Pediatric Department, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Department of Preventive and Epidemiology Medicine, Fattouma Bourguiba University Hospital, Monastir, Tunisia.
Eur J Pediatr. 2024 Oct;183(10):4379-4384. doi: 10.1007/s00431-024-05710-4. Epub 2024 Aug 3.
Lung imaging techniques are crucial for managing ventilated patients in pediatric intensive care units (PICUs). Bedside chest x-ray has limitations such as low sensitivity and radiation exposure risks. Recently, lung ultrasound has emerged as a promising technology offering advantages such as real-time monitoring and radiation-free imaging. However, the integration of lung ultrasound into clinical practice raises questions about its impact on chest x-ray prescriptions. This study aims to assess whether implementing lung ultrasound reduces reliance on chest x-rays for ventilated pediatric patients in the PICU. This before-and-after uncontrolled quality improvement project was conducted from January 2022 to December 2023 in a referral PICU. The study included three phases: retrospective evaluation, learning phase, and prospective evaluation. Patients aged under 14 years, intubated, and ventilated for ≤ 30 days were included. Lung ultrasound was performed using a standardized protocol, and chest x-rays were conducted as per clinical indications. During the study period, 430 patients were admitted to the PICU, with 142 requiring mechanical ventilation. Implementation of routine bedside lung ultrasound led to a 39% reduction in chest x-ray requests (p < 0.001). Additionally, there was a significant decrease in irradiation exposure and a 27% reduction in costs associated with chest x-rays.Conclusion: Routine bedside lung ultrasound is a valuable tool in the modern PICU, it reduces the number of chest x-rays, with reduced radiation exposure and a potential cost savings. What is known: • Bedside chest x-ray is the main imaging study in ventilated pediatric patients • Chest x-ray is a valuable tool in pediatric critical care but it is associated with irradiation exposure What is new: • Implementation of bedside lung ultrasound in pediatric critical care unites reduces the chest x-rays requests and therefore patient-irradiation.
肺部影像学技术对于管理儿科重症监护病房（PICU）中的机械通气患者至关重要。床边胸部 X 光检查具有敏感性低和辐射暴露风险等局限性。最近，肺部超声作为一种有前途的技术出现，具有实时监测和无辐射成像等优势。然而，将肺部超声纳入临床实践引发了对其对胸部 X 光检查处方影响的疑问。本研究旨在评估在 PICU 中对机械通气的儿科患者实施肺部超声是否可以减少对胸部 X 光检查的依赖。这是一项在 2022 年 1 月至 2023 年 12 月期间在一家转诊 PICU 进行的前后对照、无对照的质量改进项目。该研究包括三个阶段：回顾性评估、学习阶段和前瞻性评估。纳入年龄在 14 岁以下、插管和通气时间不超过 30 天的患者。使用标准化协议进行肺部超声检查，根据临床指征进行胸部 X 光检查。在研究期间，共有 430 名患者入住 PICU，其中 142 名需要机械通气。常规床边肺部超声的实施使胸部 X 射线请求减少了 39%（p<0.001）。此外，照射暴露量显著降低，胸部 X 射线相关成本降低了 27%。结论：常规床边肺部超声是现代 PICU 中的一种有价值的工具，它可以减少胸部 X 射线的数量，降低辐射暴露，并有潜在的成本节约。已知：• 床边胸部 X 光检查是机械通气的儿科患者的主要影像学研究• 胸部 X 光检查在儿科重症监护中是一种有价值的工具，但它与照射暴露有关新发现：• 在儿科重症监护中实施床边肺部超声可以减少胸部 X 射线检查的需求，从而减少患者的照射。
