Paediatric Surgery (Ukraine).2023.1(78): 42-49; doi 10.15574/PS.2023.78.42
Baryska I. O.¹, Hitryi G. P.¹, Levchenko T. M.¹, Yaroslavska S. M.², Ladonko O. V.³, Prytula V. P.^2,4
1Ukrainian Military Medical Academy, Kyiv, Ukraine
²Bogomolets National Medical University of Ukraine, Kyiv
³Shupyk National Healthcare University of Ukraine, Kyiv
⁴National Specialized Children’s Hospital «OKHMATDYT», Kyiv, Ukraine
⁵Ivano-Frankivsk National Medical University, Ukraine

For citation: Baryska IO, Hitryi GP, Levchenko TM, Yaroslavska SM, Ladonko OV, Prytula VP. (2023). Сlinical experience of using a standardized national lung ultrasound protocol in children for screening examinations. Paediatric Surgery (Ukraine). 1(78): 42-49; doi 10.15574/PS.2023.78.42.
Article received: Dec 07, 2022. Accepted for publication: Mar 14, 2023.

The article highlights the use of ultrasound diagnostics (US) of the lungs for screening examination of paediatric patients, as it allows for a quick differential diagnosis, a comprehensive assessment of the course of the disease, especially in doubtful cases, a reduction in the time required for examination of patients, and timely adjustment of treatment. Screening ultrasound, combined with physical examination methods, is a kind of «sonographic stethoscope», the use of which simplifies, shortens and improves the diagnostic process and the choice of treatment tactics.
Purpose – to prove the feasibility of using a standardised lung ultrasound protocol for screening paediatric patients with symptoms of respiratory system disorders in outpatient and day hospital settings.
Materials and methods. The study involved 137 patients aged 4 months to 12 years old. The data of clinical picture, physical and laboratory examinations, computed tomography and lung radiography, semiotics of lung lesions were analysed. For the study, we used stationary ultrasound devices of high and expert class «Samsung» (South Korea), «Mindray» (China), «GE» (USA), which are equipped at the Kinder Clinic, Kyiv, and the National Specialised Children’s Hospital «OKHMATDYT», Kyiv. For paediatric age, a 4-12 mHz linear sensor was mostly used.
Results. A total of 137 patients aged 4 months to 12 years were examined. Pneumonia was confirmed in 52 (38%) patients. Of the 137 patients, the polymerase chain reaction test was positive for COVID-19 in 11 (8%) cases and for influenza A in 3 (2.2%) cases. No signs of pneumonia were noted in 85 (62%) children, but 59 (69.4%) of the 85 patients had interstitial syndrome at the B+ and B++ levels, especially expressed in loci I-IV-VII. In the remaining 26 (30.6%) patients, lung ultrasound did not reveal any changes that would indicate disease. They also did not have clear clinical manifestations of acute respiratory viral infection. Separately, we analysed 7 doubtful cases (5.1% of the total) with no or one of the listed diagnostic criteria.
Conclusions. This method is recommended for effective lung screening as an «ultrasound stethoscope» for paediatric patients to detect lung pathology, in particular, in the case of latent disease, and to reduce radiation exposure. It is a priority for dynamic monitoring of the course of the disease and the effectiveness of therapeutic tactics. This diagnostic method is affordable and effective for use by doctors of various specialties.
The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies.
No conflict of interests was declared by the authors.
Keywords: COVID-19, pneumonia, lung ultrasound, screening examination, children’s age.
REFERENCES

1. Abramowicz J, Akiyama I, Evans D et al. (2020). World Federation for Ultrasound in Medicine and Biology Position Statement: how to perform a safe ultrasound examination and clean equipment in the context of COVID-19. Ultrasound in Medicine and Biology. 46 (7): 1821-1826. https://doi.org/10.1016/j.ultrasmedbio.2020.03.033; PMid:32327199 PMCid:PMC7129041

2. Balik M, Plasil P, Waldauf P et al. (2006). Ultrasound estimation of volume of pleural fluid in mechanically ventilated patients. Intensive Care Med. 32 (2): 318. https://doi.org/10.1007/s00134-005-0024-2; PMid:16432674

3. Christiane M, Nyhsen C, Humphreys H, Koerner R et al. (2017). EFSUMB Guideline. Infection prevention and control in ultrasound – best practice recommendations from the European Society of Radiology Ultrasound Working Group. Insights Imaging. 8: 523-535. https://doi.org/10.1007/s13244-017-0580-3; PMid:29181694 PMCid:PMC5707224

4. Dargent A, Chatelain E, Kreitmann L et al. (2020). Lung ultrasound score to monitor COVID-19 pneumonia progression in patients with ARDS. PLoS ONE. 15 (7): e0236312. https://doi.org/10.1371/journal.pone.0236312; PMid:32692769 PMCid:PMC7373285

5. Feshchenko YuI, Holubovska OA, Dziublyk OIa ta in. (2021). Osoblyvosti urazhennia lehen pry COVID-19. Ukr. pulmon. zhurn. 1: 5-14. https://doi.org/10.31215/2306-4927-2021-29-1-5-14

6. Huang Y et al. (2020). A preliminary study on the ultrasonic manifestations of peripulmonary lesions of non-critical novel coronavirus pneumonia (COVID-19). URL: https://ssrn.com/abstract=3544750. https://doi.org/10.2139/ssrn.3544750

7. Lichtenstein D, Axler O. (1993). Intensive use of general ultrasound in the intensive care unit. Intensive Care Medicine. 19 (6): 353-355. https://doi.org/10.1007/BF01694712; PMid:8227728

8. Lichtenstein D, Mezière G. (2011). The BLUE-points: three standardized points used in the BLUE-protocol for ultrasound assessment of the lung in acute respiratory failure. Crit. Ultrasound J. 3: 109-110. https://doi.org/10.1007/s13089-011-0066-3

9. Lichtenstein D. (2014). Lung ultrasound in the critically ill. Ann. Intensive Care. 4: 1. https://doi.org/10.1186/2110-5820-4-1; PMid:24401163 PMCid:PMC3895677

10. Manivel V, Lesnewski A, Shamim S et al. (2020, Aug). CLUE: COVID-19 lung ultrasound in emergency department. Emerg. Med. Australas. 32 (4): 694-696. https://doi.org/10.1111/1742-6723.13546; PMid:32386264 PMCid:PMC7273052

11. Mongodi S, Orlando A, Arisi E et al. (2020). Lung ultrasound in patients with acute respiratory failure reduces conventional imaging and health care provider exposure to COVID-19. Ultrasound in Medicine and Biology. 46 (8): 2090-2093. https://doi.org/10.1016/j.ultrasmedbio.2020.04.033; PMid:32451194 PMCid:PMC7200381

12. Mongodi S, Via G, Girard M, Rouquette I et al. (2016). Lung ultrasound for early diagnosis of ventilator-associated pneumonia. Chest. 149 (4): 969-980. https://doi.org/10.1016/j.chest.2015.12.012; PMid:26836896

13. Pecho-Silva S, Navarro-Solsol A, Taype-Rondan A et al. (2021 Aug). Pulmonary ultrasound in the diagnosis and monitoring of coronavirus disease (COVID-19): a systematic review. Ultrasound in Medicine and Biology. 7 (8): 1997-2005. https://doi.org/10.1016/j.ultrasmedbio.2021.04.011; PMid:34024680 PMCid:PMC8057772

14. Peng Q-Y, Wang X-T, Zhang L-N. (2020). Findings of lung ultrasonography of novel coronavirus pneumonia during the 2019-2020 epidemic. Intens. Care Med. 1-2. https://doi.org/10.1007/s00134-020-05996-6; PMid:32166346 PMCid:PMC7080149

15. Pesenti A, Musch G, Lichtenstein D, Mojoli F, Amato MBP, Cinnella G et al. (2016). Imaging in acute respiratory distress syndrome. Intens. Care Med. 42 (5): 686-698. https://doi.org/10.1007/s00134-016-4328-1; PMid:27033882

16. Safonova OM, Dynnyk OB, Gumeniuk GL, Lukiianchuk VA, Linska HV, Brovchenko MS et al. (2021). Standardized protocol for ultrasound diagnosis of the lungs with COVID-19. URL: http://www.ifp.kiev.ua/doc/journals/ic/21/pdf21-2/19.pdf. https://doi.org/10.32902/2663-0338-2021-2-19-30

17. Smargiassi A, Soldati G, Borghetti A et al. (2020). Lung ultrasonography for early management of patients with respiratory symptoms during COVID-19 pandemic. J. Ultrasound. 23 (4): 449-456. https://doi.org/10.1007/s40477-020-00501-7; PMid:32638333 PMCid:PMC7338342

18. Soldati G, Smargiassi A, Inchingolo R et al. (2020). Proposal for international standardization of the use of lung ultrasound for COVID-19 patients; a simple, quantitative, reproducible method. J. Ultrasound Med. 39 (7): 1413-1419. https://doi.org/10.1002/jum.15285; PMid:32227492 PMCid:PMC7228287

19. Soni N, Arntfield R, Kory P. (2020). Point-Of-Care Ultrasound. Philadelphia, PA: Elsevier: 502.

20. Soummer A, Perbet S, Brisson H, Arbelot C, Constantin J-M, Lu Q et al. (2012). Ultrasound assessment of lung aeration loss during a successful weaning trial predicts postextubation distress. Crit. Care Med. 40 (7): 2064-2072. https://doi.org/10.1097/CCM.0b013e31824e68ae; PMid:22584759

21. Stock K, Horn R, Mathis G. (2021). Lung Ultrasound (LUS) Protocol. European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB). URL: https://efsumb.org/wp-content/uploads/2021/01/Poster-A4-Lungenultraschall-рrotokoll_DEGUM_SGUM_OEGM_V3_englisch_100420….pdf.

22. Sultan LR, Sehgal CM. (2020). A review of early experience in lung ultrasound in the diagnosis and management of COVID-19. Ultrasound in Medicine and Biology. 46 (9): 2530-2545. https://doi.org/10.1016/j.ultrasmedbio.2020.05.012; PMid:32591166 PMCid:PMC7247506

23. Tung-Chen Y, Marti de Garcia M, Diez Tascon A et al. (2020). Correlation between chest computed tomography and lung ultrasonography in patients with coronavirus disease 2019 (COVID-19). Ultrasound in Medicine and Biology. 46 (11): 2918-2926. https://doi.org/10.1016/j.ultrasmedbio.2020.07.003; PMid:32771222 PMCid:PMC7357528

24. Valenko OO, Volkov OO, Bessarab AS. (2018). Practical aspects of the urgent sonographic examination use in the critical respiratory incidents differential diagnosis (BLUE-protocol «Bedside Lung Ultrasound in Emergency»). Perioperative medicine. 1 (1): 46-59. https://doi.org/10.31636/prmd.v1i1.7

25. Zhu S-T, Tao F-Y, Xu J-H et al. (2021). Utility of point-of-care lung ultrasound for clinical classification of COVID-19. Ultrasound in Medicine and Biology. 47 (2): 214-221. https://doi.org/10.1016/j.ultrasmedbio.2020.09.010; PMid:33168275 PMCid:PMC7505667

26. Zieleskiewicz L, Markarian T, Lopez A et al. (2020, Sep). Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Med. 46 (9): 1707-1713. https://doi.org/10.1007/s00134-020-06186-0; PMid:32728966 PMCid:PMC7388119