Thoracic Ultrasound in Pediatric Intensive Care: A Valuable Tool for Children with Acute Bronchiolitis
DOI:
https://doi.org/10.20344/amp.24309Keywords:
Bronchiolitis/diagnostic imaging, Child, Intensive Care Units, Pediatric, Lung/diagnostic imaging, UltrasonographyAbstract
Introduction: Available scoring systems for managing acute bronchiolitis lack accuracy in predicting severity and prognosis. Thoracic ultrasound may help fill this gap. This study evaluated changes in thoracic ultrasound parameters in children with acute bronchiolitis and their association with disease severity. Diaphragmatic ultrasound parameters were also compared between patients with and without invasive mechanical ventilation.
Methods: A prospective observational study included children under 24 months admitted to a Pediatric Intensive Care Unit with acute bronchiolitis. Thoracic ultrasound assessed lung ultrasound score (LUS), diaphragmatic excursion (DE), diaphragmatic thickness (DT), and thickening fraction (DTf) on days one, three, and five. Clinical severity was assessed using the Bronchiolitis Score of Sant Joan de Déu (BROSJOD) and other indicators.
Results: Twenty-six patients were enrolled. Lung ultrasound score decreased over time, while DE and DTf increased. On day one, LUS, DE, and DT positively correlated with BROSJOD (rs = 0.586, p = 0.005; rs = 0.599, p = 0.004; rs = 0.534, p = 0.013, respectively); DTf showed an inverse correlation (rs = -0.439, p = 0.047). By day five, only LUS remained significantly associated. LUS and DTf on day one varied with the fraction of inspired oxygen (FiO2) requirements. Lung ultrasound score on day one had an area under the curve of 0.806 for predicting FiO2 ≥ 50%, with a cut-off of 8.5 (sensitivity 63.6%, specificity 93.3%). Lower DT and DTf were consistently seen in patients requiring invasive mechanical ventilation (p < 0.05).
Conclusion: Lung ultrasound score and DTf correlated with disease severity from the first day in the Pediatric Intensive Care Unit, indicating their potential as early markers of disease worsening. Lower DT and DTf may suggest severe disease and the need for ventilatory support escalation. Thoracic ultrasound is a promising, non-invasive tool for monitoring children with acute bronchiolitis.
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Guarnieri V, Palmas G, Trapani S, Mollo A, Macucci C, Gambini I, et al. Exploring risk factors associated with intensive care unit admission in a retrospective cohort of 631 children with bronchiolitis. Pediatr Pulmonol. 2025;60: e27394. DOI: https://doi.org/10.1002/ppul.27394
Osman S, Alaa Adeen A, Hetta O, Alsiraihi A, Bader M, Aloufi A, et al. Epidemiology and risk factor analysis of children with bronchiolitis admitted to the intensive care unit at a tertiary care center in Saudi Arabia. Children. 2023;10:646. DOI: https://doi.org/10.3390/children10040646
Direção-Geral da Saúde. Diagnóstico e tratamento da bronquiolite aguda em idade pediátrica: Norma da DGS n.º 015/2015. Lisboa: DGS; 2015.
Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, et al. Update – 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr. 2023;49:11. DOI: https://doi.org/10.1186/s13052-022-01392-6
Serviço de Urgência Pediátrica do Hospital Pediátrico de Coimbra. Bronquiolite aguda: protocolo de abordagem e atuação. Coimbra: HPC; 2021.
Dunn JM, Zorc L, Tyler E, Pete DL, McAndrew K, Leach L. Pathway for evaluation and treatment of children with bronchiolitis. Philadelphia: Children’s Hospital of Philadelphia; 2023.
Bobillo-Perez S, Sorribes C, Gebellí P, Lledó N, Castilla M, Ramon M, et al. Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study). Eur J Pediatr . 2021;180:3509–17. DOI: https://doi.org/10.1007/s00431-021-03978-4
Granda E, Urbano M, Andrés P, Corchete M, Cano A, Velasco R. Comparison of severity scales for acute bronchiolitis in real clinical practice. Eur J Pediatr. 2023;182:1619–26. DOI: https://doi.org/10.1007/s00431-023-04840-5
Krishna D, Khera D, Toteja N, Sureka B, Choudhary B, Ganakumar VM, et al. Point-of-care thoracic ultrasound in children with bronchiolitis. Indian J Pediatr. 2022;89:1079–85. DOI: https://doi.org/10.1007/s12098-022-04117-z
Smith JA, Stone BS, Shin J, Yen K, Reisch J, Fernandes N, et al. Association of outcomes in point-of-care lung ultrasound for bronchiolitis in the pediatric emergency department. Am J Emerg Med. 2024;75:22–8. DOI: https://doi.org/10.1016/j.ajem.2023.10.019
Supino MC, Buonsenso D, Scateni S, Scialanga B, Mesturino MA, Bock C, et al. Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur J Pediatr. 2019;178:623–32. DOI: https://doi.org/10.1007/s00431-019-03335-6
La Regina DP, Bloise S, Pepino D, Iovine E, Laudisa M, Cristiani L, et al. Lung ultrasound in bronchiolitis. Pediatr Pulmonol. 2021;56:234–9. DOI: https://doi.org/10.1002/ppul.25156
Di Mauro A, Cappiello AR, Ammirabile A, Abbondanza N, Bianchi FP, Tafuri S, et al. Lung ultrasound and clinical progression of acute bronchiolitis: a prospective observational single-center study. Medicina (Kaunas). 2020;56:314. DOI: https://doi.org/10.3390/medicina56060314
Hernández-Villarroel AC, Ruiz-García A, Manzanaro C, Echevarría-Zubero R, Bote-Gascón P, Gonzalez-Bertolin I, et al. Lung ultrasound: a useful prognostic tool in the management of bronchiolitis in the emergency department. J Pers Med. 2023;13:1624. DOI: https://doi.org/10.3390/jpm13121624
Musolino AM, Tomà P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, et al. Ten years of pediatric lung ultrasound: a narrative review. Front Physiol. 2022;12:721951. DOI: https://doi.org/10.3389/fphys.2021.721951
Kogias C, Prountzos S, Alexopoulou E, Douros K. Lung ultrasound systematic review shows its prognostic and diagnostic role in acute viral bronchiolitis. Acta Paediatr. 2023;112:222–32. DOI: https://doi.org/10.1111/apa.16578
Di Mauro A, Ammirabile A, Quercia M, Panza R, Capozza M, Manzionna MM, et al. Acute bronchiolitis: is there a role for lung ultrasound? Diagnostics. 2019;9:40. DOI: https://doi.org/10.3390/diagnostics9040172
Şık N, Çitlenbik H, Öztürk A, Yılmaz D, Duman M. Point-of-care diaphragm ultrasound in acute bronchiolitis: a measurable tool to predict the clinical, sonographic severity of the disease, and outcomes. Pediatr Pulmonol. 2021;56:1053–9. DOI: https://doi.org/10.1002/ppul.25268
Buonsenso D, Supino MC, Giglioni E, Battaglia M, Mesturino A, Scateni S, et al. Point-of-care diaphragm ultrasound in infants with bronchiolitis: a prospective study. Pediatr Pulmonol. 2018;53:778–86. DOI: https://doi.org/10.1002/ppul.23993
Gómez-Zamora A, Rodriguez-Álvarez D, Durán-Lorenzo I, Schüffelmann C, Rodríguez-Rubio M, Martinez-Romillo PD. Diaphragm ultrasonography to predict noninvasive respiratory treatment failure in infants with severe bronchiolitis. Respir Care. 2022;67:455–63. DOI: https://doi.org/10.4187/respcare.09414
Lieberthal AS, Bauchner H, Hall CB, Johnson DW, Kotagal U, Light MJ, et al. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118:1774–93. DOI: https://doi.org/10.1542/peds.2006-2223
Balaguer M, Alejandre C, Vila D, Esteban E, Carrasco JL, Cambra FJ, et al. Bronchiolitis score of Sant Joan de Déu (BROSJOD): validation and usefulness. Pediatr Pulmonol. 2017;52:533–9. DOI: https://doi.org/10.1002/ppul.23546
Brat R, Yousef N, Klifa R, Reynaud S, Shankar AS, De Luca D. Lung ultrasonography score to evaluate oxygenation and surfactant need in neonates treated with continuous positive airway pressure. JAMA Pediatr. 2015;169:e151797. DOI: https://doi.org/10.1001/jamapediatrics.2015.1797
Dionísio MT, Rebelo A, Pinto C, Carvalho L, Neves JF. Ultrasound assessment of ventilator-induced diaphragmatic dysfunction in paediatrics. Acta Med Port. 2019;32:520–8.
Hendin A, Koenig S, Millington SJ. Better with ultrasound: thoracic ultrasound. Chest. 2020;158:2082–9. DOI: https://doi.org/10.1016/j.chest.2020.04.052
Basile V, Di Mauro A, Scalini E, Comes P, Lofù I, Mostert M, et al. Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr. 2015;15:63. DOI: https://doi.org/10.1186/s12887-015-0380-1
Thabet F, Zayani S, Haddad N, Daya A, Nasrallah CB, Chouchane S. Prognostic role of lung-ultrasound score in acute bronchiolitis patients treated with high flow nasal cannula: a prospective study. Pediatr Pulmonol. 2025;60: e27432. DOI: https://doi.org/10.1002/ppul.27432
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