Roychowdhoury Satyabrata, Bhakta Subhajit, Mahapatra Manas Kumar, Ghosh Saptarshi, Saha Sayantika, Konar Mithun Chandra, Sarkar Mihir, Nandi Mousumi
Department of Pediatrics, North Bengal Medical College and Hospital, Siliguri, India.
Department of Pediatrics, Medical College and Hospital, Kolkata, India.
Clin Exp Pediatr. 2022 Jul;65(7):358-366. doi: 10.3345/cep.2021.01655. Epub 2022 May 13.
During the coronavirus disease 2019 (COVID-19) pandemic, lung ultrasonography (US) has been gaining importance in pediatric intensive care and emergency settings for the screening, diagnosis, and monitoring of pulmonary pathology.
To describe the pattern of lung US changes in patients with COVID-19 pneumonia and its potential role in monitoring ventilated patients.
This prospective observational study included children aged 1 month to 12 years with a confirmed diagnosis of COVID-19. Lung US was performed using a high-frequency linear probe (5-12 MHz) in all children with moderate/severe respiratory symptoms within 24 hours of admission and then daily until the patient required oxygen therapy. Lung involvement severity was assessed using lung US scores, while lung aeration improvement or deterioration was measured using lung ultrasound reaeration scores (LUSReS).
Of 85 children with moderate to severe disease, 54 with pulmonary disease were included. Of them, 50 (92.5%) had an interstitial pattern, followed by pleural line abnormalities in 44 (81.5%), reduced or absent lung sliding in 31 (57.4%), and consolidation in 28 (51.8%). A significantly higher lung US score (median, 18; interquartile range [IQR], 11-22) was observed in ventilated versus nonventilated patients (median, 9; IQR, 6-11). LUSReS improvement after positive end-expiratory pressure titration was positively correlated with improved dynamic lung compliance and oxygenation indices and negatively correlated with the requirement for driving pressure. Successful weaning could be predicted with 100% specificity if loss of LUSReS ≤ 5.
Interstitial syndrome, fragmented pleural line, and subpleural microconsolidation were the most prevalent lung US findings in children with COVID-19 pneumonia. Thus, lung US may have the ability to monitor changes in lung aeration caused by mechanical ventilation and predict its successful weaning in children with COVID-19.
在2019冠状病毒病（COVID-19）大流行期间，肺部超声（US）在儿科重症监护和急诊环境中对于肺部病变的筛查、诊断和监测变得越来越重要。
描述COVID-19肺炎患者肺部超声变化的模式及其在监测机械通气患者中的潜在作用。
这项前瞻性观察性研究纳入了确诊为COVID-19的1个月至12岁儿童。在所有有中度/重度呼吸道症状的儿童入院后24小时内，使用高频线性探头（5-12MHz）进行肺部超声检查，然后每天检查一次，直至患者需要氧疗。使用肺部超声评分评估肺部受累严重程度，同时使用肺部超声再通气评分（LUSReS）测量肺部通气改善或恶化情况。
在85例中重度疾病儿童中，54例患有肺部疾病。其中，50例（92.5%）表现为间质模式，其次是44例（81.5%）胸膜线异常，31例（57.4%）肺滑动减少或消失，28例（51.8%）实变。与未接受机械通气的患者相比（中位数为9；四分位间距[IQR]为6-11），接受机械通气的患者肺部超声评分显著更高（中位数为18；IQR为11-22）。呼气末正压滴定后LUSReS改善与动态肺顺应性和氧合指数改善呈正相关，与驱动压需求呈负相关。如果LUSReS降低≤5，则可以100%的特异性预测成功撤机。
间质综合征、胸膜线破碎和胸膜下微实变是COVID-19肺炎儿童中最常见的肺部超声表现。因此，肺部超声可能有能力监测机械通气引起的肺部通气变化，并预测COVID-19儿童患者的成功撤机。
