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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory
Ryan L DeSanti1,2, Eileen A Cowan3, Pierre D Kory4
1Department of Pediatrics, Drexel College of Medicine, St. Christopher's Hospital for Children, Philadelphia, PA, USA. desantirl@gmail.com.
Insights
Point-of-care lung ultrasound (POC-LUS) reveals varied artifacts in pediatric acute respiratory failure (ARF). These findings show overlap across conditions like bronchiolitis and pneumonia, aiding clinical use and future research.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging
- Ultrasound technology
Background:
- Acute respiratory failure (ARF) is a common reason for pediatric intensive care unit (PICU) admission.
- Point-of-care lung ultrasound (POC-LUS) is increasingly used in pediatric critical care.
- Understanding POC-LUS findings in pediatric ARF is crucial for accurate diagnosis and management.
Purpose of the Study:
- To characterize the specific ultrasound artifact findings of POC-LUS in children with ARF.
- To describe the heterogeneity and overlap of these artifacts across common pediatric ARF etiologies.
- To provide data supporting the clinical application and further development of POC-LUS in pediatric critical care.
Main Methods:
- Secondary analysis of a prospective observational study in a 21-bed PICU.
- Inclusion of children over 37 weeks gestational age and up to 18 years old.
- POC-LUS performed and interpreted by blinded physicians, evaluating lung sliding, pleural characteristics, artifacts, and diagnosis.
Main Results:
- A-lines were the most frequent artifact across conditions, particularly in status asthmaticus (81% of zones).
- Sub-pleural consolidation was the second most common artifact, noted in 28-30% of zones in bronchiolitis and pneumonia.
- Specific ultrasound patterns for bronchiolitis, pneumonia, and status asthmaticus were identified in 31%, 10%, and 40% of subjects, respectively.
Conclusions:
- Significant heterogeneity and overlap in POC-LUS artifacts were observed among common pediatric ARF causes.
- The study describes POC-LUS artifact findings to assist clinicians and guide future pediatric research.
- Further investigation is needed to define the optimal role of POC-LUS in pediatric patient care.
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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