Lung Ultrasound Score, Severity of Acute Lung Disease, and Prolonged Mechanical Ventilation in Children

<b>Rationale:</b> Lung ultrasonography (US) may be useful for the prognostication of acute lung disease. <b>Objectives:</b> To assess whether the lung US score is associated with the severity of lung disease and may predict prolonged invasive mechanical ventilation (IMV) in critically ill children. <b>Methods:</b> Prospective observational multicenter study in children aged 1 month to 18 years who required respiratory support in the ICU. Children with chronic parenchymal lung disease were excluded. The lung US score was obtained at 12 hours and 48-72 hours after admission. Prolonged IMV was defined as at least 7 consecutive days. Correlation of the lung US score with oxygenation as well as its prognostic accuracy for prolonged IMV were investigated. <b>Measurements and Main Results:</b> A total of 538 children were included, and 62 (11.5%) required prolonged mechanical ventilation. In these subjects, the lung US score was higher at 12 (median, 24 [IQR, 19-26] vs. 8 [3-14]; <i>P</i> < 0.001) and 48-72 hours (16 [10.5-22.5] vs. 6 [3-11]; <i>P</i> < 0.001). At 12 hours, the lung US score correlated with oxygenation index (<i>R</i><sup>2</sup> = 0.435 [95% CI, 0.293-0.566]; ρ coefficient, -0.705; <i>P</i> < 0.001) and oxygen saturation index (<i>R</i><sup>2</sup> = 0.499 [95% CI, 0.370-0.613]; ρ coefficient, 0.651; <i>P</i> < 0.001). The lung US score at 12 hours had good accuracy in predicting prolonged IMV (area under the receiver operating characteristic curve [AUROC], 0.87; 95% CI, 0.81-0.93), and its use in a multivariable model had excellent accuracy in derivation (AUROC, 0.92; 95% CI, 0.89-0.95) and internal validation (AUROC, 0.91; 95% CI, 0.90-0.92). <b>Conclusions:</b> In critically ill children, the lung US score early after admission may predict prolonged IMV.

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Journal
American Journal of Respiratory and Critical Care Medicine
Published
2024-10-17
DOI
https://doi.org/10.1164/rccm.202404-0843oc
Citations
11
Primary Topic
Ultrasound in Clinical Applications
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article
Field-Weighted Citation Impact
4.64
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article

Lung Ultrasound Score, Severity of Acute Lung Disease, and Prolonged Mechanical Ventilation in Children

María Sánchez-Porras, Lorena Bermúdez Barrezueta, Patricia Rodríguez‐Campoy, S. Sanchiz-Cárdenas et al.
11 citations
American Journal of Respiratory and Critical Care Medicine
Ultrasound in Clinical Applications
4.64
article

Lung Ultrasound Score, Severity of Acute Lung Disease, and Prolonged Mechanical Ventilation in Children

María Sánchez-Porras, Lorena Bermúdez Barrezueta, Patricia Rodríguez‐Campoy, S. Sanchiz-Cárdenas, Almudena Alonso‐Ojembarrena, Javier Rodríguez‐Fanjul, Juan Mayordomo‐Colunga, Juan Valencia-Ramos, Javier Gil-Antón, I Sánchez-Martínez, Daniel Palanca-Arias, Ignacio Oulego‐Erroz, Rafael González, María Ángeles Murillo-Pozo, Pilar Sánchez-Yáñez, Manuel Rodríguez-Martínez, Antonio Rodrı́guez-Núñez, Olivia Pérez-Quevedo, Ana Vivanco-Allende, Jorge López-González, Andrea Fernández-de la Ballina, Nuria Chaves-Caro, Raúl Borrego-Domínguez, Pedro José Carballo-Martín, María del Pilar De Castro-Vecino, Laia Vega-Puyal, Marta Muñoyerro-Sesmero, Luisa Barón-González de Suso, Úrsula Quesada-Ortega
article en
11 citations

Abstract

<b>Rationale:</b> Lung ultrasonography (US) may be useful for the prognostication of acute lung disease. <b>Objectives:</b> To assess whether the lung US score is associated with the severity of lung disease and may predict prolonged invasive mechanical ventilation (IMV) in critically ill children. <b>Methods:</b> Prospective observational multicenter study in children aged 1 month to 18 years who required respiratory support in the ICU. Children with chronic parenchymal lung disease were excluded. The lung US score was obtained at 12 hours and 48-72 hours after admission. Prolonged IMV was defined as at least 7 consecutive days. Correlation of the lung US score with oxygenation as well as its prognostic accuracy for prolonged IMV were investigated. <b>Measurements and Main Results:</b> A total of 538 children were included, and 62 (11.5%) required prolonged mechanical ventilation. In these subjects, the lung US score was higher at 12 (median, 24 [IQR, 19-26] vs. 8 [3-14]; <i>P</i> < 0.001) and 48-72 hours (16 [10.5-22.5] vs. 6 [3-11]; <i>P</i> < 0.001). At 12 hours, the lung US score correlated with oxygenation index (<i>R</i><sup>2</sup> = 0.435 [95% CI, 0.293-0.566]; ρ coefficient, -0.705; <i>P</i> < 0.001) and oxygen saturation index (<i>R</i><sup>2</sup> = 0.499 [95% CI, 0.370-0.613]; ρ coefficient, 0.651; <i>P</i> < 0.001). The lung US score at 12 hours had good accuracy in predicting prolonged IMV (area under the receiver operating characteristic curve [AUROC], 0.87; 95% CI, 0.81-0.93), and its use in a multivariable model had excellent accuracy in derivation (AUROC, 0.92; 95% CI, 0.89-0.95) and internal validation (AUROC, 0.91; 95% CI, 0.90-0.92). <b>Conclusions:</b> In critically ill children, the lung US score early after admission may predict prolonged IMV.

American Journal of Respiratory and Critical Care MedicineVol. 211(1)
Universitat Autònoma de Barcelona (ES), Universidad de Zaragoza (ES), Hospital Universitario Insular de Gran Canaria (ES), Hospital Universitario La Paz (ES), Instituto de Salud Carlos III (ES), Hospital de Sant Pau (ES), Hospital General Universitario Gregorio Marañón (ES), Hospital Universitario Nuestra Señora de Candelaria (ES), BioCruces Health research Institute (ES), Hospital Universitario Dexeus (ES), Complejo Hospitalario Universitario de Santiago (ES), Complejo Hospitalario de Navarra (ES), Complejo Hospitalario de Salamanca (ES), Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (ES), Biogipuzkoa Health Research Institute (ES), Hospital Universitario 12 De Octubre (ES), Hospital Regional Universitario de Málaga (ES), Hospital Virgen de la Salud (ES), Hospital Universitario Miguel Servet (ES), Hospital Universitario de Burgos (ES), Biomedical Research and Innovation Institute of Cadiz (ES), Hospital Materno-Infantil (ES), USP Institut Universitari Dexeus (ES), Hospital Universitario Central de Asturias (ES), Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol (ES), Hospital de Cruces (ES), Donostiako Unibertsitate Ospitalea (ES), Comunidad de Madrid (ES), Complexo Hospitalario Universitario A Coruña (ES), Hospital Universitario Puerta del Mar (ES), Instituto de Investigación Sanitaria de Santiago (ES), Hospital Universitario Virgen de la Arrixaca (ES), Hospital Universitario Son Espases (ES), Hospital Universitario Virgen del Rocío (ES), Hospital Universitari Germans Trias i Pujol (ES), Hospital Clínico Universitario de Valladolid (ES), Hospital Universitario Ramón y Cajal (ES), Complejo Hospitalario Universitario de Toledo (ES), Complejo Asistencial Universitario de Palencia (ES), Instituto de Investigación Sanitaria del Principado de Asturias (ES), Hospital Universitario de Toledo (ES), Universidad de Burgos (ES), Universidad de Málaga (ES), Universidad de Navarra (ES), Universidad de León (ES)
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Openalex Percentile: Top 5%
Ultrasound in Clinical Applications
4.64
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