Special topics in lung ultrasound in children
Authors:
V. Zoľák 1; S. Nosáľ 1; B. Zoľáková 2; M. Fedor 1; M. Janíková 1
Authors‘ workplace:
Klinika detskej anestéziológie a intenzívnej medicíny JLF UK a UNM, Martin
prednosta doc. MUDr. S. Nosáľ, PhD.
1; Neonatologická klinika JLF UK a UNM, Martin
prednosta prof. MUDr. M. Zibolen, PhD.
2
Published in:
Čes-slov Pediat 2015; 70 (5): 259-266.
Category:
Original Papers
Overview
Objective:
Lung ultrasound (LUS) is one of the newest imaging method currently used in diagnostics of respiratory diseases. Simplicity, feasibility and high reliability of LUS designates this method for common clinical practice.
Aims:
To define lung ultrasound specifics for children, comparison of 3 ultrasound probes, definition of physiologic image of lungs in healthy children (“physiologic B lines”), comparison of LUS images in ventilated and non-ventilated children, calculation of sensitivity and specificity for pneumonia, atelectasis, ARDS, bronchiolitis and pleural effusions diagnosed by LUS.
Methods:
135 children included in study, 45 children in research group, 90 children in control group (of them 62 healthy children and 28 critically ill children without respiratory pathology).
Results:
We have not achieved statistical significance in comparison of 10 basic lung signs and artifacts (Pearson`s chi-square test, p=0.1–0.687) between adult and pediatric LUS. By interobserver analysis we found out absolute inadequacy of microconvex array in pediatric LUS (concordance with linear 15.56% and convex 11.76% of cases). In all children from control group only physiological images were obtained, but we were also able to detect literature described “physiologic B-line” in control group (in 38.7% healthy children, and 28.5% in critically ill children without lung pathology). In several children we have detected “physiologic B-line” in more than 1 examined areas. We did not show significant difference in distribution of such a B-lines (p>0.05). In analysis of LUS images in ventilated and non-ventilated patients (examined before and after weaning) we did not determine statistically significant difference p=0.744–1.0. We calculated sensitivity and specificity of LUS in pneumonia (94.74% and 98.04%), bronchiolitis (89.29% and 98.04%), atelectasis (83.33% and 97.09%), lung contusion (91.84% and 98.04%) and pleural effusions (93.1% and 95.24%) in children.
Conclusion:
We manifested the unique role of lung ultrasound in clinical environment in diagnosis of respiratory diseases in children. In comparison with adult medicine several differences and specifics exist for pediatric population.
Key words:
lung ultrasonography, children, respiratory diseases, pneumonia, lung contusion
Sources
1. Barillari A, Fioretti M. Lung ultrasound: a new tool for the emergency physician. Intern Emerg Med 2010; 5: 335–340.
2. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. International Liaison Committee on Lung Ultrasound (ILC-LUS) for International Consensus Conference on Lung Ultrasound (ICC-LUS). Intensive Care Med 2012 Apr; 38 (4): 577–591.
3. Lichtenstein D. Whole Body Ultrasonography in the Critically Ill. 2nd ed. Berlin: Heidelberg: Springer-Verlag, 2010. ISBN: 978-3-642-05327-6.
4. Gargani L, Volpicelli G. How I do it: Lung ultrasound. Cardiovasc Ultrasound 2014 Jul 4; 12: 25.
5. Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children. Radiol Med 2008, 113: 190–198.
6. Lichtenstein DA. Lung ultrasound in the critically ill. Ann Intensive Care 2014; 1: 315–322.
7. Agricola E, et al. ‘Ultrasound comet-tail images’: a marker of pulmonary edema: a comparative study with wedge pressure and extravascular lung water. Chest 2005; 127: 1690–1695.
8. Volpicelli G, Mussa A, Garofalo G. Bedside lung ultrasound in the assessment of alveolar-interstitial syndrome. Am J Emerg Med 2006; 24: 689–696.
9. Tomà P, Owens C. Chest ultrasound in children: critical appraisal. Pediatr Radiol 2013; 43: 1427–1434.
10. Mong A, Epelman M, Darge K. Ultrasound of the pediatric chest. Pediatr Radiol 2012; 42: 1287–1297.
11. Acosta CM, et al. Accuracy of transthoracic lung ultrasound for diagnosing anesthesia-induced atelectasis in children. Anesthesiology 2014 Jun; 120 (6): 1370–1379.
12. Mayo P, Beaulieu Y, Doelken P, et al. American College of Chest Physicians/La Société de Réanimation de Langue Française statement on competence in critical care ultrasonography. Chest 2009; 4: 1050–1060.
13. Riccabona M. Ultrasound of the chest in children (mediastinum excluded). Eur Radiol 2008; 18: 390–399.
14. Via G, Storti E, Gulati G, et al. Lung ultrasound in the ICU: From diagnostic instrument to respiratory monitoring tool. Minerva Anestesiol 2012; 78: 1282–1296.
15. Lichtenstein D, Lascols N, Mezičre G, et al. Ultrasound diagnosis of alveolar consolidation in the critically ill. Intensive Care Med 2004; 30: 276–281.
16. Caiulo VA, Gargani L, Caiulo S, et al. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol 2013; 48: 280–287.
17. Kurian J, Levin TL, Han BK, et al. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol 2009; 193: 1648–1654.
18. Coley BD. Chest sonography in children: Current indications, techniques, and imaging findings. Radiol Clin N Am 2011; 49: 825–846
19. Volpicelli G, Silva F, Radeos M. Real-time lung ultrasound for the diagnosis of alveolar consolidation and interstitial syndrome in the emergency department. Eur J Emerg Med 2010 Apr; 17 (2): 63–72.
20. Yang PC, et al. Value of sonography in determining the nature of pleural effusion: analysis of 320 cases. AJR Am J Roentgenol 1992; 159: 29–33.
21. Vignon P, et al. Quantitative assessment of pleural effusion in critically ill patients by means of ultrasonography. Crit Care Med 2005; 33: 1757–1763.
22. Arberlot CH, Ferrari F, Bouhemad B, et al. Lung ultrasound in acute respiratory distress syndrome and acute lung injury. Cur Opin Crit Care 2008; 14: 70–74..
23. Zechner PM, et al. Lung ultrasound in acute and critical care medicine. Anaesthesist 2012 Jul; 61 (7): 608–617.
24. Gardelli G, et al. Chest ultrasonography in the ICU. Respir Care 2012 May; 57 (5): 773–781.
25. Lichtenstein D. Ultrasound examination of the lungs in the intensive care unit. Pediatr Crit Care Med 2009; 10 (6): 693–698.
26. Noble VE, Nelson BP. Manual of Emergency and Critical Care Ultrasound. 2nd ed. Cambridge: Cambridge University Press, 2011. ISBN 978-0-521-17091-8.
27. Esposito S, Papa SS, Borzani I, et al. Performance of lung ultrasonography in children with community-acquired pneumonia. Ital J Pediatr 2014; 17 (4): 37–40.
28. Caiulo VA, Gargani L, Caiulo S, et al. Lung ultrasound in bronchiolitis: comparison with chest x-ray. Eur J Pediatr 2011; 170: 1427–1433.
Labels
Neonatology Paediatrics General practitioner for children and adolescentsArticle was published in
Czech-Slovak Pediatrics
2015 Issue 5
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