Characterization of Cardiopulmonary Interactions and Exploring Their Prognostic Value in Acute Bronchiolitis: A Prospective Cardiopulmonary Ultrasound Study

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.

Correlation between urinary and serum NT‐proBNP in acute bronchiolitis: A pilot study

“…A growing body of evidence shows the applicability and benefits of noninvasive complementary exams such as cardiopulmonary ultrasound to evaluate the severity of acute bronchiolitis 38–40 . Our findings suggest that urinary NT‐proBNP measurements could be another useful noninvasive tool, overall, in settings where ultrasound expertise is not available.…”

Correlation between urinary and serum NT-proBNP in acute bronchiolitis. A pilot study

“…Therefore, it is not surprising that urine NT-proBNP presented similar results for clinical outcomes of severity in acute bronchiolitis than those previously reported for serum NT-proBNP, pointing out the potential value of the measurement of urinary NT-proBNP as a non-invasive tool to assess severity in acute bronchiolitis. A growing body of evidence shows the applicability and benefits of non-invasive complementary exams such as cardiopulmonary ultrasound to evaluate the severity of acute bronchiolitis in previously healthy infants [32][33][34]. Our findings suggest that urinary NT-proBNP measurements may be another useful non-invasive tool for this, overall, in settings where ultrasound expertise is not available.…”

Double Doppler Tei index combined with lung ultrasound to evaluate the right ventricular function and lung condition in neonates with pulmonary hypertension

“…The proposal of LUS provides quantitative indicators for clinical practice, which could reflect the more comprehensive and systematic nature and severity of lung lesions. Rodriguez et al 22 found that the higher LUS ( p < 0.001) increased the Tei index ( p < 0.001) and pulmonary artery pressures ( p < 0.001), and that is a positive correlation between LUS and additional ventilation mode classification and ventilator use time. In this study, LUS was also positively associated with pulmonary arterial pressure, assisted breathing therapy, and days of invasive mechanical ventilation, which supports the literature view.…”