Lung ultrasound to evaluate lung recruitment in neonates with respiratory distress (RELUS study)

Abstract

Background: Lung ultrasound (LUS) is a bedside tool useful to diagnose neonatal respiratory disease and to guide surfactant therapy. LUS scores have emerged as useful tool for newborn respiratory distress but is unknown if respiratory support settings may influence it. The aim of the study was to evaluate the feasibility of LUS scores evaluating lung recruitment in term newborns with respiratory distress when noninvasive respiratory it is increased.Material and Methods: Prospective study in a tertiary neonatal intensive care unit.Inclusion criteria were term neonates with respiratory distress requiring noninvasive respiratory support with nasal continuous positive airway pressure (nCPAP) within first 6 h of life with an LUS score higher than 8 were enrolled. LUS was performed three times. First LUS (LUS-1) was done in patients in nCPAP (Fabian Device) (Acutronic) (pressure of 6 cmH 2 O). Afterwards patients were placed in duo positive airway pressure (12/6 cmH 2 O), a second LUS (LUS-2) was performed immediately and a third (LUS-3) was done 2 h later on the same respiratory support. The primary outcome was to compare LUS scores in the different timelines. Second outcomes were to evaluate the level of respiratory distress and oxygenation were evaluated with SpO 2 /fraction of inspired oxygen (FiO 2 ) ratio (S/F ratio), FiO 2 ratio, respiratory rate, and blood gas analysis which were analyzed during the LUS-1 and the LUS-3.To evaluate newborn discomfort, patients were evaluated with Crying Requires oxygen Increased vital signs Expression Sleep (CRIES) scale.Results: Forty neonates were enrolled. Fifty percent were female (n = 20), median gestational age was 38 + 4 (interquartile range [IQR]: 37 + 5-39 + 4) with a median weight of 3155 g (IQR: 2637-3532). Duration of non invasive ventilation support was 72 h (IQR: 54-96). None of the patients required surfactant therapy or mechanical ventilation. LUS scores were no different between LUS-1 9 (IQR: 8.3-10) and LUS-2 9 (IQR: 8.3-10) (p = 0.675) but there were differences between LUS-1 and LUS-3 7 (IQR: 6.3-8.5) (p = 0.036). There was an improvement in the oxygen parameters, respiratory rate, and CO 2 between LUS-1 and LUS-3 (p < 0.001). There were no changes in the CRIES scale.

Lung ultrasound score in the decision of patent ductus arteriosus closure in neonates

“…Previous reports have shown that B lines on LUS correlate with the presence of lung water content 20,32 . Although controversial reports have found the efficacy of the LUS score in the diagnosis of lung pathologies, use in the neonatal intensive care unit (NICU), is increasing 33–35 . Only a few studies have evaluated the effects of PDA in preterm using LUS 6,10 .…”

“…20,32 Although controversial reports have found the efficacy of the LUS score in the diagnosis of lung pathologies, use in the neonatal intensive care unit (NICU), is increasing. [33][34][35] Only a few studies have evaluated the effects of PDA in preterm using LUS. In this study, we planned an "early symptomatic" policy for the F I G U R E 3 ROC curve for assessing for patent ductus arteriosus for closure therapy with lung ultrasound score.…”

Use of Cardio-Pulmonary Ultrasound in the Neonatal Intensive Care Unit

“…LUS-guided recruitment better mitigated lung inflammation and reduced duration of mechanical ventilation. LUS guided recruitment has been attempted on non-invasive ventilation as well [ 60 ]. LUS guided recruitment constitutes an act of integrated CPUS, as the assessment of the hemodynamic status and eventual stabilization are prerequisite for the success of LUS guided open lung ventilation.…”

2022 Year in review: Neonatal pulmonology

“…There were intriguing studies using LU for predicting a level of respirator support or for evaluating clinical efficacy. Rodriquez‐Fanjul et al 5 conducted a prospective study with 40 full‐term neonates who required nCPAP within first 6 h of life with an LUS higher than 8. They found that LUS was no different between the first LU, which was done in patients on nasal CPAP (nCPAP) (6 cmH 2 O), and the second LU, which was done after the subjects were placed on duo positive airway pressure (12/6 cmH 2 O).…”

“…Study outcome [1] Nationwide prospective cross-sectional survey LU in diagnosis of respiratory diseases: PTX (95%), RDS (89%), TTN (89%), PE (88%), Atelectasis (66%), Pneumonia (64%), BPD (43%), CPAM (41%), CDH (34%) [2] Review of literature LU patterns: type 1 (white lung), type 2 (prevalence of B lines), type 3 (predominance of A lines) LUS: 0: A-pattern (presence of only A-lines), 1: B-pattern (presence of 3 or more B-lines), 2: severe B-pattern (presence of crowded and coalescent B lines), 3: extended consolidation [3] Cross-sectional study Comparing POCUS to standard-of-care for ETT placement: POCUS was rapid and reliable [4] Retrospective cohort study Diagnosis of PTX: A-line in the anterior transverse plan was superior to mirrored ribs sign [5] Prospective study Evaluating lung recruitment: There was no difference in LUS between the first LU (LU-1) and LU-2, but there was an improvement in the oxygenation, RR, and CO 2 between LU-1 and LU-3.…”