Christie Glau, MD
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
.jpg "Thomas Conlon, MD photo")
Thomas Conlon, MD
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Garrett Keim, MD (he/him/his)
Children's Hospital of Philadelphia
Philadelphia, Pennsylvania
Disclosure information not submitted.
Akira Nishisaki, MD, MSCE
Associate Professor of Anesthesia and Critical Care Medicine
The Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Adam Himebauch, MD
Assistant Professor of Anesthesiology and Critical Care Medicine
The Children's Hospital of Philadelphia
Philadelphia, Pennsylvania, United States
Disclosure information not submitted.
Title:Lung ultrasound score in pediatric acute respiratory failure with and without LRTIs
Introduction/Hypothesis: Lung ultrasound (LUS) score has been utilized to quantify regional lung disease in pediatric acute respiratory illness. In critically ill patients with acute respiratory failure, we hypothesized that the LUS score would be higher in those with lower respiratory tract infection (LRTI) compared to those without LRTI and that LUS score inter-rater agreement would be high.
Methods: This was a prospective study of children ( > 1 month to < 18 years) admitted to pediatric intensive care unit requiring new high flow nasal cannula, non-invasive or invasive positive pressure ventilation. Subjects were stratified into those with and without LRTI. For both groups a protocolized LUS was performed between 0-24 hours of admission. For the LRTI group, a second LUS was performed 12-36 hours following the first. Two raters blinded to patient clinical information determined LUS scores: images were scored between 0 to 3 (0 = normal, 3= least aerated) for a total of 12 regions. Nonparametric descriptive and comparative statistics were calculated. Intraclass correlation coefficient (ICC) was calculated for inter-rater agreement.
Results: There were 14 children in the LRTI group and 10 children in the non-LRTI group who completed the study procedures. Median age was 1.4 years old (IQR: 0.5-10.3). The first LUS was performed at a median 11.8 hours (IQR 8.4-16.6). Respiratory support for the LRTI group at first LUS was HFNC (n=2), CPAP (n=3), BPAP (n=6) and conventional invasive mechanical ventilation (n=3) while all subjects in the non-LRTI group were on conventional invasive mechanical ventilation. Median time 1 LUS score was 2 (IQR 1-4) in LRTI and 1 (IQR 0-2) in control (p=0.092). Respiratory support was discontinued in 9 children with LRTI (64.3%) between time 1 and time 2 LUS. The second LUS was performed at a median 25.2 hours (IQR 22.6-27.8) following the first LUS in the LRTI group with no change in the median LUS score of 2 (IQR 1-4, p=0.976). There was excellent inter-rater agreement with ICC = 0.98 (95% CI 0.91-0.99, p< 0.001) between 2 blinded raters.
Conclusions: LUS score was low in critically ill patients with and without LRTI. The majority of children with LRTI had clinical improvement with unchanged LUS score over 24 hours. Inter-rater agreement for LUS score was excellent.