Role of a simple lung ultrasound score in defining pulmonary edema during early fluid overload in pediatric mechanically ventilated patients

Fluid overload is a common complication in children who are admitted to the
pediatric intensive care for mechanical ventilation. In these critically ill
children, fluid overload is associated with adverse outcome, such as longer
mechanical ventilation or higher mortality. A large part of the adverse effects
of fluid overload is likely related to an increase in extra-vascular lung water
(EVLW), indicating pulmonary edema, impeding ventilation and oxygenation.
Various methods are used currently to assess pulmonary edema, however all of
these have their own drawbacks. Lung ultrasonography is an easy-to-use,
bedside, non-invasive diagnostic tool for EVLW with pulmonary edema
estimation. Lung ultrasound scores have been shown to correlate well with
amount of EVLW in animal settings, as well as a variety of adult clinical
settings. EVLW can be seen on ultrasonography as it generates artifacts called
B-lines.. In critically ill children, little is known regarding the use of lung
ultrasound for presence of pulmonary edema as caused by fluid overload.

To assess whether pulmonary edema as detected by a lung ultrasound B-line score
correlates with the occurrence of early fluid overload and oxygenation failure
in mechanically ventilated critically ill children.

This study concerns a prospective observational cohort study at the pediatric
intensive care unit (PICU) of the AMC. Mechanically ventilated children will be
subjected to serial lung ultrasound examinations, aiming to assess the relation
between lung ultrasound B-line scores with early fluid overload and oxygenation
failure. Similar study protocols will be applied at the adult intensive care
units.

Lung ultrasound is a harmless, non-invasive diagnostic tool, which is already
used with great frequency in intensive care units to assess multiple
(disease-specific) aspects of the lung. Also, in the pediatric intensive care
unit it is used increasingly in standard clinical care. Due to the known
relation between fluid overload and adverse outcomes, an easy detection tool of
pulmonary edema using lung sonographymay provide great benefit in clinical care
of these patients. Lung sonography does not cause any additional risk or
discomfort to the children on mechanical ventilation. Even more so, as all
children on mechanical ventilation are sedated in the PICU, ensuring minimal to
no burden to participants. On average an examination lasts 5-10 minutes.