Lung ultrasound in pediatric intensive care: state of art in 2020

Abstract

Lung ultrasound (LUS) use has considerably increased in adults’ intensive care units but its use in neonatal and pediatric intensive care unit, although increasing, remains low and chest X-ray is still the first line exam in most hospitals. The purpose of this review is to present the studies focusing on pediatric intensive care, so as to evaluate the actual knowledge, the advantages and the limits of LUS. After describing its use in neonatal and communal pediatric lung diseases, we describe the specific use in pediatric intensive care. LUS has three interests: emergency diagnosis, guide for therapeutic procedures and monitoring of immediate and late evolution. In neonates, it helps understanding the cause of immediate or late respiratory distress and managing life threatening emergencies. In general pediatrics, it is useful to diagnose pneumonia and bronchiolitis and detect their complications. In pediatric intensive care, it can show ventilator-associated pneumonia and evaluate and monitor alveolar recruitment in acute respiratory distress syndrome or perioperative atelectasis. In association with hemodynamic evaluation, LUS helps the management of patients with high risk of lung edema particularly in case of heart diseases or sepsis. Finally, LUS quickly identifies respiratory complications related to intensive care or surgery, thoracic traumatic damages and some potentially reversible causes of cardiac arrest. The recent publication of international guidelines on point of care ultrasound for neonates and children might help LUS generalization in daily practice.