Lung Ultrasound and Clinical Progression of Acute Bronchiolitis: A Prospective Observational Single-Center Study

Abstract

Background and Objectives: Recent literature suggests that lung ultrasound might have a role in the diagnosis and management of bronchiolitis. The aim of the study is to evaluate the relationship between an ultrasound score and the clinical progression of bronchiolitis: need for supplemental oxygen, duration of oxygen therapy and hospital stay. Materials and Methods: This was a prospective observational single-center study, conducted in a pediatric unit during the 2017–2018 epidemic periods. All consecutive patients admitted with clinical signs of acute bronchiolitis, but without the need for supplemental oxygen, underwent a lung ultrasound in the first 24 h of hospital care. The lung involvement was graded based on the ultrasound score. During clinical progression, need for supplemental oxygen, duration of oxygen therapy and duration of hospital stay were recorded. Results: The final analysis included 83 patients, with a mean age of 4.5 ± 4.1 months. The lung ultrasound score in patients that required supplemental oxygen during hospitalization was 4.5 ± 1.7 (range: 2.0–8.0), different from the one of the not supplemented infants (2.5 ± 1.8; range: 0.0–6.0; p < 0.001). Ultrasound score was associated with the need for supplemental oxygen (OR = 2.2; 95% CI = 1.5–3.3; p < 0.0001). Duration of oxygen therapy was not associated with LUS score (p > 0.05). Length of hospital stay (coef. = 0.5; 95% CI = 0.2–0.7; p < 0.0001) correlates with LUS score. Conclusion: Lung ultrasound score correlates with the need of supplemental oxygen and length of hospital stay in infants with acute bronchiolitis.

Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure

“…These reports, however, have been limited in the number of children enrolled with ARF, which may affect the sensitivity and specificity of the POC-LUS exam [ 11 ]. It has been consistently described that children with more ultrasound abnormalities have prolonged clinical courses and higher resource utilization [ 12 , 13 , 16 , 26 , 29 , 31 ]. Our study is the first to characterize diagnostic POC-LUS artifact findings in children admitted to the PICU for undifferentiated ARF, demonstrating significant heterogeneity with a range of sonographic findings across the most common causes of pediatric ARF: bronchiolitis/viral pneumonitis, pneumonia, and status asthmaticus.…”

“…This is in comparison to those evaluating a known or suspected single disease entity and supports the idea that the current sonographic criteria that have been well defined in adult POC-LUS may not extrapolate to the pediatric population, and in particular, to the critically ill pediatric population [ 11 , 34 ]. It may turn out that pediatric POC-LUS is best used to help clinicians differentiate underlying lung pathophysiology or disease severity to guide treatment [ 16 , 26 , 29 , 37 , 38 ], rather than to help determine a specific clinical diagnosis. As examples, using POC-LUS pre- and post-albuterol may aid in determining albuterol responsiveness; using POC-LUS pre- and post-ventilator adjustment to determine lung recruitability, and using POC-LUS to guide fluid administration/removal.…”

Lack of Association Between a Quantified Lung Ultrasound Score and Illness Severity in Pediatric Emergency Department Patients With Acute Lower Respiratory Infections

“…There have only been a handful of small studies assessing the utility of using LUS protocols in pediatrics to identify and predict severity, mostly in specific disease states or limited age groups. In infants with bronchiolitis, higher QLUS has been associated with increased oxygen requirements, need for respiratory support, hospital admission, and length of stay 25–28 . Among mechanically ventilated patients with bronchiolitis, QLUS is moderately correlated with the oxygen saturation index 29 .…”

“…In infants with bronchiolitis, higher QLUS has been associated with increased oxygen requirements, need for respiratory support, hospital admission, and length of stay. [25][26][27][28] Among mechanically ventilated patients with bronchiolitis, QLUS is moderately correlated with the oxygen saturation index. 29 More recently, QLUS has shown some utility in assessing pulmonary disease burden and discerning mild from moderate or severe disease in pediatric patients with COVID-19 infections.…”

Lung Ultrasound in Pediatrics and Neonatology: An Update

“…This report is based on deep literature research over the last 20 years with the aim of providing clinical indi- Starting from the knowledge of most common sonographic findings, ultrasound severity scores can be developed to correctly stratify affected children and to predict the clinical course of bronchiolitis; they can also be compared with clinical scores based on the most common symptoms and signs with a reported agreement of 90.6%. LUS allows for the identification of patients in need of supplemental oxygen with high sensitivity and specificity (96.6% and 98.7%, respectively) and correlates with the length of hospital stay [104][105][106][107][108]. According to Bueno-Campana, the identification of at least one consolidation >1 cm in the posterior areas has a relative risk of 4.4 for the need of non-invasive ventilation [109].…”