Lung Ultrasound Score and Pediatric Intensive Care Outcomes (LUS-PICO)
Condition: Lung Injury; Extravascular Lung Water; Pulmonary Edema; Acute Respiratory Distress Syndrome; Shock
MeSH terms: Respiratory Distress Syndrome; Respiratory Distress Syndrome, Newborn; Acute Lung Injury; Lung Injury; Pulmonary Edema
Study type: Observational [Patient Registry]

Summary: 
      Bedside lung ultrasonography helps to obtain reliable clinical information about lung
      aeration, that has been categorized by means of the so-called lung ultrasound score (LUS). In
      critically ill adults, LUS has been related with the outcome both in patients with
      respiratory and some non-respiratory conditions. Pediatric studies about lung aeration have
      been done mainly on postoperative cardiac patients and infants with bronchiolitis. In this
      prospective, observational, multicenter, feasibility and diagnostic accuracy study, we will
      explore the degree of lung aeration impairment as a potential outcome predictor in critically
      ill children with a variety of underlying conditions. Children from 1 month to 18 years of
      age admitted to PICU will be recruited and LUS will be calculated at two time points: at 12 ±
      6 hours and at 48-72 hours. Univariate and multivariate statistical analysis will be
      performed in order to ascertain the outcome influence of clinical factors in general and LUS
      in particular.
    

Detailed description: 
      Lung aeration can be assessed at the bedside by means of lung ultrasound, a non-invasive,
      quick, simple, and reproducible technique. It provides semiquantitative information about the
      amount of extravascular lung water (EVLW), which correlates with lung aeration. Accumulation
      of EVLW occurs secondarily to acute lung injury due to infection, inflammation or fluid
      overload. Lung aeration, measured by the lung ultrasound score (LUS), has been associated to
      patients' outcome in several studies in adult patients, suggesting that critically ill
      subjects showing higher degree of aeration loss have a worse outcome. This fact has been
      shown not only in patients with baseline respiratory conditions (for example in severe acute
      respiratory syndrome coronavirus 2), but also in adults with non-respiratory conditions, such
      as shock and in high-risk postoperative patients. Furthermore, animal studies have suggested
      that information obtained through lung ultrasonography may precede clinical signs and could
      help anticipate focused treatment.

      To date, pediatric studies addressing the potential relationship between LUS and the outcome
      of critically ill children are scarce and limited to postoperative cardiac patients and
      infants with bronchiolitis.

      In our research, children from 1 month to 18 years of age admitted to pediatric intensive
      care unit (PICU) who fulfill inclusion criteria will be recruited and will undergo point of
      care lung ultrasound examination at 12 ± 6 hours and at 48-72 hours from admission. Clinical
      data will be recorded and LUS will be calculated. The main objective of our study is to
      assess the potential role of LUS (as a semiquantitative indicator or lung aeration) as a
      feasible and reliable outcome prediction tool in children admitted to PICU. Secondary
      objectives will include to analyze the correlations between LUS and the need and length of
      ventilatory support, inflammatory and cardiac markers, hydric balance, renal replacement
      therapies requirement, and validated prognostic scales, as well as age, underlying disease,
      co-morbidities, length-of-stay, and other clinical characteristics of included children.

      Patients with acute respiratory distress syndrome (ARDS) or shock during PICU admission time
      will also undergo additional lung ultrasound examinations at 12 ± 6 hours and at 48-72 hours
      from ARDS or shock diagnosis, as these subgroups represent a very specific and severe cohort
      of patients, which merits further analysis.
    

Intervention name(s): Bedside lung ultrasound examination
Intervention type(s): Diagnostic Test
Intervention description(s): Lung ultrasound exploring 12 areas (6 in each lung) at 12 +/- 6 hours and at 48-72 hours from PICU admission. Clinical and analytical data collection coinciding with ultrasound imaging and during follow-up while admitted to PICU.
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Children 1 month to 18 years-old admitted to PICU due to an acute condition