Lung Ultrasound Score, Severity of Acute Lung Disease, and Prolonged Mechanical Ventilation in Children

Abstract

Abstract Rationale Lung ultrasonography (US) may be useful for the prognostication of acute lung disease. Objectives To assess whether the lung US score is associated with the severity of lung disease and may predict prolonged invasive mechanical ventilation (IMV) in critically ill children. Methods Prospective observational multicenter study in children aged 1 month to 18 years who required respiratory support in the ICU. Children with chronic parenchymal lung disease were excluded. The lung US score was obtained at 12 hours and 48–72 hours after admission. Prolonged IMV was defined as at least 7 consecutive days. Correlation of the lung US score with oxygenation as well as its prognostic accuracy for prolonged IMV were investigated. Measurements and Main Results A total of 538 children were included, and 62 (11.5%) required prolonged mechanical ventilation. In these subjects, the lung US score was higher at 12 (median, 24 [IQR, 19–26] vs. 8 [3–14]; P < 0.001) and 48–72 hours (16 [10.5–22.5] vs. 6 [3–11]; P < 0.001). At 12 hours, the lung US score correlated with oxygenation index (R2 = 0.435 [95% CI, 0.293–0.566]; ρ coefficient, −0.705; P < 0.001) and oxygen saturation index (R2 = 0.499 [95% CI, 0.370–0.613]; ρ coefficient, 0.651; P < 0.001). The lung US score at 12 hours had good accuracy in predicting prolonged IMV (area under the receiver operating characteristic curve [AUROC], 0.87; 95% CI, 0.81–0.93), and its use in a multivariable model had excellent accuracy in derivation (AUROC, 0.92; 95% CI, 0.89–0.95) and internal validation (AUROC, 0.91; 95% CI, 0.90–0.92). Conclusions In critically ill children, the lung US score early after admission may predict prolonged IMV.