Lung ultrasound to detect cardiopulmonary interactions in acutely ill children

Abstract

Objective and design Our prospective observational study is the first study that evaluates the lung ultrasound (LUS) findings of cardiopulmonary interactions in acutely ill children with elevated pro‐brain natriuretic peptide (BNP) levels, with the aim of establishing the specific LUS pattern in this category of patients without primary lung diseases. Methodology We prospectively analyzed epidemiological, clinical, laboratory, instrumental, and lung ultrasound parameters in acutely ill children aged 1 month to 18 years admitted to the Department of Pediatrics between March 2020 to August 2020. Among the acutely ill patients evaluated, only patients with pro‐BNP > 300 pg/ml and who underwent LUS before the start of any treatment were included. They were stratified into three subcategories based on the diagnosis (A) cardiac disease, (B) systemic inflammatory disease/sepsis without functional and/or organic alterations of the myocardium, and (C) systemic inflammatory disease/sepsis and cardiac disease, and were classified into two groups based on the level of pro‐BNP. We also enrolled patients belonging to two other categories (patients with primary infectious lung disease and completely healthy patients) analyzing their epidemiological, clinical, laboratory, instrumental parameters, and lung ultrasound findings and comparing them with those of acutely ill children. Results and Conclusion We found that LUS findings in these acutely ill children are different from the ultrasound pattern of other categories of children and in particular (1) children with acute lower respiratory tract infections and (2) healthy infants. The finding in a child of a sonographic interstitial syndrome with multiple, bright, long, separate, and nonconfluent B‐lines/long vertical artifacts deriving from a normal and regular pleural line, in the absence of subpleural consolidations, is strongly predictive of cardiogenic pulmonary edema or pulmonary congestion in the course of systemic inflammatory disease/sepsis.

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

“…This high rate of patients with pulmonary alterations reinforces the need of LU screening early after admission. According previously reported, we observed a good correlation between clinical and ultrasound findings [12,16]. Of note, LU can identify lung abnormalities not revealed by chest-X-ray [17].…”

“…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.…”

“…LU is increasingly used to assess the respiratory state and even to predict evolution and guide treatment in bronchiolitis with promising results [8,12]. In the study by Bueno-Campaña et al the ultrasound lung score combined with the WDF scale and age shows a moderate prognostic accuracy for the need of respiratory support, with an AUC of 0.84 (95%CI: 0.781-0.909) and, both posterior consolidations > 1 cm and greater extension of the interstitial pattern in anterior fields, present a higher correlation with the need of respiratory support [16].…”

“…The integrative cardiopulmonary ultrasound (CPU) approach is an emerging non-invasive technique that combines lung ultrasound (LU) and echocardiography to evaluate lung and cardiac conditions simultaneously, especially in the critical care setting [10,11]. To date, there are few investigations evaluating concomitant dysfunction of the pulmonary and cardiac systems in critically ill children [12], and no publications in infants with acute bronchiolitis. Using bedside CPU would allow for a rapid and thorough assessment of both the cardiovascular and respiratory state in these setting.…”

The Role of Lung Ultrasound in Diagnosing COVID-19-Related Multisystemic Inflammatory Disease: A Preliminary Experience

“…Among our cases, seven children (70%) reported a link with SARS-CoV-2, and all had serological evidence of a previous COVID-19 infection with no co-infections. Of note, MIS-C has some overlapping clinical and laboratory features with Kawasaki Disease [ 16 , 30 ], and although some immunological differences have been highlighted, the differential diagnosis can remain difficult. For this reason, we cannot exclude the possibility that lung ultrasound may also detect ultrasound patterns of interstitial inflammation due to vascular overload in Kawasaki Disease also, as has recently been described by Buonsenso et al in a study assessing cardiopulmonary interactions in children with systemic inflammatory diseases [ 31 ].…”