Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

Shah, Vaishali; Tunik, Michael G.; Tsung, James W.

doi:10.1001/2013.jamapediatrics.107

Cited by 270 publications

(332 citation statements)

References 37 publications

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“…Some experiences show high interobserver agreement [13]. A burgeoning literature, up to a consensus conference [74][75][76][77][78][79][80][81][82][83][84][85][86][87][88], seems to confirm this accessibility. A scientific assessment of the learning curve remains to be done, not in volunteers (creating a selection bias), but in unselected physicians.…”

Section: Limitationsmentioning

confidence: 88%

Lung ultrasound in the critically ill

Lichtenstein

2014

Current Opinion in Critical Care

181

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Lung ultrasound is a basic application of critical ultrasound, defined as a loop associating urgent diagnoses with immediate therapeutic decisions. It requires the mastery of ten signs: the bat sign (pleural line), lung sliding (yielding seashore sign), the A-line (horizontal artifact), the quad sign, and sinusoid sign indicating pleural effusion, the fractal, and tissue-like sign indicating lung consolidation, the B-line, and lung rockets indicating interstitial syndrome, abolished lung sliding with the stratosphere sign suggesting pneumothorax, and the lung point indicating pneumothorax. Two more signs, the lung pulse and the dynamic air bronchogram, are used to distinguish atelectasis from pneumonia. All of these disorders were assessed using CT as the "gold standard" with sensitivity and specificity ranging from 90% to 100%, allowing ultrasound to be considered as a reasonable bedside "gold standard" in the critically ill. The BLUE-protocol is a fast protocol (<3 minutes), which allows diagnosis of acute respiratory failure. It includes a venous analysis done in appropriate cases. Pulmonary edema, pulmonary embolism, pneumonia, chronic obstructive pulmonary disease, asthma, and pneumothorax yield specific profiles. Pulmonary edema, e.g., yields anterior lung rockets associated with lung sliding, making the "B-profile." The FALLS-protocol adapts the BLUE-protocol to acute circulatory failure. It makes sequential search for obstructive, cardiogenic, hypovolemic, and distributive shock using simple real-time echocardiography (right ventricle dilatation, pericardial effusion), then lung ultrasound for assessing a direct parameter of clinical volemia: the apparition of B-lines, schematically, is considered as the endpoint for fluid therapy. Other aims of lung ultrasound are decreasing medical irradiation: the LUCIFLR program (most CTs in ARDS or trauma can be postponed), a use in traumatology, intensive care unit, neonates (the signs are the same than in adults), many disciplines (pulmonology, cardiology…), austere countries, and a help in any procedure (thoracentesis). A 1992, cost-effective gray-scale unit, without Doppler, and a microconvex probe are efficient. Lung ultrasound is a holistic discipline for many reasons (e.g., one probe, perfect for the lung, is able to scan the whole-body). Its integration can provide a new definition of priorities. The BLUE-protocol and FALLS-protocol allow simplification of expert echocardiography, a clear advantage when correct cardiac windows are missing.Keywords: Lung ultrasound; Acute respiratory failure; Acute circulatory failure; Pulmonary oedema; Pulmonary embolism; Pneumonia; Pneumothorax; Interstitial syndrome; Fluid therapy; Haemodynamic assessment; Intensive care unit Lung ultrasound in the critically illThe possibility of exploring the lung using ultrasound, at the bedside and noninvasively, is gaining popularity among intensivists. Lung ultrasound would be of minor interest if the usual tools (bedside radiography, CT) did not have drawbacks (irradiation, ...

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Section: Limitationsmentioning

confidence: 88%

Lung ultrasound in the critically ill

Lichtenstein

2014

Current Opinion in Critical Care

181

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“…On the other hand, Copetti and Cattarossi [3] correctly underlined that US yields to radiology in the follow-up of neonatal respiratory distress after surfactant administration. The same authors first found the high value of US in diagnosing pediatric pneumonia [4], a finding that has been recently confirmed by a large multicenter trial in the United States [5].…”

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confidence: 80%

Pediatric chest ultrasound versus conventional radiology: experimental evidence first

2014

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“…20,26,[46][47][48] Point-of-care US in pediatric patients by PEM providers has recently been adopted into practice, and the literature is still evolving. Nonetheless, there are numerous studies demonstrating the accuracy of point-of-care US by PEM physicians [49][50][51][52][53][54][55][56][57][58] and the ability of PEM physicians to become proficient in point-of-care US after adequate training. 55,56,59 Although the point-ofcare US examinations performed should be specific to the needs of the department, the most common indications for which point-of-care US is being used in PEM are for focused assessment with sonography in trauma, soft tissue evaluation, and vascular access.…”

Section: Diagnostic and Procedural Indicationsmentioning

confidence: 99%

Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians

2015

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Emergency physicians have used point-of-care ultrasonography since the 1990s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.Point-of-care ultrasonography (US) is a bedside technology that enables clinicians to integrate clinical examination findings with real-time sonographic imaging. General emergency physicians and other specialists have used point-of-care US for many years, and more recently, pediatric emergency medicine (PEM) physicians have adopted point-of-care US as a diagnostic and procedural adjunct. This technical report and accompanying policy statement 1 provide a framework for point-of-care US training and point-of-care US integration into pediatric care by PEM physicians.

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Prospective Evaluation of Point-of-Care Ultrasonography for the Diagnosis of Pneumonia in Children and Young Adults

Cited by 270 publications

References 37 publications

Lung ultrasound in the critically ill

Lung ultrasound in the critically ill

Pediatric chest ultrasound versus conventional radiology: experimental evidence first

Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians

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