Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze

Varshney, Terry; Mok, Élise; Shapiro, Adam J.; Li, Patricia; Dubrovsky, Alexander Sasha

doi:10.1136/emermed-2015-205302

Cited by 70 publications

(98 citation statements)

References 25 publications

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“…The significance of B‐lines, artefacts that appear in healthy lung, was first studied by Lichtenstein in 1997, which linked the presence of multiple diffuse bilateral B‐lines to alveolar‐interstitial syndromes . In a study in non‐hospitalized patients with mild AB, Varshney suggested that B‐lines were the most common US finding . The presence of B‐lines could be therefore considered an early marker of AB.…”

Section: Discussionmentioning

confidence: 99%

Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: A cohort study

Campaña¹,

Sainz

Alba³

et al. 2019

Pediatric Pulmonology

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Objective Respiratory tract infections are among the most common causes of morbidity and mortality worldwide. Acute bronchiolitis (AB) is the leading cause of hospital admission among infants. Clinical scores have proven to be inaccurate in predicting prognosis. Our aim was to build a score based on findings of lung ultrasound (LU) performed at admission, to stratify patients at risk of needing respiratory support (non‐invasive and invasive ventilation). Study design Prospective, multicenter study including infants <6 months of age admitted with AB. Point‐of‐care LU was performed on admission, and a score was calculated based on ultrasound findings (presence and localization of B lines, B line confluence and/or consolidations) and clinical data. Main outcome was need of respiratory support. Results A total of 145 patients were included in the study, with a median age of 1.7 months [IQR: 1.2‐2.8], 47.6% were female. Mean duration of symptoms prior to admission was 3.1 days (SD 1.8). Fifty‐six patients (39%) required non‐invasive ventilation (NIV), 14 (9.7%) were transferred to PICU, and 3 needed invasive ventilation (3/145). Identification of at least one posterior consolidation >1 cm was the main factor associated to NIV (RR 4.4; [CI95%1.8‐10.8]) The LU score built according to the findings on admission showed an AUC: 0.845(CI95%:0.78‐0.91). A score ≥3.5 showed a sensitivity of 89.1% (CI95%:78.2‐94.9%) and specificity of 56% (CI95%: 45.3‐66.1%) Conclusions Among infants below 6 months of age admitted with AB, point‐of‐care LU was a helpful tool to identify patients at risk of needing respiratory support.

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Section: Discussionmentioning

confidence: 99%

Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: A cohort study

Campaña¹,

Sainz

Alba³

et al. 2019

Pediatric Pulmonology

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show abstract

“…58 Four studies provided interobserver agreement, with three reporting high agreement for consolidation on ultrasound (κ=0.8-0.9). [50][51][52][53][54][55][56][57][58][59] Only one study reported the interobserver agreement for chest radiography and ultrasound simultaneously; agreement for ultrasound was fair (κ=0.55) but better than that for chest radiography (κ=0.33). 58 The limitations of ultrasound include its inability to visualize the whole lung at the same time or to identify consolidation deep within the lung parenchyma.…”

Section: Incidence Of Pneumonia In Childhoodmentioning

confidence: 99%

Advances in the diagnosis of pneumonia in children

Zar

Andronikou

Nicol

2017

BMJ

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Pneumonia remains a major cause of childhood mortality and morbidity globally. Accurate diagnosis and attribution of the causes of pneumonia are important for measuring the burden of disease, implementing appropriate preventive or treatment strategies, and developing more effective interventions. This review summarizes recent diagnostic advances in radiological techniques, specimen collection, and laboratory methods. Although chest ultrasound and chest magnetic resonance imaging are promising modalities for radiological diagnosis, their role in clinical management and their impact on outcomes need further study. Rapid, highly sensitive, multiplex laboratory tests performed on upper respiratory tract samples or induced sputum can detect nucleic acid from potential pathogens in most children with pneumonia. However, it may be difficult to attribute causality because it is often impossible to distinguish between organisms colonizing or infecting the upper respiratory tract and those causing pneumonia. Currently available host biomarkers lack accuracy for distinguishing bacterial or mixed bacterial-viral infections from viral infections. New biomarkers derived from host transcriptional profile analysis may be more accurate but require validation. Prospective studies with appropriate control populations, including studies of clinical impact, are needed to improve our understanding of the role of tests. Although progress has been made in radiological techniques and laboratory testing, current methods for diagnosing and attributing the causes of pneumonia are suboptimal.

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“…These range from conditions such as respiratory distress syndrome (RDS) and transient tachypnea of the newborn (TTN) seen in the neonatal ICU [202], to others such as pulmonary contusions from trauma and chemical pneumonitis [203, 204], as well as different causes of wheezing in children [205]. …”

Section: Diagnostic Applications Of Ultrasoundmentioning

confidence: 99%

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

et al. 2016

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The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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Point-of-care lung ultrasound in young children with respiratory tract infections and wheeze

Cited by 70 publications

References 25 publications

Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: A cohort study

Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: A cohort study

Advances in the diagnosis of pneumonia in children

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

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