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Rodríguez García L, Hierro Delgado E, Oulego Erroz I, Rey Galán C, Mayordomo Colunga J. Clinical-Ultrasound Model to Predict the Clinical Course in Bronchiolitis. CHILDREN (BASEL, SWITZERLAND) 2024; 11:987. [PMID: 39201922 PMCID: PMC11352824 DOI: 10.3390/children11080987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024]
Abstract
BACKGROUND The aim of the present study was to develop a clinical-ultrasound model for early detection of hospital admission, pediatric intensive care unit (PICU) admission, and oxygen requirement in children diagnosed with acute bronchiolitis (AB). Furthermore, the prognostic ability of models including sonographic data from antero-lateral, lateral-posterior, and posterior areas (eight zones) vs. antero-lateral and lateral-posterior areas (six zones) vs. only antero-lateral areas (four zones) was analyzed. METHODS A prospective study was conducted on infants under 12 months with AB. A lung ultrasound (LUS) was performed within 24 h of hospital care and analyzed using the Lung Ultrasound Combined Score (LUCS) based on the ultrasound patterns and their extent. Regression models combining LUCS (using eight, six, or four lung areas) with age and clinical scale were created. RESULTS A total of 90 patients were included (62 admitted to the ward, 15 to PICU), with a median age of 3.7 months. Clinical-ultrasound models with eight and six lung zones predicted hospital admission (AUC 0.89), need for oxygen therapy (AUC 0.88), and its duration (40% explanatory capacity). Models using four lung areas had lower prognostic yield. No model predicted PICU admission needs or duration. CONCLUSIONS The ultrasound pattern and its extension combined with clinical information may be useful to predict hospital admission and oxygen requirement.
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Affiliation(s)
- Lucía Rodríguez García
- Childhood and Adolescence Clinical Management Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.R.G.)
| | - Elena Hierro Delgado
- Paediatrics Department, Complejo Asistencial Universitario de León, 24071 León, Spain
| | - Ignacio Oulego Erroz
- Paediatrics Department, Complejo Asistencial Universitario de León, 24071 León, Spain
- Institute of Biomedicine of León, Universidad de León, 24071 León, Spain
| | - Corsino Rey Galán
- Childhood and Adolescence Clinical Management Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.R.G.)
- Cooperative Research Networks Oriented to Health Outcomes (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28029 Madrid, Spain
- Department of Medicine, Universidad de Oviedo, 33006 Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
| | - Juan Mayordomo Colunga
- Childhood and Adolescence Clinical Management Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (C.R.G.)
- Cooperative Research Networks Oriented to Health Outcomes (RICORS), Instituto de Salud Carlos III, RD21/0012/0020, 28029 Madrid, Spain
- Department of Medicine, Universidad de Oviedo, 33006 Oviedo, Spain
- Health Research Institute of the Principality of Asturias (ISPA), 33011 Oviedo, Spain
- Biomedical Research Networking Center (CIBER)-Respiratory Diseases, Instituto de Salud Carlos III, 28029 Madrid, Spain
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2
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Recker F, Kipfmueller F, Wittek A, Strizek B, Winter L. Applications of Point-of-Care-Ultrasound in Neonatology: A Systematic Review of the Literature. Life (Basel) 2024; 14:658. [PMID: 38929641 PMCID: PMC11204601 DOI: 10.3390/life14060658] [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: 04/09/2024] [Revised: 05/10/2024] [Accepted: 05/20/2024] [Indexed: 06/28/2024] Open
Abstract
Point-of-care ultrasound (POCUS) integration into neonatology offers transformative potential for diagnostics and treatment, enhancing immediacy and precision of clinical decision-making in this vulnerable patient population. This systematic review aims to synthesize evidence on POCUS applications, benefits, challenges, and educational strategies in neonatology. Literature search was conducted using SPIDER scheme keywords and MeSH terms related to POCUS and neonatology. Studies focusing on POCUS applications, its impact on clinical outcomes, and educational interventions for skill acquisition were included and analyzed using standardized tools, followed by a narrative synthesis of the findings. The search yielded 68 relevant publications, encompassing original research, reviews, and guidelines. POCUS applications varied across cardiovascular, pulmonary, neurological, and abdominal assessments. Key benefits included a reduced need for invasive procedures and rapid bedside diagnosis. Challenges included steep learning curves for clinicians and the need for standardized training and guidelines. Educational strategies highlighted the effectiveness of simulation-based training in enhancing ultrasound proficiency among neonatal care providers. POCUS represents a significant advancement in neonatal medicine, offering benefits for patient care. Addressing identified challenges through comprehensive training programs and developing standardized guidelines is crucial for optimized use. Future research should focus on evaluating educational outcomes and long-term impacts of POCUS integration into neonatal care.
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Affiliation(s)
- Florian Recker
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Florian Kipfmueller
- Department of Neonatology and Pediatric Intensive Care, Children’s Hospital University of Bonn, Venusberg Campus 1, 53127 Bonn, Germany;
| | - Agnes Wittek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Brigitte Strizek
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
| | - Lone Winter
- Department of Obstetrics and Gynecology, University Hospital Bonn, Venusberg Campus 1, 53127 Bonn, Germany; (A.W.); (B.S.); (L.W.)
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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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Lee CS, Li M, Lou Y, Abbasi QH, Imran MA. Acoustic Lung Imaging Utilized in Continual Assessment of Patients with Obstructed Airway: A Systematic Review. SENSORS (BASEL, SWITZERLAND) 2023; 23:6222. [PMID: 37448069 DOI: 10.3390/s23136222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 07/03/2023] [Accepted: 07/04/2023] [Indexed: 07/15/2023]
Abstract
Smart respiratory therapy is enabled by continual assessment of lung functions. This systematic review provides an overview of the suitability of equipment-to-patient acoustic imaging in continual assessment of lung conditions. The literature search was conducted using Scopus, PubMed, ScienceDirect, Web of Science, SciELO Preprints, and Google Scholar. Fifteen studies remained for additional examination after the screening process. Two imaging modalities, lung ultrasound (LUS) and vibration imaging response (VRI), were identified. The most common outcome obtained from eleven studies was positive observations of changes to the geographical lung area, sound energy, or both, while positive observation of lung consolidation was reported in the remaining four studies. Two different modalities of lung assessment were used in eight studies, with one study comparing VRI against chest X-ray, one study comparing VRI with LUS, two studies comparing LUS to chest X-ray, and four studies comparing LUS in contrast to computed tomography. Our findings indicate that the acoustic imaging approach could assess and provide regional information on lung function. No technology has been shown to be better than another for measuring obstructed airways; hence, more research is required on acoustic imaging in detecting obstructed airways regionally in the application of enabling smart therapy.
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Affiliation(s)
- Chang-Sheng Lee
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
- Global Technology and Innovation Department, Hill-Rom Services Pte Ltd., Singapore 768923, Singapore
| | - Minghui Li
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Yaolong Lou
- Global Technology and Innovation Department, Hill-Rom Services Pte Ltd., Singapore 768923, Singapore
| | - Qammer H Abbasi
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
| | - Muhammad Ali Imran
- James Watt School of Engineering, University of Glasgow, Glasgow G12 8QQ, UK
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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; 13:1765. [PMID: 37238249 PMCID: PMC10217038 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
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6
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Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, Zampogna S, Carnielli VP, Favilli S, Ruggieri M, Perri D, Di Mauro G, Gattinara GC, D'Avino A, Becherucci P, Prete A, Zampino G, Lanari M, Biban P, Manzoni P, Esposito S, Corsello G, Baraldi E. UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr 2023; 49:19. [PMID: 36765418 PMCID: PMC9912214 DOI: 10.1186/s13052-022-01392-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 11/29/2022] [Indexed: 02/12/2023] Open
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.
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Affiliation(s)
| | - Annamaria Staiano
- SIP "Società Italiana di Pediatria", University "Federico II", Naples, Italy
| | - Luigi Orfeo
- SIN "Società Italiana di Neonatologia", Hospital San Giovanni Calibita Fatebenefratelli, Rome, Italy
| | - Fabio Midulla
- SIMRI "Società Italiana per le Malattie Respiratorie Infantili", University of Rome "La Sapienza", Rome, Italy
| | - Gian Luigi Marseglia
- SIAIP "Società Italiana di Allergologia e Immunologia Pediatrica", Foundation IRCCS Policlinico San Matteo, Pavia, Italy
| | - Chiara Ghizzi
- AMIETIP "Accademia Medica Infermieristica di Emergenza e Terapia Intensiva Pediatrica", Major Hospital Polyclinic: Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Bologna, Italy
| | - Stefania Zampogna
- SIMEUP "Società Italiana di Medicina di Emergenza ed Urgenza Pediatrica", Pugliese Ciaccio Hospital, Catanzaro, Italy
| | - Virgilio Paolo Carnielli
- SIMP "Società Italiana di Medicina Perinatale", University Hospital of Ancona Umberto I G M Lancisi G Salesi, Ancona, Italy
| | - Silvia Favilli
- SICP "Società Italiana di Cardiologia Pediatrica", University Hospital Meyer, Firenze, Italy
| | - Martino Ruggieri
- SINP "Società Italiana di Neurologia Pediatrica", University of Catania, Catania, Italy
| | - Domenico Perri
- SIPO "Società Italiana Pediatria Ospedaliera", San Giuseppe Moscati Hospital, Aversa, Italy
| | - Giuseppe Di Mauro
- SIPPS "Società Italiana di Pediatria Preventiva e Sociale", Local Health Authority Caserta, Caserta, Italy
| | - Guido Castelli Gattinara
- SITIP "Società Italiana di Infettivologia Pediatrica", Bambino Gesu Pediatric Hospital, Rome, Italy
| | - Antonio D'Avino
- FIMP "Federazione Italiana Medici Pediatri", Local Health Authority Naples 1 Centre, Naples, Italy
| | - Paolo Becherucci
- SICuPP "Società Italiana delle Cure Primarie Pediatriche", Florence City Council, Florence, Italy
| | - Arcangelo Prete
- AIEOP "Società Italiana di Ematologia e Oncologia Pediatrica", IRCCS University Hospital of Bologna, Bologna, Italy
| | - Giuseppe Zampino
- SIMGePeD "Società Italiana Malattie Genetiche Pediatriche e Disabilità Congenite", University Hospital Agostino Gemelli, Rome, Italy
| | | | - Paolo Biban
- University Hospital of Verona, Verona, Italy
| | - Paolo Manzoni
- Ospedale Degli Infermi, Biella, Italy
- University of Turin, Turin, Italy
| | | | | | - Eugenio Baraldi
- Department of Women's and Children's Health, Neonatal Intensive Care Unit, University Hospital of Padova, Padova, Italy.
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Kogias C, Prountzos S, Alexopoulou E, Douros K. Lung ultrasound systematic review shows its prognostic and diagnostic role in acute viral bronchiolitis. Acta Paediatr 2023; 112:222-232. [PMID: 36261915 DOI: 10.1111/apa.16578] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/14/2022] [Accepted: 10/18/2022] [Indexed: 01/13/2023]
Abstract
AIM Lung ultrasound (LUS) has not been included in the current guidelines for the diagnosis of bronchiolitis so far, even though data concerning its effectiveness have been published. METHODS A systematic literature review was carried out to determine the role of LUS scores in the diagnosis and prognosis of patients aged 0-2 years with bronchiolitis, using MEDLINE, Scopus and ScienceDirect databases from their inception to December 2021. RESULTS A total of 18 studies matching our eligibility criteria were analysed for the purposes of this review and 1249 patients with bronchiolitis were included. The sonographic and radiological findings were comparable and chest radiography was found to have a higher sensitivity in ruling out severe complications such as concomitant pneumonia. The LUS scores were correlated to the clinical course of bronchiolitis and it was able to predict the need of admission in paediatric intensive care unit, the duration of hospitalisation and the need for respiratory support. CONCLUSION This review suggests that LUS could have both a diagnostic and a prognostic role in bronchiolitis during first evaluation in the emergency department and hospitalisation. Physicians could adjust management according to sonographic findings as a useful adjunct to the clinical ones.
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Affiliation(s)
- Christos Kogias
- Faculty of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Spyridon Prountzos
- 2nd Department of Radiology, National and Kapodistrian University of Athens, Faculty of Medicine, University General Hospital 'Attikon', Athens, Greece
| | - Efthymia Alexopoulou
- 2nd Department of Radiology, National and Kapodistrian University of Athens, Faculty of Medicine, University General Hospital 'Attikon', Athens, Greece
| | - Konstantinos Douros
- 3rd Department of Paediatrics, National and Kapodistrian University of Athens, Faculty of Medicine, University General Hospital 'Attikon', Athens, Greece
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Bhattacharya D, Sarkar S, Mandal M, Esquinas AM. Point-of-Care Thoracic Ultrasound in Children with Bronchiolitis: Correspondence. Indian J Pediatr 2022; 89:1161. [PMID: 36107288 DOI: 10.1007/s12098-022-04338-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 07/02/2022] [Accepted: 07/15/2022] [Indexed: 01/04/2023]
Affiliation(s)
- Dipasri Bhattacharya
- Department of Anesthesiology, Pain Medicine, and Critical Care, R. G. Kar Medical College, Kolkata, West Bengal, India
| | - Susanta Sarkar
- Department of Anesthesiology, North Bengal Medical College & Hospital, Sushrutanagar, Darjeeling, West Bengal, India
| | - Mohanchandra Mandal
- Department of Anesthesiology, Institute of Post Graduate Medical Education and Research/S.S.K.M. Hospital, Kolkata, West Bengal, 700020, India.
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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; 11:4233. [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
| | | | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A, Gemelli IRCCS, 00168 Rome, Italy;
| | | | - 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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