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

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants <12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients underwent clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 h of hospital admission. The existence of significant correlation between cardiac and respiratory parameters was the primary outcome. The association of different cardiopulmonary variables with the need of respiratory support higher than O2, the length of stay hospitalization, the PICU stay and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5–3) months; 62% males) hospitalized with acute bronchiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction (Tei index). Up to 36 (32%) infants required respiratory support during the hospitalization. This group presented with higher lung ultrasound score (p < 0.001) and increased values of NT-proBNP (p < 0.001), the Tei index (p < 0.001) and pulmonary artery pressures (p < 0.001). All the analyzed respiratory and cardiac variables showed moderate-to-strong correlations with the LOS of hospitalization and the time of respiratory support. Lung ultrasound and echocardiography showed a moderate-to-strong predictive accuracy for the need of respiratory support in the ROC analysis, with the AUC varying from 0.74 to 0.87. Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ultrasonography could be a useful tool to easily identify high-risk populations for complicated acute bronchiolitis hospitalization.

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

10.20944/preprints202112.0032.v1 ◽

2021 ◽

Author(s):

Moises Rodriguez-Gonzalez ◽

Patricia Rodriguez-Campoy ◽

Lorena Estepa-Pedregosa ◽

Ana Estalella-Mendoza ◽

Ana Castellano-Martinez ◽

...

Keyword(s):

Lung Ultrasound ◽

Predictive Accuracy ◽

Clinical Laboratory ◽

Myocardial Dysfunction ◽

Respiratory Support ◽

Secondary Outcome ◽

High Risk Population ◽

Acute Bronchiolitis ◽

Cardiopulmonary Interactions ◽

Ultrasound Study

We aimed to delineate cardiopulmonary interactions in acute bronchiolitis and to evaluate the capacity of a combined cardiopulmonary ultrasonography to predict the need for respiratory support. This was a prospective observational single-center study that includes infants < 12 month of age admitted to a hospital due to acute bronchiolitis. All the included patients under-went clinical, laboratory and cardiopulmonary ultrasonographic evaluation at the same time point within 24 hours of hospital admission. The existence of significant correlation between car-diac and respiratory parameters was the primary outcome. The association of different cardio-pulmonary variables with the need of respiratory support higher than O2, the length of stay hos-pitalization, the PICU stay, and the duration of respiratory support were a secondary outcome. We enrolled 112 infants (median age 1 (0.5-3) months; 62% males) hospitalized with acute bron-chiolitis. Increased values of the pulmonary variables (BROSJOD score, pCO2 and LUS) showed moderate correlations with NT-proBNP and all echocardiographic parameters indicative of pulmonary hypertension and myocardial dysfunction. Up to 36 (32%) infants required respira-tory support during the hospitalization. This group presented with higher lung ultrasound score (p<0.001), and increased values of Tei index (p<0.001) and pulmonary artery pressures (p<0.001). All the analyzed respiratory and cardiac variables showed moderate to strong correlations with the LOS hospitalization and the time of respiratory support. Lung ultrasound and echocardiog-raphy showed a moderate to strong predictive accuracy for the need of respiratory support in the ROC analysis, with AUC varying from 0.74 to 0.87. Conclusion: Those cases of bronchiolitis with a worse pulmonary status presented with a more impaired cardiac status. Cardiopulmonary ul-trasonography could be a good strategy to easily identify high-risk population for a complicated acute bronchiolitis hospitalization.

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Lung ultrasound for prediction of respiratory support in infants with acute bronchiolitis: A cohort study

Pediatric Pulmonology ◽

10.1002/ppul.24287 ◽

2019 ◽

Vol 54 (6) ◽

pp. 873-880 ◽

Cited By ~ 9

Author(s):

Mercedes Bueno‐Campaña ◽

Talía Sainz ◽

Maria Alba ◽

Teresa del Rosal ◽

Ana Mendez‐Echevarría ◽

...

Keyword(s):

Cohort Study ◽

Lung Ultrasound ◽

Respiratory Support ◽

Acute Bronchiolitis

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Lung Ultrasound to detect cardiopulmonary interactions in acutely ill children

10.22541/au.162500677.76140519/v1 ◽

2021 ◽

Author(s):

Danilo Buonsenso ◽

Cristina De Rose ◽

Valentina Ferro ◽

Rosa Morello ◽

Anna Maria Musolino ◽

...

Keyword(s):

Inflammatory Disease ◽

Cardiac Disease ◽

Lung Ultrasound ◽

Clinical Laboratory ◽

Cardiopulmonary Interactions ◽

Systemic Inflammatory Disease ◽

Ultrasound Findings ◽

Tract Infections ◽

Ultrasound Parameters ◽

B Lines

Objective and design: Our prospective observational study is the first study that evaluates the LUS findings of cardiopulmonary interactions in acutely ill children with elevated pro-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 sub-categories 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 non-confluent B-lines / long vertical artefacts 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.

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Lung ultrasound and computed tomography to monitor COVID-19 pneumonia in critically ill patients: a two-center prospective cohort study

Intensive Care Medicine Experimental ◽

10.1186/s40635-020-00367-3 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Micah L. A. Heldeweg ◽

Jorge E. Lopez Matta ◽

Mark E. Haaksma ◽

Jasper M. Smit ◽

Carlos V. Elzo Kraemer ◽

...

Keyword(s):

Critically Ill ◽

Critically Ill Patients ◽

Lung Ultrasound ◽

Composite Endpoint ◽

Pulmonary Involvement ◽

Chest Ct ◽

Secondary Outcome ◽

Icu Stay ◽

Academic Hospitals ◽

Ultrasound Score

Abstract Background Lung ultrasound can adequately monitor disease severity in pneumonia and acute respiratory distress syndrome. We hypothesize lung ultrasound can adequately monitor COVID-19 pneumonia in critically ill patients. Methods Adult patients with COVID-19 pneumonia admitted to the intensive care unit of two academic hospitals who underwent a 12-zone lung ultrasound and a chest CT examination were included. Baseline characteristics, and outcomes including composite endpoint death or ICU stay > 30 days were recorded. Lung ultrasound and CT images were quantified as a lung ultrasound score involvement index (LUSI) and CT severity involvement index (CTSI). Primary outcome was the correlation, agreement, and concordance between LUSI and CTSI. Secondary outcome was the association of LUSI and CTSI with the composite endpoints. Results We included 55 ultrasound examinations in 34 patients, which were 88% were male, with a mean age of 63 years and mean P/F ratio of 151. The correlation between LUSI and CTSI was strong (r = 0.795), with an overall 15% bias, and limits of agreement ranging − 40 to 9.7. Concordance between changes in sequentially measured LUSI and CTSI was 81%. In the univariate model, high involvement on LUSI and CTSI were associated with a composite endpoint. In the multivariate model, LUSI was the only remaining independent predictor. Conclusions Lung ultrasound can be used as an alternative for chest CT in monitoring COVID-19 pneumonia in critically ill patients as it can quantify pulmonary involvement, register changes over the course of the disease, and predict death or ICU stay > 30 days. Trial registration: NTR, NL8584. Registered 01 May 2020—retrospectively registered, https://www.trialregister.nl/trial/8584

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Lung Ultrasound Patterns and Clinical-Laboratory Correlates during COVID-19 Pneumonia: A Retrospective Study from North East Italy

Journal of Clinical Medicine ◽

10.3390/jcm10061288 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1288

Author(s):

Riccardo Senter ◽

Federico Capone ◽

Stefano Pasqualin ◽

Lorenzo Cerruti ◽

Leonardo Molinari ◽

...

Keyword(s):

Lung Ultrasound ◽

Clinical Laboratory ◽

Imaging Modality ◽

Case Series ◽

Severity Index ◽

Disease Stage ◽

Retrospective Case ◽

North East ◽

High Flow Oxygen ◽

B Lines

Background and Aim. Lung ultrasound (LUS) is a convenient imaging modality in the setting of coronavirus disease-19 (COVID-19) because it is easily available, can be performed bedside and repeated over time. We herein examined LUS patterns in relation to disease severity and disease stage among patients with COVID-19 pneumonia. Methods. We performed a retrospective case series analysis of patients with confirmed SARS-CoV-2 infection who were admitted to the hospital because of pneumonia. We recorded history, clinical parameters and medications. LUS was performed and scored in a standardized fashion by experienced operators, with evaluation of up to 12 lung fields, reporting especially on B-lines and consolidations. Results. We included 96 patients, 58.3% men, with a mean age of 65.9 years. Patients with a high-risk quick COVID-19 severity index (qCSI) were older and had worse outcomes, especially for the need for high-flow oxygen. B-lines and consolidations were located mainly in the lower posterior lung fields. LUS patterns for B-lines and consolidations were significantly worse in all lung fields among patients with high versus low qCSI. B-lines and consolidations were worse in the intermediate disease stage, from day 7 to 13 after onset of symptoms. While consolidations correlated more with inflammatory biomarkers, B-lines correlated more with end-organ damage, including extrapulmonary involvement. Conclusions. LUS patterns provide a comprehensive evaluation of patients with COVID-19 pneumonia that correlated with severity and dynamically reflect disease stage. LUS patterns may reflect different pathophysiological processes related to inflammation or tissue damage; consolidations may represent a more specific sign of localized disease, whereas B-lines seem to be also dependent upon generalized illness due to SARS-CoV-2 infection.

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Lung Ultrasound in Bronchopulmonary Dysplasia: Patterns and Predictors in Very Preterm Infants

Neonatology ◽

10.1159/000517585 ◽

2021 ◽

pp. 1-9

Author(s):

Victoria Aldecoa-Bilbao ◽

Mar Velilla ◽

Marta Teresa-Palacio ◽

Carla Balcells Esponera ◽

Ana Herranz Barbero ◽

...

Keyword(s):

Preterm Infants ◽

Bronchopulmonary Dysplasia ◽

Lung Ultrasound ◽

Respiratory Support ◽

Very Preterm Infants ◽

Very Preterm ◽

Pleural Line ◽

Respiratory Management ◽

Postmenstrual Age ◽

Severity Of The Disease

Introduction: Lung ultrasound (LUS) is useful for respiratory management in very preterm infants (VPI), but little is known about the echographic patterns in bronchopulmonary dysplasia (BPD), the relation between the image findings, and the severity of the disease and its long-term outcomes. We aimed to describe LUS patterns in BPD and analyze the accuracy of LUS to predict the need for respiratory support at 36 weeks postmenstrual age (PMA) in VPI. Methods: Preterm infants ≤30.6 weeks of gestational age were recruited. LUS was performed at admission, at 7th, and 28th day of life (DOL) with a standardized protocol (6 zones: anterior, lateral, and posterior fields). Clinical data, respiratory outcomes, and image findings were recorded. Results: Eighty-nine patients were studied. Infants with BPD had significantly higher LUS score at admission, at 7th, and 28th DOL. Patients with BPD exhibited more consolidations and pleural line abnormalities at 7th and 28th DOL than those without BPD (p < 0.001), regardless of the definition used for BPD. LUS at 7th DOL predicted NICHD 2001-BPD with R2 = 0.522; AUC = 0.87 (0.79–0.94), p < 0.001, and Jensen 2019-BPD with R2 = 0.315 (AUC = 0.80 [0.70–0.90], p < 0.001). A model including mechanical ventilation >5 days, oxygen therapy for 7 days and LUS score at 7th DOL accurately predicted the need for respiratory support at 36 weeks PMA (R2 = 0.655, p < 0.001) with an AUC = 0.90 (0.84–0.97), p < 0.001. Conclusion: LUS score, pleural line abnormalities, and consolidations can be useful to diagnose BPD in VPI and to predict its severity after the first week of life.

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Pulmonary Tuberculosis Wheezing In Early Childhood

Acta Medica Marisiensis ◽

10.2478/amma-2013-0035 ◽

2013 ◽

Vol 59 (3) ◽

pp. 151-153

Author(s):

G Dumitra ◽

Ana Bobârnac ◽

Venera Dinescu ◽

D Bulucea

Keyword(s):

Pulmonary Tuberculosis ◽

Rural Areas ◽

Clinical Laboratory ◽

Acute Bronchiolitis ◽

Epidemiological Investigation ◽

Pediatric Clinic ◽

Alarm Symptom ◽

Tuberculosis In Children ◽

Hospital Clinic

Abstract Background: Primary pulmonary tuberculosis in children and infants can be suggested by the presence of a wheezing, often interpreted as acute bronchiolitis or asthma. The objective of this study is to assess the frequency and mechanism of wheezing in infants and toddlers with tuberculosis and to assess its value as an alarm symptom in children from areas where tuberculosis incidence is high. Material and method: We carried out a retrospective study in the Pediatric Clinic of the ”Filantropia” Municipal Hospital Clinic of Craiova between 2007-2011. We studied 25 children and infants, who at hospitalization presented signs like: wheezing, cough and dyspnoea. Results: There were 25 children and infants diagnosed with primary tuberculosis. Twenty-one cases (84%) came from rural areas and 56% (14 cases) occurred in infants. Out of the 25 cases, 22 (88%) presented wheezing, 18 (72%) were accompanied by dyspnoea and 16 patients (64%) presented cough. The majority of cases (16 out of 25, representing 64%) came from families in which a tuberculosis focus was identified during the epidemiological investigation. Conclusions: The positive epidemiological research, together with other data provided by the clinical, laboratory analyses and the collaboration with other specialties determine the classification of wheezing as a symptom within tuberculosis.

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Ventilator-associated pneumonia in neonates: the role of point of care lung ultrasound

European Journal of Pediatrics ◽

10.1007/s00431-020-03710-8 ◽

2020 ◽

Vol 180 (1) ◽

pp. 137-146

Author(s):

Nora Tusor ◽

Angela De Cunto ◽

Yousef Basma ◽

John L. Klein ◽

Virginie Meau-Petit

Keyword(s):

Lung Disease ◽

Chronic Lung Disease ◽

Lung Ultrasound ◽

Clinical Laboratory ◽

Control Group ◽

Ventilator Associated Pneumonia ◽

Lung Pathology ◽

Rater Agreement ◽

X Ray ◽

Chest X Ray

AbstractNo consensus exists regarding the definition of ventilator-associated pneumonia (VAP) in neonates and reliability of chest X-ray (CXR) is low. Lung ultrasound (LU) is a potential alternative diagnostic tool. The aim was to define characteristics of VAP in our patient population and propose a multiparameter score, incorporating LU, for VAP diagnosis. Between March 25, 2018, and May 25, 2019, infants with VAP were identified. Clinical, laboratory and microbiology data were collected. CXRs and LU scans were reviewed. A multiparameter VAP score, including LU, was calculated on Day 1 and Day 3 for infants with VAP and for a control group and compared with CXR. VAP incidence was 10.47 episodes/1000 ventilator days. LU and CXR were available for 31 episodes in 21 infants with VAP, and for six episodes in five patients without VAP. On Day 1, a VAP score of > 4, and on Day 3 a score of > 5 showed sensitivity of 0.94, and area under the curve of 0.91 and 0.97, respectively. AUC for clinical information only was 0.88 and for clinical and CXR 0.85.Conclusion: The multiparameter VAP score including LU could be useful in diagnosing VAP in neonates with underlying lung pathology. What is Known:• Ventilator associated pneumonia (VAP) is common in infants on the neonatal unit and is associated with increased use of antibiotics, prolonged ventilation and higher incidence of chronic lung disease.• Commonly used definitions of VAP are difficult to apply in neonates and interpretation of chest X-ray is challenging with poor inter-rater agreement in patients with underlying chronic lung disease. What is New:• The multiparameter VAP score combining clinical, microbiology and lung ultrasound (LU) data is predictive for VAP diagnosis in preterm infants with chronic lung disease.• LU findings of VAP in neonates showed high inter-rater agreement and included consolidated lung areas, dynamic bronchograms and pleural effusion.

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Lung Ultrasound and Clinical Progression of Acute Bronchiolitis: A Prospective Observational Single-Center Study

Medicina ◽

10.3390/medicina56060314 ◽

2020 ◽

Vol 56 (6) ◽

pp. 314

Author(s):

Antonio Di Mauro ◽

Anna Rita Cappiello ◽

Angela Ammirabile ◽

Nicla Abbondanza ◽

Francesco Paolo Bianchi ◽

...

Keyword(s):

Hospital Stay ◽

Oxygen Therapy ◽

Lung Ultrasound ◽

Length Of Hospital Stay ◽

Supplemental Oxygen ◽

Acute Bronchiolitis ◽

Clinical Progression ◽

Single Center Study ◽

Ultrasound Score ◽

Center Study

Background and Objectives: Recent literature suggests that lung ultrasound might have a role in the diagnosis and management of bronchiolitis. The aim of the study is to evaluate the relationship between an ultrasound score and the clinical progression of bronchiolitis: need for supplemental oxygen, duration of oxygen therapy and hospital stay. Materials and Methods: This was a prospective observational single-center study, conducted in a pediatric unit during the 2017–2018 epidemic periods. All consecutive patients admitted with clinical signs of acute bronchiolitis, but without the need for supplemental oxygen, underwent a lung ultrasound in the first 24 h of hospital care. The lung involvement was graded based on the ultrasound score. During clinical progression, need for supplemental oxygen, duration of oxygen therapy and duration of hospital stay were recorded. Results: The final analysis included 83 patients, with a mean age of 4.5 ± 4.1 months. The lung ultrasound score in patients that required supplemental oxygen during hospitalization was 4.5 ± 1.7 (range: 2.0–8.0), different from the one of the not supplemented infants (2.5 ± 1.8; range: 0.0–6.0; p < 0.001). Ultrasound score was associated with the need for supplemental oxygen (OR = 2.2; 95% CI = 1.5–3.3; p < 0.0001). Duration of oxygen therapy was not associated with LUS score (p > 0.05). Length of hospital stay (coef. = 0.5; 95% CI = 0.2–0.7; p < 0.0001) correlates with LUS score. Conclusion: Lung ultrasound score correlates with the need of supplemental oxygen and length of hospital stay in infants with acute bronchiolitis.

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Surveillance arterioveNous fistulAs using ultRasound (SONAR) trial in haemodialysis patients: a study protocol for a multicentre observational study

BMJ Open ◽

10.1136/bmjopen-2019-031210 ◽

2019 ◽

Vol 9 (7) ◽

pp. e031210 ◽

Cited By ~ 1

Author(s):

James Richards ◽

Mohammed Hossain ◽

Dominic Summers ◽

Matthew Slater ◽

Matthew Bartlett ◽

...

Keyword(s):

Observational Study ◽

Venous Catheter ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Patient Acceptability ◽

Arteriovenous Fistulas ◽

Ultrasound Study ◽

Registration Number ◽

Stage Renal Disease ◽

End Stage

IntroductionArteriovenous fistulas (AVFs) are considered the best and safest modality for providing haemodialysis in patients with end-stage renal disease. Only 20% of UK centres achieve the recommended 80% target for achieving dialysis of the prevalent dialysis population via permanent access (as opposed to a central venous catheter). This is partly due to the relatively poor maturation rate of newly created fistulas, with as many as 50% of fistulas failing to mature.The Surveillance Of arterioveNous fistulAe using ultRasound study will examine whether a protocolised programme of Doppler ultrasound (US) surveillance can identify, early after creation, potentially correctable problems in those AVFs that subsequently fail to mature.Methods and analysisThis is a multicentre observational study that will assess newly created AVFs by Doppler US performed at 2, 4, 6 and 10 weeks after creation. The primary outcome measure will be primary fistula patency at week 10. Secondary outcome measures include: successful use of the fistula; clinical suitability for dialysis; creation of new fistula or radiological salvage; fistula thrombosis; secondary fistula patency rate and patient acceptability.Ethics and disseminationThe study has been approved by the Cambridgeshire and Hertfordshire Research Ethics Committee and by the Health Research Authority (REC 18/EE/0234). The results generated from this work will be published as open access, within 3 years of trial commencement. We will also present our findings at key national/international renal meetings, as well as support volunteers at renal patient groups to disseminate the trial outcome.Trial registration numberISRCTN36033877

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