Lung ultrasound to detect cardiopulmonary interactions in acutely ill children

Danilo Buonsenso, Cristina De Rose, Valentina Ferro, Rosa Morello, Annamaria Musolino, Piero Valentini

Research output: Contribution to journalArticlepeer-review

Abstract

Objective and design Our prospective observational study is the first study that evaluates the lung ultrasound (LUS) findings of cardiopulmonary interactions in acutely ill children with elevated pro-brain natriuretic peptide (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 subcategories 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 nonconfluent B-lines/long vertical artifacts 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.
Original languageEnglish
Pages (from-to)483-497
Number of pages15
JournalPediatric Pulmonology
Volume57
DOIs
Publication statusPublished - 2022

Keywords

  • Child
  • Humans
  • Infant
  • Lung
  • Lung Diseases
  • Pleura
  • Pulmonary Edema
  • Ultrasonography
  • acutely ill children
  • cardiopulmonary interactions
  • children
  • lung ultrasound
  • pro-BNP

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