitaro E, Ferro V, Nacca R, Sinibaldi S, Palma P, Villani A, Tomà P. The Role of Lung Ultrasound in Diagnosing COVID-19-Related Multisystemic Inflammatory Disease: A Preliminary Experience. J Clin Med 2022; 11:234. [PMID: 35011975 DOI: 10.3390/jcm11010234] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 12/06/2021] [Accepted: 12/08/2021] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND To date, there are no data regarding the systematic application of Point-of-Care Lung Ultrasound (PoC-LUS) in children with Multisystem Inflammatory Syndrome in Children (MIS-C). The main aim of this study is to show the role of Point-of-Care Lung Ultrasound as an additional aid in the diagnosis of COVID-19-related Multisystem Inflammatory Syndrome in Children (MIS-C). METHODS Between April 2020 and April 2021, patients aged 0-18 years referred to our emergency department for fever, and later hospitalized without a specific diagnosis, underwent PoC-LUS. Ultrasound images of patients with a final diagnosis of MIS-C were retrospectively evaluated. RESULTS Ten patients were enrolled. All were described to have pleural irregularities and B-lines. In particular: 8/10 children presented with isolated B-lines in at least half of the lung areas of interest; 8/10 presented with multiple B-lines and 3/8 had them in at least 50% of lung areas; 5/10 had a white lung appearance in at least one lung area and 1/5 had them in half of the areas of interest. Pleural effusion was described in 9/10. CONCLUSIONS During the ongoing COVID-19 pandemic, we suggest performing PoC-LUS in febrile patients with high levels of inflammatory indices and clinical suspicion of MIS-C, or without a certain diagnosis; the finding of many B-lines and pleural effusion would support the diagnosis of a systemic inflammatory disease.
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