Lung ultrasound in bronchiolitis

Abstract

Background Bronchiolitis is the most common acute viral infection of the lower respiratory tract in infants. Clinical severity is associated with different risk factors; however, no clinical, laboratory, or radiological findings are able to predict the course of the disease in full‐term infants. Lung ultrasound (LUS) is a valid technique for the diagnosis and evaluation of pediatric respiratory diseases. Aims The aim of our study was to correlate an LUS score with a clinical score, to describe lung ultrasound findings in cases and controls, and to compare LUS findings with chest X‐ray (CXR) in infants hospitalized with bronchiolitis. Methods We conducted a single‐center, longitudinal, prospective study on 92 infants. Sixty‐three out of 92 infants were hospitalized for acute bronchiolitis (cases) and twenty‐nine out of 92 for diseases not involving the respiratory system (controls). All patients with bronchiolitis underwent a clinical evaluation with the assignment of a clinical severity score and performed lung ultrasound with the assignment of an LUS score. Twenty‐three out of 63 infants with bronchiolitis underwent also a CXR for clinical indications. Control infants performed only LUS. Results In infants with bronchiolitis LUS score showed a positive correlation with the clinical score (r = .62, p < .001) and the length of hospitalization (r = .42; p < .001). The need of oxygen therapy was more frequent in the patients with higher LUS score (p < .001). LUS findings observed in the cases were the presence of B‐lines, subpleural consolidations, and abnormalities of the pleural line. No LUS alterations were observed in the controls. In patients who performed LUS and CXR, we found a correlation between the presence of abnormalities of the pleural line with LUS and the presence of air trapping with CXR (r = .55; p = .007).

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

“…Clinically, these lung conditions manifest in the most severe cases as increased respiratory effort and impaired gas exchange with subsequent hypoxemia and acidosis. As we showed in this study, LU in infants with bronchiolitis can show diffuse and heterogeneous alveolar–interstitial involvement, which can range from mild alterations, such as pleuropulmonary line abnormalities and B-line pattern, to large pulmonary consolidations [ 6 , 7 , 8 , 12 , 16 ]. Most studies about LU in bronchiolitis used their own scores, as we did.…”

“…Thus, lung ultrasound (LUS) is now emerging as a valuable tool in the assessment of the respiratory status in bronchiolitis. The literature supports the use of LUS as a reliable imaging test that could benefit the clinical management of bronchiolitis [ 6 , 7 , 8 ]. The presence of myocardial strain assessed by echocardiography is also being increasingly recognized in this setting, where approximately 20% of patients present myocardial dysfunction (MD) or pulmonary hypertension (PHT) at the time of hospitalization [ 9 ].…”

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

“…Clinically, these lung conditions manifest in most severe cases as increased respiratory effort and impaired gas exchange with subsequent hypoxemia and acidosis. As we showed in this study, LU in infants with bronchiolitis can show diffuse and heterogeneous alveolar-interstitial involvement, which can range from mild alterations, such as pleuropulmonary line abnormalities and B-line pattern, to large pulmonary consolidations [6][7][8]12,16]. Most studies about LU in bronchiolitis used an own score as we did.…”

“…Thus, lung ultrasound (LUS) is now emerging as a valuable tool in assessment of respiratory status in bronchiolitis. Literature supports the use of LUS as a reliable imaging test that could benefit the clinical management of bronchiolitis [6][7][8]. The presence of myocardial strain assessed by echocardiography is also being increasingly recognized in this setting, where approximately 20% of patients present myocardial dysfunction (MD) or pulmonary hypertension (PHT) at the time of hospitalization [9].…”

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].…”