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Observational Study
. 2022 Dec;25(4):929-937.
doi: 10.1007/s40477-022-00675-2. Epub 2022 Apr 10.

Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure

Ryan L DeSanti  1   2 , Eileen A Cowan  3 , Pierre D Kory  4 , Michael R Lasarev  5 , Jessica Schmidt  6 , Awni M Al-Subu  3
Affiliations
Observational Study

Lung Ultrasound Artifact Findings in Pediatric Patients Admitted to the Intensive Care Unit for Acute Respiratory Failure

Ryan L DeSanti et al. J Ultrasound. 2022 Dec.

Abstract

Purpose: To describe point-of-care lung ultrasound (POC-LUS) artifact findings in children admitted to the pediatric intensive care unit (PICU) for acute respiratory failure (ARF).

Methods: This is a secondary analysis of a prospective observational study completed in a 21-bed PICU. Children > 37 weeks gestational age and ≤ 18 years were enrolled from December 2018 to February 2020. POC-LUS was completed and interpreted by separate physicians blinded to all clinical information. POC-LUS was evaluated for the presence of lung sliding, pleural line characteristics, ultrasound artifacts, and the ultrasound diagnosis.

Results: Eighty-seven subjects were included. A-lines were the most frequent artifact, occurring in 58% of lung zones (163/281) in those with bronchiolitis, 39% of lung zones (64/164) in those with pneumonia, and 81% of lung zones (48/59) in those with status asthmaticus. Sub-pleural consolidation was second most common, occurring in 28% (80/281), 30% (50/164), and 12% (7/59) of those with bronchiolitis, pneumonia, and status asthmaticus, respectively. The pattern a priori defined as bronchiolitis, pneumonia, and status asthmaticus was demonstrated in 31% (15/48), 10% (3/29), and 40% (4/10) of subjects with bronchiolitis, pneumonia, and status asthmaticus, respectively.

Conclusion: We found significant heterogeneity and overlap of POC-LUS artifacts across the most common etiologies of ARF in children admitted to the PICU. We have described the POC-LUS artifact findings in pediatric ARF to support clinicians using POC-LUS and to guide future pediatric POC-LUS studies. Determining the optimal role of POC-LUS as an adjunct in the care of pediatric patients requires further study.

Keywords: Acute respiratory failure; Critical care; Diagnostic imaging; Lung ultrasound; Pediatrics; Point-of-care ultrasound.

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Conflict of interest statement

Dr. Al-Subu has a consulting agreement with Edwards Lifesciences LLC. The remaining authors have declared no conflicts of interest related to this work.

Figures

Fig. 1
Fig. 1
Lung ultrasound scanning locations. Anterior zone located between the anterior axillary line and sternum, lateral zone between the anterior and posterior axillary lines, and posterior zone between the posterior axillary line and spine
Fig. 2
Fig. 2
Ultrasound artifact examples. Video examples of ultrasound artifacts in the online supplement
See this image and copyright information in PMC

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