(1493) Serial Point-of-Care Lung Ultrasound Score to Predict Respiratory Support in Critical Bronchiolitis

Monday, February 24, 2025

9:00am – 10:00am Eastern Time

Location: Connections Central - RST 10

First Author(s)

Kelly Cline, M.D.

Childrens National Health Systems
Children's National Hospital, United States

Co-Author(s)

ET

Eduardo Trujillo Rivera, Ph.D.

Assistant Professor of Pediatrics
Children's National Hospital, Children's National Research Institute, George Washington University, United States
SB

Sonali Basu, MD (she/her/hers)

Associate Chief, Critical Care Medicine
Children's National Hospital
Washington, District of Columbia, United States
EK

Esther Kim, M.D.

Attending Physician, Division of Critical Care Medicine, Assistant Professor of Pediatrics
Children's National Hospital, George Washington University, United States
RT

Rosemary Thomas-Mohtat, M.D.

Director of Emergency Ultrasound, Director of Emergency Ultrasound Fellowship, Associate Professor
Children's National Hospital, George Washington University, United States
DC

Daniel Timothy Carr, M.D.

Attending Physician, Division of Emergency Medicine, Assistant Professor of Pediatrics
Children's National Hospital, George Washington University, United States
SL

Simone Lawson, M.D.

Assistant Director of Emergency Ultrasound Fellowship,Asst Prof of Pediatrics and Emergency Medicine
Children's National Hospital, George Washington University, United States
SM

Stephanie Milne, M.D.

PICU Hospitalist Physician
Children's National Hospital, United States
AM

Angela Maxwell, M.D.

Attending Physician, Division of Emergency Medicine, Asst Prof of Pediatrics and Emergency Medicine
Children's National Hospital, George Washington University, United States
TT

Tonetta Bobbe Thomas, n/a

Clinical Research Program Manager
Children's National Hospital, United States
SI

Samuel Indresano, B.S.

Clinical Research Assistant
Children's National Hospital, United States
MW

Molly Walker, B.S.

Clinical Research Assistant
Children's National Hospital, United States
AW

Abigail Wukitch, B.S.

Clinical Research Assistant
Children's National Hospital, United States
SL

Savannah Latimer, B.S.

Clinical Research Assistant
Children's National Hospital, United States
DE

Desiree Edemba, M.B.S., B.S.

Clinical Research Assistant
Children's National Hospital, United States
HT

Hodaka Takaiso, M.B.

Pediatric Resident
Children's National Hospital, United States

Introduction: Critical bronchiolitis (CB), a leading cause of pediatric ICU admissions, complicates resource allocation due to difficulty predicting which patients are at greatest risk of decompensation and which are likely to be able to de-escalate. Point of care lung ultrasound (LUS) has emerged as a promising prognostic tool for bronchiolitis in the emergency department and may provide insight into the need for ICU admission and respiratory support (RS). This study investigates the role of serial LUS in patients with CB requiring ICU-level RS (high flow nasal cannula (HFNC) or positive pressure ventilation (PPV), including RAM cannula, biphasic positive airway pressure (BiPAP), and mechanical ventilation (MV)) to predict risk of escalation and de-escalation of RS.

Methods: This prospective study included patients 1 month to 2 years old with CB. LUS was obtained within 12 hours of starting ICU-level RS and was repeated at 6-12 hour intervals. LUS scores of 0–18 were calculated. The primary outcome was the need for PPV at 24 hours after LUS. The secondary outcomes were maximum level of RS and duration of ICU-level RS. Current and historical LUS scores and current level of RS were used to predict the subsequent risk of requiring each level of RS using a Bayesian hierarchical model.

Results: 27 patients were included with a median age of 9.1 months (IQR 4,14.8). 63 LUS were obtained with a median LUS score of 3 (IQR 2,7). Maximum level of RS included HFNC (52%) and PPV (48%). PPV included RAM cannula (30.8%), BiPAP (61.5%), and MV (7.7%). Median duration of ICU-level RS was 30.5 hours (IQR 17.7,62.8).
A positive correlation was seen between maximum LUS score and duration of ICU-level RS (r(25)=.66, p<.001). Maximum LUS score differed between groups with HFNC, RAM cannula/BiPAP, and MV as maximum levels of RS (2 vs 5 vs 16, p =.006).
Analysis of our model showed that for patients on HFNC, LUS score of >8 predicted an increased risk of escalation to PPV within the next 24 hours and LUS score < 3 predicted an increased risk of de-escalation to low flow nasal cannula or room air within the next 24 hours.

Conclusions: The preliminary results of this study suggest that serial LUS scores may have value in predicting the escalation and de-escalation, maximum level, and duration of ICU-level RS in children with CB.