Taveira M, Yousef N, Miatello J, Roy C, Claude C, Boutillier B, Dubois C, Pierre A-F, Tissières P, Durand P
Service réanimation pédiatrique et néonatale, centre hospitalier universitaire Kremlin-Bicêtre, 78, rue Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
Service réanimation pédiatrique et néonatale, centre hospitalier universitaire Kremlin-Bicêtre, 78, rue Général-Leclerc, 94270 Le Kremlin-Bicêtre, France.
Arch Pediatr. 2018 Feb;25(2):112-117. doi: 10.1016/j.arcped.2017.11.005. Epub 2017 Dec 13.
Lung ultrasound (LU) is a bedside point-of-care technique in critical care and emergency medicine. LU is quick and non-irradiating, and provides accurate diagnostic information when compared with chest radiographs. Specific LU signs have been described for bronchiolitis. This study aimed to evaluate the correlation between severity of LU-diagnosed lung lesions, using a quantitative LU score, and the length of non-invasive ventilation (LOV) for infants diagnosed with severe viral bronchiolitis.
This was a prospective observational single-center study conducted at a level 3 pediatric intensive care unit. A LU score was calculated for 47 infants under 6 months of age with severe acute viral bronchiolitis during the 2015-2016 epidemic, and the number of intercostal spaces with consolidation or interstitial syndrome was counted for each lung. The LU score is based on the presence of A lines or B-line artifacts and consolidation (0-2 points). The modified Wood score (mWCAS) was used to define clinical severity. Other parameters such as gestational age at birth, age, supplemental oxygen (LOS), and length of stay were recorded. All LU scans were later reviewed by two trained ultrasonographers to assess the score's inter-rater reproducibility.
The LU score on admission (3.5±2.6) did not correlate with LOV (69±68.6), mWCAS score (4±1.6), LOS (3±3.4), or length of stay (4±3.4). However, there was a significant correlation between the number of affected intercostal spaces on the right and LOS (Spearman's Rho 0.318; P=0.037).
This is the first study to evaluate the use of LU in infants needing PICU admission for severe acute bronchiolitis. The LU score does not correlate with LOV, mWCAS, LOS, or length of stay, but the number of pathological intercostal spaces on the right side correlates significantly with LOS. Although LU scores have been validated for the newborn and the adult, this has been in the setting of restrictive lung diseases. Bronchiolitis is a predominantly obstructive lung disease and this may explain the lack of performance observed.
肺部超声（LU）是重症监护和急诊医学中的一种床旁即时护理技术。肺部超声检查快速且无辐射，与胸部X光片相比，能提供准确的诊断信息。针对细支气管炎已有特定的肺部超声征象描述。本研究旨在评估使用定量肺部超声评分诊断的肺部病变严重程度与确诊为重症病毒性细支气管炎的婴儿无创通气时长（LOV）之间的相关性。
这是一项在三级儿科重症监护病房进行的前瞻性观察性单中心研究。对2015 - 2016年流行期间47例6个月以下患有严重急性病毒性细支气管炎的婴儿计算肺部超声评分，并统计每个肺叶出现实变或间质综合征的肋间间隙数量。肺部超声评分基于A线或B线伪像及实变情况（0 - 2分）。采用改良伍德评分（mWCAS）来定义临床严重程度。记录其他参数，如出生时的胎龄、年龄、吸氧情况（LOS）和住院时长。所有肺部超声扫描结果随后由两名经过培训的超声检查人员复查，以评估评分者间的可重复性。
入院时的肺部超声评分（3.5±2.6）与无创通气时长（69±68.6）、改良伍德评分（mWCAS）（4±1.6）、吸氧情况（3±3.4）或住院时长（4±3.4）均无相关性。然而，右侧受影响的肋间间隙数量与住院时长之间存在显著相关性（斯皮尔曼等级相关系数0.318；P = 0.037）。
这是第一项评估肺部超声在因严重急性细支气管炎需入住儿科重症监护病房的婴儿中的应用的研究。肺部超声评分与无创通气时长、改良伍德评分、吸氧情况或住院时长均无相关性，但右侧病理性肋间间隙数量与住院时长显著相关。尽管肺部超声评分已在新生儿和成人的限制性肺病中得到验证，但细支气管炎主要是一种阻塞性肺病，这可能解释了所观察到的该评分表现不佳的原因。
