Lung Ultrasound in Pediatric Acute Respiratory Distress Syndrome Received Extracorporeal Membrane Oxygenation: A Prospective Cohort Study

Abstract

ObjectiveThe aim of this study was to assess the prognostic value of the lung ultrasound (LUS) score in patients with pediatric acute respiratory distress syndrome (pARDS) who received extracorporeal membrane oxygenation (ECMO).MethodsA prospective cohort study was conducted in a pediatric intensive care unit (PICU) of a tertiary hospital from January 2016 to June 2021. The severe pARDS patients who received ECMO were enrolled in this study. LUS score was measured at initiation of ECMO (LUS-0 h), then at 24 h (LUS-24 h), 48 h (LUS-48 h), and 72 h (LUS-72 h) during ECMO, and when weaned from ECMO (LUS-wean). The value of LUS scores at the first 3 days of ECMO as a prognostic predictor was analyzed.ResultsTwenty-nine children with severe pARDS who received ECMO were enrolled with a median age of 26 (IQR 9, 79) months. The median duration of ECMO support was 162 (IQR 86, 273) h and the PICU mortality was 31.0% (9/29). The values of LUS-72 h and LUS-wean were significantly lower in survivors than that in non-survivors (both P < 0.001). Daily fluid balance volume during the first 3 days of ECMO support were strongly correlated with LUS score [1st day: r = 0.460, P = 0.014; 2nd day: r = 0.540, P = 0.003; 3rd day: r = 0.589, P = 0.001]. The AUC of LUS-72 h for predicting PICU mortality in these patients was 1.000, and the cutoff value of LUS-72 h was 24 with a sensitivity of 100.0% and a specificity of 100.0%. Furthermore, patients were stratified in two groups of LUS-72 h ≥ 24 and LUS-72 h < 24. Consistently, PICU mortality, length of PICU stay, ratio of shock, vasoactive index score value, and the need for continuous renal replacement therapy were significantly higher in the group of LUS-72 h ≥ 24 than in the group of LUS-72 h < 24 (all P < 0.05).ConclusionLung ultrasound score is a promising tool for predicting the prognosis in patients with ARDS under ECMO support. Moreover, LUS-72 h ≥ 24 is associated with high risk of PICU mortality in patients with pARDS who received ECMO.

The value of lung ultrasound score in neonatal respiratory distress syndrome: a prospective diagnostic cohort study

“…An RI greater than 1 is indicative of significantly reduced oxygenation, while an RI above 2 necessitates the use of endotracheal intubation and mechanical ventilation with oxygen for avoiding hypoxia and nitric oxide retention ( 27 ). An OI in the normal range of 400–500 mm Hg reflects the degree of hypoxia, with lower values indicating impaired lung gas exchange ( 31 , 32 ). SOFA scores assess the respiratory, coagulation, liver, circulatory, neurological, and renal systems, thereby providing an overview of the patient’s overall organ function.…”

Lung ultrasound to evaluate pulmonary changes in patients with cardiogenic shock undergoing extracorporeal membrane oxygenation: a retrospective study

“…At present, lung ultrasound has been widely used to evaluate the condition of severe patients. The lung ultrasound (LUS) has been proven to be an alternative method for monitoring pulmonary oedema and accurately assessing the severity of ARDS [6,7]. LUS has been used to assess lung changes in patients with COVID-19 in intensive care units who were treated with ECMO, and the LUS results have been compared with C-reactive protein (CRP) and ventilator settings [8].…”