The Importance of Dynamic Monitoring of Cardiopulmonary Ultrasound in Evaluating Severe Pneumonia in Pediatric Patients

The Importance of Dynamic Monitoring of Cardiopulmonary Ultrasound in Evaluating Severe Pneumonia in Pediatric Patients | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Importance of Dynamic Monitoring of Cardiopulmonary Ultrasound in Evaluating Severe Pneumonia in Pediatric Patients Li-ping Liang, Xiao-qian Liu, Zhi-peng Qin This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7334438/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Severe pneumonia poses a significant health threat to children, contributing to high morbidity rates and substantial economic burden.This study investigates the clinical value of combined cardiac and pulmonary ultrasound in assessing cardiopulmonary function in children with severe pneumonia at different treatment stages. Severe pneumonia remains a critical health issue among young children, with timely and accurate assessment of cardiopulmonary function being essential for effective management.A prospective observational design was employed, involving 60 children aged 3 to 5 years diagnosed with severe pneumonia, who underwent both combined cardiac and pulmonary ultrasound and conventional chest X-ray examinations. The results demonstrated significant dynamic changes in cardiopulmonary function throughout the treatment phases, with key indicators such as left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and tricuspid annular plane systolic excursion (TAPSE) showing marked improvement post-treatment (P<0.05), while the E/e′ ratio significantly decreased. Additionally, a negative correlation was found between lung ultrasound scores and chest X-ray grading (r=-0.736; r=-0.573; r=-0.609, P<0.001), highlighting the potential of ultrasound in prognostic evaluation. The study underscores the advantages of using combined cardiac and pulmonary ultrasound for dynamic monitoring of cardiopulmonary function in severe pneumonia cases. However, limitations such as a small sample size and absence of long-term follow-up warrant consideration. In conclusion, this research supports the incorporation of combined ultrasound techniques in clinical practice for better assessment and management of severe pneumonia in pediatric patients, suggesting further exploration of its applicability in other respiratory diseases. Cardiopulmonary ultrasound Children Severe pneumonia X-ray examination Disease evaluation Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction The evaluation of cardiopulmonary function in children suffering from severe pneumonia is critical for improving clinical outcomes. Severe pneumonia is now an important public health issue among pediatric populations, often leading to substantial morbidity and mortality.It is characterized by an inflammatory response in the lungs, which can severely compromise respiratory function and, consequently, overall cardiopulmonary performance. In children, the physiological implications of pneumonia can differ significantly from those in adults due to their unique anatomical and physiological characteristics. Understanding these differences is essential for developing effective treatment strategies and improving patient prognosis[ 1 ].Recent research has underscored the importance of assessing cardiopulmonary function as part of the management of severe pneumonia in children. Traditional imaging techniques, such as chest radiography, often provide limited insights into the dynamic changes occurring in the heart and lungs during the course of the disease. Therefore, there is a pressing need for more comprehensive assessment methodologies that account for these dynamic alterations. The integration of cardiac and pulmonary ultrasound provides a novel approach to evaluate the cardiopulmonary function in these patients, offering advantages such as real-time monitoring, non-invasiveness, and the capability to repeatedly assess changes over time [ 2 ].The current body of literature highlights a gap in the understanding of the correlation between cardiopulmonary function and treatment outcomes in children with severe pneumonia. Previous studies have primarily focused on either cardiac or pulmonary evaluations in isolation, thereby neglecting the interconnectedness of these two systems in the context of pneumonia. Emerging evidence suggests that alterations in cardiac function may be closely tied to the severity of pulmonary involvement. This relationship necessitates a holistic approach towards monitoring and managing pediatric pneumonia, where a combined ultrasound assessment can yield better prognostic information[ 3 ]. This study aims to address these gaps by employing a prospective observational methodology to examine the clinical value of combined cardiac and pulmonary ultrasound in evaluating the cardiopulmonary function of children diagnosed with severe pneumonia across different stages of treatment. By selecting a cohort of 60 children aged 3 to 5 years, we seek to dynamically monitor the cardiopulmonary function at various treatment intervals, thereby providing a comprehensive overview of the clinical course of each patient. The innovative aspect of this research lies in its dual focus on both cardiac and pulmonary parameters, which will enable us to elucidate the complex interactions that occur in severe pneumonia[ 4 ]. In summary, the proposed study is poised to significantly advance our understanding of the clinical implications of cardiopulmonary function in pediatric severe pneumonia. By utilizing advanced imaging techniques that assess both cardiac and pulmonary functions concurrently, we aim to provide clinicians with reliable data that can guide treatment decisions and improve patient outcomes. This research not only emphasizes the need for integrated assessments in pediatric respiratory diseases but also opens avenues for future studies to explore similar methodologies in other pediatric respiratory conditions[ 5 ]. Materials and Methods General Information A total of 60 children aged 3 to 5 years with severe pneumonia from the pediatric department at the Second Affiliated Hospital of Baotou Medical College between June 2023 and December 2024 were selected as the study subjects, including 37 males and 23 females, with an average age of (3.65 ± 1.72) years, height of (100.25 ± 16.32) cm, and weight of (17.00 ± 4.26) kg. Inclusion criteria: Children with clinical manifestations and arterial blood gas analysis consistent with the diagnosis of typical severe pneumonia, diagnosed according to the "Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia in Children (2024 Revised Edition)" in China; Exclusion criteria: Children with significant congenital malformations like heart defects, respiratory issues, chromosomal disorders, and low protein levels. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Baotou Medical College, and all participants had their parents or legal guardians sign informed consent forms. Methods All children underwent combined cardiac and pulmonary ultrasounds and chest X-rays before treatment (prior to clinical treatment upon admission), during treatment (48–72 hours after receiving symptomatic treatment such as anti-infection after hospitalization), and after treatment (before discharge). Instruments We used the China Mindray Resona 7 and American GE Healthcare's Vivid E9 bedside ultrasound systems. Cardiac ultrasound utilized a phased array probe with a scanning frequency of 3–5 MHz, while lung ultrasound used a high-frequency linear array probe with a scanning frequency of 6–12 MHz. To avoid systematic errors, the same preset instrument settings were used. All examinations were performed by the same ultrasound physician trained specifically in cardiac and pulmonary ultrasound. The results of the cardiac and pulmonary ultrasound examinations were evaluated by three specialized ultrasound doctors. Lung Ultrasound Examination While calm, the children were positioned supine, lateral, and prone. The lungs were divided into 12 regions based on the lines connecting the nipples, the parasternal line, the anterior axillary line, the posterior axillary line, and the paravertebral line,as shown in Fig. 1 .Each region was examined to observe the pleural line, A-lines (horizontal artifacts caused by multiple reflections due to differences in acoustic impedance at the pleural-lung interface, which appear as a series of echogenic lines parallel to the pleural line, located below the pleural line with equal spacing), B-lines (linear echogenicities originating from the pleural line, perpendicular to it, radiating into the lung fields and reaching the edge of the scanning screen), pleural sliding, and the presence of pulmonary interstitial syndrome, lung consolidation, bilateral lung points, pulmonary edema, lung pulsation, pleural effusion, etc., while standardized images were stored and recorded. Cardiac Ultrasound Examination The children were positioned in the left lateral position. In the long-axis view of the left ventricle, M-mode echocardiography was initiated, and we placed the sample line vertically at the mitral valve chordae tendineae level to measure the left ventricular end-systolic diameter and left ventricular end-diastolic diameter, with the instrument automatically displaying LVEF and LVFS. In the apical four-chamber view, the spectral Doppler mode was first activated, placing the PW sample volume at the level of the mitral valve tip to measure the peak E wave velocity during diastole. Then, the tissue Doppler mode was activated, placing the PW sample volume at the left ventricular free wall and interventricular septum to measure the mitral valve annulus diastolic tissue velocity e, with the maximum velocity averaged to obtain e', and E/e' was calculated. Finally, M-mode echocardiography was initiated, with the sample line placed at the tricuspid valve annulus right ventricular free wall as parallel as possible to the right heart long axis, measuring the displacement of the tricuspid valve annulus from the end of diastole to the end of systole (TAPSE) over one cardiac cycle. The above parameters were measured continuously over three cardiac cycles, and the average value was taken. X-ray Chest Examination The German Siemens MULTIX Fusion Max series X-ray photography system was used for routine anteroposterior and lateral views, with the child and guardian wearing protective lead aprons. Determination Criteria (1) Lung ultrasound scoring criteria[6]: According to existing literature, evaluation was conducted based on changes in A-lines, presence and distribution of B-lines, scoring the most severe ultrasound manifestations in each of the 12 regions, with a total score ranging from 0 to 48 points. See Table 1, Fig. 2. (2) X-ray grading[7]: Based on the extent of pulmonary infiltration, distribution of lesions, and the presence of complications, specific grading is shown in Table 2. Table 1 Lung Ultrasound Scoring Criteria Score Scoring Content 4 points (normal) A-lines are smooth and clearly visible, occasionally fewer than 3 isolated B-lines 3 points (mild loss of ventilation) A-lines are blurred, scattered clear B-lines visible 2 points (moderate loss of ventilation) A-lines are unclear, numerous B-lines partially fused 1 point (severe loss of ventilation) A-lines not visible, numerous fused B-lines, presenting waterfall sign 0 points Lung consolidation or atelectasis, typical bronchial inflation or bronchial fluid signs visible Table 2 X-ray Chest Grading Table X-ray Grade Specific Observations Grade I (mild) Unilateral focal infiltration (e.g., single lobe affected), without pleural effusion or atelectasis Grade II (moderate) Unilateral multilobar infiltration or bilateral focal infiltration, possibly with a small amount of pleural effusion Grade III (severe) Bilateral extensive infiltration (multilobar affected), large pleural effusion, formation of lung abscess, or lung consolidation extending beyond one lobe Statistical Methods We performed statistical analysis using SPSS 26.0. Measurement data were expressed as (x±s), and comparisons between groups were conducted using paired t-tests for normally distributed data; non-parametric rank-sum tests were used for data that did not meet the conditions. Correlation analysis was conducted using Kendall's rank correlation test, with P<0.05 indicating statistical significance. Results Comparison of Cardiac and Pulmonary Ultrasound Parameters at Different Stages of Treatment After treatment by clinical doctors, the condition of the children gradually improved. The lung ultrasound scores reflecting the changes in lung conditions of children with severe pneumonia gradually increased, with scores before and during treatment (t=-21.83) and during and after treatment (t=-17.43), showing statistically significant differences at different treatment stages (P < 0.05).The LVEF, LVFS, and TAPSE reflecting cardiac function in children with severe pneumonia gradually increased during treatment, with changes before and during treatment and during and after treatment being (t=-21.57, -15.72; t=-17.680, -8.91; t=-6.21,-6.02).The E/e' ratio gradually decreased during treatment, with changes before and during treatment and during and after treatment being (t = 6.126; t = 4.600), and the differences at different treatment stages were statistically significant (P < 0.05),as shown in Table 3 , Fig. 3 .At the same time,with the changes in the condition,the lungs and heart of children with severe pneumonia showed a trend of synchronous changes.With the improvement of lung function before,during,and after treatment,the increase in lung ultrasound scores,and the simultaneous increase in cardiac EF,FS,andTAPSE(indicators of ventricular systolic function) showed a positive correlation,while the decrease in E/e' (an indicator of ventricular diastolic function) showed a negative correlation, showing statistically significant differences at different treatment stages (P < 0.05),as illustrated in Fig. 4 . Table 3 Comparison of Cardiac and Pulmonary Ultrasound Parameters in Children with Severe Pneumonia at Different Treatment Stages (x ± s) Treatment Stage Lung Ultrasound Score LVEF LVFS E/e’ TAPSE Before Treatment 27.50 ± 7.38 60.91 ± 3.58 32.40 ± 3.14 8.52 ± 1.38 18.32 ± 1.93 During Treatment 34.68 ± 6.72 65.30 ± 3.28 36.15 ± 2.86 7.79 ± 0.92 19.15 ± 1.87 After Treatment 41.38 ± 5.25 69.60 ± 4.38 40.83 ± 4.54 7.34 ± 0.73 19.80 ± 1..83 t -21.83 ※ /-17.43 △ -21.57 ※ /-15.72 △ -17.68 ※ /-8.91 △ 6.13 ※ /4.60 △ -6.21 ※ /-6.02 △ P 0.000 ※ /0.000 △ 0.000 ※ /0.000 △ 0.000 ※ /0.000 △ 0.000 ※ /0.000 △ 0.000 ※ /0.000 △ Note: ※ indicates the comparison of lung function before and during treatment in children with severe pneumonia; △ indicates the comparison of lung function during and after treatment in children with severe pneumonia. Figure 3 The table shows the changes in cardiopulmonary condition of the same patient at different treatment stages.Figure a is a lung ultrasound image of a 3-year-old child with severe pneumonia before treatment: diffuse fused B lines and multiple lung lobe consolidation;Figure b is the lung ultrasound image of the same child 72 hours after treatment: reduction of B lines, appearance of A lines, and absorption of consolidation;Figure c is the lung ultrasound image of the same child before discharge: A lines are blurred or clear, with scattered clear B lines visible. Correlation Analysis of Lung Ultrasound Scores and X-ray Grading at Different Stages of Treatment Lung ultrasound scores in children with severe pneumonia were negatively correlated with X-ray grading before, during, and after treatment (r=-0.736; r=-0.573; r=-0.609, P < 0.001), with statistically significant differences. See Fig. 5 . Discussion Severe pneumonia represents a significant global health issue, especially among children, as it contributes to high morbidity and mortality rates. The disease is characterized by inflammation of the lung parenchyma, which can lead to severe respiratory distress and complications if not effectively managed. The burden of severe pneumonia is particularly pronounced in pediatric populations, where the potential for severe outcomes is heightened due to the vulnerability of developing respiratory systems. The economic impact on healthcare systems is substantial, necessitating innovative approaches to early detection and management of this condition. Current treatment strategies primarily include antibiotic therapy and supportive care, however, these methods often fall short in terms of timely diagnosis and accurate assessment of disease severity.Therefore there is a critical need for enhanced diagnostic tools that can facilitate earlier intervention and more effective management of severe pneumonia [ 8 ][ 9 ]. In this study, we focused on the cardiac and pulmonary function changes in children suffering from severe pneumonia and their correlation with ultrasonography scores. Previous studies have highlighted the promising role of cardiac and pulmonary ultrasound in the clinical evaluation of severe pneumonia; however, systematic analyses of ultrasound parameters across different treatment stages remain limited. Our research aimed to bridge this gap by providing a comprehensive evaluation of heart and lung function through ultrasound imaging, alongside chest X-ray assessments, in a cohort of children diagnosed with severe pneumonia. By investigating the relationship between ultrasound parameters and clinical outcomes, our findings have the potential to introduce new insights into the management of severe pneumonia, ultimately aiding clinical decision-making and improving patient outcomes[ 8 ] [ 10 ][ 11 ]. The innovation of our study lies in its comprehensive exploration of cardiopulmonary function changes in pediatric patients diagnosed with severe pneumonia, utilizing a systematic approach to assess the correlation between ultrasound scores and clinical parameters. Previous studies, such as those by Madico et al. (1993) and Chisti et al. (2015), primarily focused on singular aspects of pneumonia management, often neglecting the dynamic interplay of various physiological parameters during different treatment phases. Our research fills this gap by providing a detailed analysis of heart and lung function through echocardiographic measures, which have been correlated with traditional imaging modalities like X-ray. This dual approach not only substantiates the validity of ultrasound as a diagnostic tool but also provides a foundation for its application in real-time clinical assessments, as evidenced by the significant improvements in lung ultrasound scores and cardiac function parameters observed during our study[ 12 ][ 13 ]. The results of our study hold considerable implications for clinical practice, particularly in the management of severe pneumonia in children. The demonstrated correlation between improved ultrasound scores and enhanced clinical outcomes suggests that incorporating echocardiographic evaluations into routine assessments could lead to earlier detection of worsening conditions and facilitate timely interventions. This is particularly relevant in settings where traditional imaging techniques may not be readily available or feasible. Additionally, the findings support the development of standardized protocols for utilizing ultrasound in the monitoring of pediatric pneumonia, potentially influencing clinical guidelines and policies aimed at optimizing treatment strategies for this vulnerable population[ 14 ][ 15 ]. However, we acknowledge several limitations within our study that may affect the generalizability of our findings. The relatively small sample size and the single-center design may limit the applicability of our results to broader populations. Furthermore, the absence of long-term follow-up data restricts our ability to evaluate the sustained impact of the identified echocardiographic changes on patient outcomes. Future research should aim to include larger, multi-center cohorts and extend the follow-up period to assess the long-term efficacy of ultrasound-guided management strategies. Additionally, integrating biomarker analyses could enhance our understanding of the underlying pathophysiological mechanisms at play in severe pneumonia cases, ultimately guiding the development of personalized treatment approaches[ 16 ][ 17 ]. Conclusions In conclusion, this study systematically analyzed the variations in cardiopulmonary function among children with severe pneumonia and demonstrated the significant role of ultrasound in disease assessment. The findings underscore the potential of ultrasound as a reliable tool for clinical evaluation, which may refine treatment strategies and improve patient outcomes. Future research should aim to further optimize therapeutic approaches and enhance prognostic accuracy to ultimately improve the quality of life for affected children. Abbreviations LVEF：left ventricular ejection fraction LVFS：left ventricular fractional shortening TAPSE：tricuspid annular plane systolic excursion Declarations Acknowledgements The authors would like to thank the participants and their families for their cooperation and support throughout the study. We also acknowledge the contributions of the Science and Technology Research Joint Fund of Public Hospital of Inner Mongolia Academy of Medical Sciences and the Science Research and Development Fund of Baotou Medical College for funding this research. Clinical trial number Not applicable. Authors' contributions Liang LP: Conception, design, data acquisition and analysis, drafting and revising, final approval. Liu XQ: Data acquisition and analysis. Qin ZP: Data acquisition. Funding This study was supported by the Science and Technology Research Joint Fund of Public Hospital of Inner Mongolia Academy of Medical Sciences(2023GLLH0217) and the Science Research and Development Fund of Baotou Medical College (BYJJ-GCJH 202503). Availability of data and materials The datasets generated during this study are available from the corresponding author on reasonable request. Ethics approval and consent to participate This study follows the ethical principles of the Helsinki Declaration and has obtained ethical approval from the Medical Ethics Committee of the Second Affiliated Hospital of Baotou Medical College (Approval No: ZX083). All human participants have signed an informed consent form before participating in the study, confirming their voluntary participation. All participants have provided informed consent, and all information during the research process has been fully explained to the participants, including the research purpose, methods, potential risks, and benefits. Participants have the right to withdraw from the study at any time without any adverse effects. Specifically, for all participants under the age of 16, written informed consent was obtained from their parents or legal guardians prior to enrollment in this study. Consent for publication Parents or legal guardians of all participants under the age of 16 have obtained informed consent for publication. Parents or legal guardians of all participants have been informed of the purpose of the study and the use of their data in the publication. Competing Interests The authors declare that they have no competing interests. References Xie M, Chou YH, Zhang L, Zhang D, Tiu CM. 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07:23:38","extension":"html","order_by":16,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77267,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/796e8ff8d42c6122814f0763.html"},{"id":93012896,"identity":"21b3b32b-2e2d-4471-a03f-8d091e6878ba","added_by":"auto","created_at":"2025-10-08 07:23:38","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":185154,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic Diagram of the Twelve Lung Regions\u003c/p\u003e\n\u003cp\u003eFigure a \u0026nbsp;Supine position showing regions 1-4 Figure b \u0026nbsp;Lateral position showing regions 5-6\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/98845844427b497b4657fb9b.png"},{"id":93012897,"identity":"c8cd125f-7df3-456e-92a0-cc99ed9a323b","added_by":"auto","created_at":"2025-10-08 07:23:38","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":243278,"visible":true,"origin":"","legend":"\u003cp\u003eUltrasound images of different degrees of lung ultrasound scores in children with severe pneumonia.\u003c/p\u003e\n\u003cp\u003eFigure 2a 4 points; Figure 2b 3 points; Figure 2c 2 points; Figure 2d 1 point; Figure 2e 0 points.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/db8b60b580cb754675d58f92.png"},{"id":93010890,"identity":"a71f32c8-71d4-4efc-b32a-868ad2155950","added_by":"auto","created_at":"2025-10-08 07:15:38","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":183174,"visible":true,"origin":"","legend":"\u003cp\u003eThe table shows the changes in cardiopulmonary condition of the same patient at different treatment stages.Figure a is a lung ultrasound image of a 3-year-old child with severe pneumonia before treatment: diffuse fused B lines and multiple lung lobe consolidation;Figure b is the lung ultrasound image of the same child 72 hours after treatment: reduction of B lines, appearance of A lines, and absorption of consolidation;Figure c is the lung ultrasound image of the same child before discharge: A lines are blurred or clear, with scattered clear B lines visible.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/66da4b57fabe493e1d2c9120.png"},{"id":93010893,"identity":"e6b9aeb3-35d4-4f79-9860-91ca59891d87","added_by":"auto","created_at":"2025-10-08 07:15:38","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":170106,"visible":true,"origin":"","legend":"\u003cp\u003eThe changing trend of the parameters of cardiopulmonary echocardiography in different stages\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/88cec300973de45ed684ef03.png"},{"id":93010891,"identity":"c5856f44-2bff-4df9-90aa-4733fba4edff","added_by":"auto","created_at":"2025-10-08 07:15:38","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":75330,"visible":true,"origin":"","legend":"\u003cp\u003eScatter plot of the correlation between lung ultrasound scores and X-ray grading at different treatment periods.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/17282f3d9695beab4c85226b.png"},{"id":93013878,"identity":"082e9b71-9e08-4b61-b21d-2c0591d12e2a","added_by":"auto","created_at":"2025-10-08 07:31:39","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1480753,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7334438/v1/57ec7bf5-c7e3-45f7-a5d0-1908f0d5354f.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Importance of Dynamic Monitoring of Cardiopulmonary Ultrasound in Evaluating Severe Pneumonia in Pediatric Patients","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe evaluation of cardiopulmonary function in children suffering from severe pneumonia is critical for improving clinical outcomes. Severe pneumonia is now an important public health issue among pediatric populations, often leading to substantial morbidity and mortality.It is characterized by an inflammatory response in the lungs, which can severely compromise respiratory function and, consequently, overall cardiopulmonary performance. In children, the physiological implications of pneumonia can differ significantly from those in adults due to their unique anatomical and physiological characteristics. Understanding these differences is essential for developing effective treatment strategies and improving patient prognosis[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].Recent research has underscored the importance of assessing cardiopulmonary function as part of the management of severe pneumonia in children. Traditional imaging techniques, such as chest radiography, often provide limited insights into the dynamic changes occurring in the heart and lungs during the course of the disease. Therefore, there is a pressing need for more comprehensive assessment methodologies that account for these dynamic alterations. The integration of cardiac and pulmonary ultrasound provides a novel approach to evaluate the cardiopulmonary function in these patients, offering advantages such as real-time monitoring, non-invasiveness, and the capability to repeatedly assess changes over time [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].The current body of literature highlights a gap in the understanding of the correlation between cardiopulmonary function and treatment outcomes in children with severe pneumonia. Previous studies have primarily focused on either cardiac or pulmonary evaluations in isolation, thereby neglecting the interconnectedness of these two systems in the context of pneumonia. Emerging evidence suggests that alterations in cardiac function may be closely tied to the severity of pulmonary involvement. This relationship necessitates a holistic approach towards monitoring and managing pediatric pneumonia, where a combined ultrasound assessment can yield better prognostic information[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. This study aims to address these gaps by employing a prospective observational methodology to examine the clinical value of combined cardiac and pulmonary ultrasound in evaluating the cardiopulmonary function of children diagnosed with severe pneumonia across different stages of treatment. By selecting a cohort of 60 children aged 3 to 5 years, we seek to dynamically monitor the cardiopulmonary function at various treatment intervals, thereby providing a comprehensive overview of the clinical course of each patient. The innovative aspect of this research lies in its dual focus on both cardiac and pulmonary parameters, which will enable us to elucidate the complex interactions that occur in severe pneumonia[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In summary, the proposed study is poised to significantly advance our understanding of the clinical implications of cardiopulmonary function in pediatric severe pneumonia. By utilizing advanced imaging techniques that assess both cardiac and pulmonary functions concurrently, we aim to provide clinicians with reliable data that can guide treatment decisions and improve patient outcomes. This research not only emphasizes the need for integrated assessments in pediatric respiratory diseases but also opens avenues for future studies to explore similar methodologies in other pediatric respiratory conditions[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003eGeneral Information\u003c/h2\u003e\u003cp\u003eA total of 60 children aged 3 to 5 years with severe pneumonia from the pediatric department at the Second Affiliated Hospital of Baotou Medical College between June 2023 and December 2024 were selected as the study subjects, including 37 males and 23 females, with an average age of (3.65\u0026thinsp;\u0026plusmn;\u0026thinsp;1.72) years, height of (100.25\u0026thinsp;\u0026plusmn;\u0026thinsp;16.32) cm, and weight of (17.00\u0026thinsp;\u0026plusmn;\u0026thinsp;4.26) kg. Inclusion criteria: Children with clinical manifestations and arterial blood gas analysis consistent with the diagnosis of typical severe pneumonia, diagnosed according to the \"Guidelines for the Diagnosis and Treatment of Community-Acquired Pneumonia in Children (2024 Revised Edition)\" in China; Exclusion criteria: Children with significant congenital malformations like heart defects, respiratory issues, chromosomal disorders, and low protein levels. This study was approved by the Ethics Committee of the Second Affiliated Hospital of Baotou Medical College, and all participants had their parents or legal guardians sign informed consent forms.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eMethods\u003c/h3\u003e\n\u003cp\u003eAll children underwent combined cardiac and pulmonary ultrasounds and chest X-rays before treatment (prior to clinical treatment upon admission), during treatment (48\u0026ndash;72 hours after receiving symptomatic treatment such as anti-infection after hospitalization), and after treatment (before discharge).\u003c/p\u003e\n\u003ch3\u003eInstruments\u003c/h3\u003e\n\u003cp\u003eWe used the China Mindray Resona 7 and American GE Healthcare's Vivid E9 bedside ultrasound systems. Cardiac ultrasound utilized a phased array probe with a scanning frequency of 3\u0026ndash;5 MHz, while lung ultrasound used a high-frequency linear array probe with a scanning frequency of 6\u0026ndash;12 MHz. To avoid systematic errors, the same preset instrument settings were used. All examinations were performed by the same ultrasound physician trained specifically in cardiac and pulmonary ultrasound. The results of the cardiac and pulmonary ultrasound examinations were evaluated by three specialized ultrasound doctors.\u003c/p\u003e\n\u003ch3\u003eLung Ultrasound Examination\u003c/h3\u003e\n\u003cp\u003eWhile calm, the children were positioned supine, lateral, and prone. The lungs were divided into 12 regions based on the lines connecting the nipples, the parasternal line, the anterior axillary line, the posterior axillary line, and the paravertebral line,as shown in Fig. \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e.Each region was examined to observe the pleural line, A-lines (horizontal artifacts caused by multiple reflections due to differences in acoustic impedance at the pleural-lung interface, which appear as a series of echogenic lines parallel to the pleural line, located below the pleural line with equal spacing), B-lines (linear echogenicities originating from the pleural line, perpendicular to it, radiating into the lung fields and reaching the edge of the scanning screen), pleural sliding, and the presence of pulmonary interstitial syndrome, lung consolidation, bilateral lung points, pulmonary edema, lung pulsation, pleural effusion, etc., while standardized images were stored and recorded.\u003c/p\u003e\n\u003ch3\u003eCardiac Ultrasound Examination\u003c/h3\u003e\n\u003cp\u003eThe children were positioned in the left lateral position. In the long-axis view of the left ventricle, M-mode echocardiography was initiated, and we placed the sample line vertically at the mitral valve chordae tendineae level to measure the left ventricular end-systolic diameter and left ventricular end-diastolic diameter, with the instrument automatically displaying LVEF and LVFS. In the apical four-chamber view, the spectral Doppler mode was first activated, placing the PW sample volume at the level of the mitral valve tip to measure the peak E wave velocity during diastole. Then, the tissue Doppler mode was activated, placing the PW sample volume at the left ventricular free wall and interventricular septum to measure the mitral valve annulus diastolic tissue velocity e, with the maximum velocity averaged to obtain e', and E/e' was calculated. Finally, M-mode echocardiography was initiated, with the sample line placed at the tricuspid valve annulus right ventricular free wall as parallel as possible to the right heart long axis, measuring the displacement of the tricuspid valve annulus from the end of diastole to the end of systole (TAPSE) over one cardiac cycle. The above parameters were measured continuously over three cardiac cycles, and the average value was taken.\u003c/p\u003e\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003eX-ray Chest Examination\u003c/h2\u003e\u003cp\u003eThe German Siemens MULTIX Fusion Max series X-ray photography system was used for routine anteroposterior and lateral views, with the child and guardian wearing protective lead aprons.\u003c/p\u003e\u003c/div\u003e\n\u003ch3\u003eDetermination Criteria\u003c/h3\u003e\n\u003cp\u003e(1) Lung ultrasound scoring criteria[6]: According to existing literature, evaluation was conducted based on changes in A-lines, presence and distribution of B-lines, scoring the most severe ultrasound manifestations in each of the 12 regions, with a total score ranging from 0 to 48 points. See Table 1, Fig. 2. (2) X-ray grading[7]: Based on the extent of pulmonary infiltration, distribution of lesions, and the presence of complications, specific grading is shown in Table 2.\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv\u003eTable 1\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eLung Ultrasound Scoring Criteria\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScore\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eScoring Content\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e4 points (normal)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA-lines are smooth and clearly visible, occasionally fewer than 3 isolated B-lines\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3 points (mild loss of ventilation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA-lines are blurred, scattered clear B-lines visible\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2 points (moderate loss of ventilation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA-lines are unclear, numerous B-lines partially fused\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1 point (severe loss of ventilation)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eA-lines not visible, numerous fused B-lines, presenting waterfall sign\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0 points\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLung consolidation or atelectasis, typical bronchial inflation or bronchial fluid signs visible\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cdiv\u003e\n \u003ctable id=\"Tab2\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n \u003cdiv\u003eTable 2\u003c/div\u003e\n \u003cdiv\u003e\n \u003cp\u003eX-ray Chest Grading Table\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eX-ray Grade\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSpecific Observations\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade I (mild)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnilateral focal infiltration (e.g., single lobe affected), without pleural effusion or atelectasis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade II (moderate)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUnilateral multilobar infiltration or bilateral focal infiltration, possibly with a small amount of pleural effusion\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eGrade III (severe)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBilateral extensive infiltration (multilobar affected), large pleural effusion, formation of lung abscess, or lung consolidation extending beyond one lobe\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Methods \u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe performed statistical analysis using SPSS 26.0. Measurement data were expressed as (x\u0026plusmn;s), and comparisons between groups were conducted using paired t-tests for normally distributed data; non-parametric rank-sum tests were used for data that did not meet the conditions. Correlation analysis was conducted using Kendall\u0026apos;s rank correlation test, with P\u0026lt;0.05 indicating statistical significance. \u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec12\" class=\"Section2\"\u003e\n \u003ch2\u003eComparison of Cardiac and Pulmonary Ultrasound Parameters at Different Stages of Treatment\u003c/h2\u003e\n \u003cp\u003eAfter treatment by clinical doctors, the condition of the children gradually improved. The lung ultrasound scores reflecting the changes in lung conditions of children with severe pneumonia gradually increased, with scores before and during treatment (t=-21.83) and during and after treatment (t=-17.43), showing statistically significant differences at different treatment stages (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05).The LVEF, LVFS, and TAPSE reflecting cardiac function in children with severe pneumonia gradually increased during treatment, with changes before and during treatment and during and after treatment being (t=-21.57, -15.72; t=-17.680, -8.91; t=-6.21,-6.02).The E/e\u0026apos; ratio gradually decreased during treatment, with changes before and during treatment and during and after treatment being (t\u0026thinsp;=\u0026thinsp;6.126; t\u0026thinsp;=\u0026thinsp;4.600), and the differences at different treatment stages were statistically significant (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05),as shown in Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e,\u003cem\u003eFig.\u0026nbsp;3\u003c/em\u003e.At the same time,with the changes in the condition,the lungs and heart of children with severe pneumonia showed a trend of synchronous changes.With the improvement of lung function before,during,and after treatment,the increase in lung ultrasound scores,and the simultaneous increase in cardiac EF,FS,andTAPSE(indicators of ventricular systolic function) showed a positive correlation,while the decrease in E/e\u0026apos; (an indicator of ventricular diastolic function) showed a negative correlation, showing statistically significant differences at different treatment stages (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05),as illustrated in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\n \u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Cardiac and Pulmonary Ultrasound Parameters in Children with Severe Pneumonia at Different Treatment Stages (x\u0026thinsp;\u0026plusmn;\u0026thinsp;s)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTreatment Stage\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLung Ultrasound Score\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLVEF\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eLVFS\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eE/e\u0026rsquo;\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTAPSE\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBefore Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e27.50\u0026thinsp;\u0026plusmn;\u0026thinsp;7.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e60.91\u0026thinsp;\u0026plusmn;\u0026thinsp;3.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.40\u0026thinsp;\u0026plusmn;\u0026thinsp;3.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e8.52\u0026thinsp;\u0026plusmn;\u0026thinsp;1.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18.32\u0026thinsp;\u0026plusmn;\u0026thinsp;1.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDuring Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e34.68\u0026thinsp;\u0026plusmn;\u0026thinsp;6.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65.30\u0026thinsp;\u0026plusmn;\u0026thinsp;3.28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.15\u0026thinsp;\u0026plusmn;\u0026thinsp;2.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.79\u0026thinsp;\u0026plusmn;\u0026thinsp;0.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.15\u0026thinsp;\u0026plusmn;\u0026thinsp;1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAfter Treatment\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e41.38\u0026thinsp;\u0026plusmn;\u0026thinsp;5.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e69.60\u0026thinsp;\u0026plusmn;\u0026thinsp;4.38\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e40.83\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7.34\u0026thinsp;\u0026plusmn;\u0026thinsp;0.73\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.80\u0026thinsp;\u0026plusmn;\u0026thinsp;1..83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-21.83\u003csup\u003e※\u003c/sup\u003e/-17.43\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-21.57\u003csup\u003e※\u003c/sup\u003e/-15.72\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-17.68\u003csup\u003e※\u003c/sup\u003e/-8.91\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e6.13\u003csup\u003e※\u003c/sup\u003e/4.60\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-6.21\u003csup\u003e※\u003c/sup\u003e/-6.02\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e※\u003c/sup\u003e/0.000\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e※\u003c/sup\u003e/0.000\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e※\u003c/sup\u003e/0.000\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e※\u003c/sup\u003e/0.000\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.000\u003csup\u003e※\u003c/sup\u003e/0.000\u003csup\u003e△\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eNote: ※ indicates the comparison of lung function before and during treatment in children with severe pneumonia; △ indicates the comparison of lung function during and after treatment in children with severe pneumonia.\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n \u003cp\u003eFigure 3 The table shows the changes in cardiopulmonary condition of the same patient at different treatment stages.Figure a is a lung ultrasound image of a 3-year-old child with severe pneumonia before treatment: diffuse fused B lines and multiple lung lobe consolidation;Figure b is the lung ultrasound image of the same child 72 hours after treatment: reduction of B lines, appearance of A lines, and absorption of consolidation;Figure c is the lung ultrasound image of the same child before discharge: A lines are blurred or clear, with scattered clear B lines visible.\u003c/p\u003e\n\u003c/div\u003e\n\u003cdiv id=\"Sec13\" class=\"Section2\"\u003e\n \u003ch2\u003eCorrelation Analysis of Lung Ultrasound Scores and X-ray Grading at Different Stages of Treatment\u003c/h2\u003e\n \u003cp\u003eLung ultrasound scores in children with severe pneumonia were negatively correlated with X-ray grading before, during, and after treatment (r=-0.736; r=-0.573; r=-0.609, P\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with statistically significant differences. See Fig. \u003cspan class=\"InternalRef\"\u003e5\u003c/span\u003e.\u003c/p\u003e\n\u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eSevere pneumonia represents a significant global health issue, especially among children, as it contributes to high morbidity and mortality rates. The disease is characterized by inflammation of the lung parenchyma, which can lead to severe respiratory distress and complications if not effectively managed. The burden of severe pneumonia is particularly pronounced in pediatric populations, where the potential for severe outcomes is heightened due to the vulnerability of developing respiratory systems. The economic impact on healthcare systems is substantial, necessitating innovative approaches to early detection and management of this condition. Current treatment strategies primarily include antibiotic therapy and supportive care, however, these methods often fall short in terms of timely diagnosis and accurate assessment of disease severity.Therefore there is a critical need for enhanced diagnostic tools that can facilitate earlier intervention and more effective management of severe pneumonia [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e][\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn this study, we focused on the cardiac and pulmonary function changes in children suffering from severe pneumonia and their correlation with ultrasonography scores. Previous studies have highlighted the promising role of cardiac and pulmonary ultrasound in the clinical evaluation of severe pneumonia; however, systematic analyses of ultrasound parameters across different treatment stages remain limited. Our research aimed to bridge this gap by providing a comprehensive evaluation of heart and lung function through ultrasound imaging, alongside chest X-ray assessments, in a cohort of children diagnosed with severe pneumonia. By investigating the relationship between ultrasound parameters and clinical outcomes, our findings have the potential to introduce new insights into the management of severe pneumonia, ultimately aiding clinical decision-making and improving patient outcomes[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e][\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe innovation of our study lies in its comprehensive exploration of cardiopulmonary function changes in pediatric patients diagnosed with severe pneumonia, utilizing a systematic approach to assess the correlation between ultrasound scores and clinical parameters. Previous studies, such as those by Madico et al. (1993) and Chisti et al. (2015), primarily focused on singular aspects of pneumonia management, often neglecting the dynamic interplay of various physiological parameters during different treatment phases. Our research fills this gap by providing a detailed analysis of heart and lung function through echocardiographic measures, which have been correlated with traditional imaging modalities like X-ray. This dual approach not only substantiates the validity of ultrasound as a diagnostic tool but also provides a foundation for its application in real-time clinical assessments, as evidenced by the significant improvements in lung ultrasound scores and cardiac function parameters observed during our study[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e][\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe results of our study hold considerable implications for clinical practice, particularly in the management of severe pneumonia in children. The demonstrated correlation between improved ultrasound scores and enhanced clinical outcomes suggests that incorporating echocardiographic evaluations into routine assessments could lead to earlier detection of worsening conditions and facilitate timely interventions. This is particularly relevant in settings where traditional imaging techniques may not be readily available or feasible. Additionally, the findings support the development of standardized protocols for utilizing ultrasound in the monitoring of pediatric pneumonia, potentially influencing clinical guidelines and policies aimed at optimizing treatment strategies for this vulnerable population[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e][\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eHowever, we acknowledge several limitations within our study that may affect the generalizability of our findings. The relatively small sample size and the single-center design may limit the applicability of our results to broader populations. Furthermore, the absence of long-term follow-up data restricts our ability to evaluate the sustained impact of the identified echocardiographic changes on patient outcomes. Future research should aim to include larger, multi-center cohorts and extend the follow-up period to assess the long-term efficacy of ultrasound-guided management strategies. Additionally, integrating biomarker analyses could enhance our understanding of the underlying pathophysiological mechanisms at play in severe pneumonia cases, ultimately guiding the development of personalized treatment approaches[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e][\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eIn conclusion, this study systematically analyzed the variations in cardiopulmonary function among children with severe pneumonia and demonstrated the significant role of ultrasound in disease assessment. The findings underscore the potential of ultrasound as a reliable tool for clinical evaluation, which may refine treatment strategies and improve patient outcomes. Future research should aim to further optimize therapeutic approaches and enhance prognostic accuracy to ultimately improve the quality of life for affected children.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eLVEF：left ventricular ejection fraction\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLVFS：left ventricular fractional shortening \u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTAPSE：tricuspid annular plane systolic excursion\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participants and their families for their cooperation and support throughout the study. We also acknowledge the contributions of the Science and Technology Research Joint Fund of Public Hospital of Inner Mongolia Academy of Medical Sciences and the Science Research and Development Fund of Baotou Medical College for funding this research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Not applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eLiang LP: Conception, design, data acquisition\u0026nbsp;and\u0026nbsp;analysis, drafting\u0026nbsp;and revising, final approval.\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLiu XQ: Data acquisition and analysis.\u003c/p\u003e\n\u003cp\u003eQin ZP: Data acquisition.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Science and Technology Research Joint Fund of Public Hospital of Inner Mongolia Academy of Medical Sciences(2023GLLH0217) and the Science Research and Development Fund of Baotou Medical College (BYJJ-GCJH 202503).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during this study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study follows the ethical principles of the Helsinki Declaration and has obtained ethical approval from the Medical Ethics Committee of the Second Affiliated Hospital of Baotou Medical College (Approval No: ZX083). All human participants have signed an informed consent form before participating in the study, confirming their voluntary participation. All participants have provided informed consent, and all information during the research process has been fully explained to the participants, including the research purpose, methods, potential risks, and benefits. Participants have the right to withdraw from the study at any time without any adverse effects.\u0026nbsp;Specifically, for all participants under the age of 16, written informed consent was obtained from their parents or legal guardians prior to enrollment in this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eParents or legal guardians of all participants under the age of 16 have obtained informed consent for publication. Parents or legal guardians of all participants have been informed of the purpose of the study and the use of their data in the publication.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting Interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eXie M, Chou YH, Zhang L, Zhang D, Tiu CM. Application of Point-of-care Cardiac Ultrasonography in COVID-19 Infection: Lessons Learned from the Early Experience. J Med Ultrasound. 2021 Mar 20;29(1):3-8. doi:10.4103/JMU.JMU_140_20.PMID: 34084709; PMCID: PMC8081104.\u003c/li\u003e\n\u003cli\u003eKaramolegkos N,Albanese A,Chbat NW. Heart-Lung Interactions During Mechanical Ventilation: Analysis via a Cardiopulmonary Simulation Model. IEEE Open J Eng Med Biol. 2021 Nov 17;2:324-341. doi:10.1109/OJEMB.2021.3128629. PMID:35402980; PMCID: PMC8975239.\u003c/li\u003e\n\u003cli\u003eTakken T, Hulzebos EH. Practical Aspects of Cardiopulmonary Exercise Testing in Children. Int J Sports Med. 2024 Jun;45(6):403-410. doi:10.1055/a-2191-0518.Epub 2023 Oct 12. PMID: 37827506; PMCID: PMC11150037.\u003c/li\u003e\n\u003cli\u003eValente C,Tursi M,Poser H,Guglielmini C.Left Pulmonary Artery Coarctation Associated with Pneumonia and Pulmonary Hypertension in a Cat.Vet Sci.2021 Dec 12;8(12):325. doi: 10.3390/vetsci8120325. PMID: 34941852; PMCID: PMC8708697.\u003c/li\u003e\n\u003cli\u003eOpinc A,Brzezińska O, Makowska J.Underdiagnosis of cardiopulmonary involvement in patients with idiopathic inflammatory myopathies.Reumatologia. 2021;59(5):276-284.doi:10.5114/reum.2021.110609.Epub 2021 Nov 7.PMID:34819701;PMCID: PMC8609382.\u003c/li\u003e\n\u003cli\u003eMiger KC, Fabricius-Bjerre A, Maschmann CP, et al.Clinical Applicability of Lung Ultrasound Methods in the Emergency Department to Detect Pulmonary Congestion on Computed Tomography.Ultraschall Med.2021;42(3):e21-e30. doi:10.1055/a-1021-1470 https://pubmed.ncbi.nlm.nih.gov/31648347/.\u003c/li\u003e\n\u003cli\u003eCunningham LW, Promisloff RA, Cichelli AV. Pulmonary infiltrates associated with Vibrio vulnificus septicemia. J Am Osteopath Assoc.1991 Jan;91(1):84-6. PMID: 1997461.\u003c/li\u003e\n\u003cli\u003eSuzuki S, Manzello SL. Firebrands Generated in Shurijo Castle Fire on October 30th, 2019. Fire Technol. 2022;58(2):10.1007/s10694-021-01176-0. doi: 10.1007/s10694-021-01176-0. PMID: 38868669; PMCID: PMC11167696.\u003c/li\u003e\n\u003cli\u003eSimonato M,Padalino M,Vedovelli L, Carollo C,Sartori A,Vida V,Gregori D, Carnielli V,Cogo P.Effect of preoperative pulmonary hemodynamic and cardiopulmonary bypass on lung function in children with congenital heart disease. Eur J Pediatr. 2023 Jun;182(6):2549-2557. doi: 10.1007/s00431-023-04926-0. Epub 2023 Mar 18. PMID: 36933017; PMCID: PMC10257631.\u003c/li\u003e\n\u003cli\u003eHashimoto K, Kawaguchi T,Yamasaki K, Ikegami H, Kawanami T, Yatera K. Severe infectious acute respiratory failure mimicking COVID-19 in a healthy adolescent. Respirol Case Rep. 2022 Mar 16;10(4):e0933. doi: 10.1002/rcr2.933. PMID: 35317171; PMCID: PMC8924947.\u003c/li\u003e\n\u003cli\u003eCrane SD,Banerjee SK,Pechous RD.Treatment with Fluticasone Propionate Increases Antibiotic Efficacy during Treatment of Late-Stage Primary Pneumonic Plague. Antimicrob Agents Chemother. 2022 Jan 18;66(1):e0127521. doi: 10.1128/AAC.01275-21. Epub 2021 Nov 15. PMID: 34780267; PMCID: PMC8765263.\u003c/li\u003e\n\u003cli\u003eMadico G, Gilman RH, Jabra A, Rojas L, Hern\u0026aacute;ndez H, Fukuda J, Bern C, Steinhoff M. The role of pulse oximetry. Its use as an indicator of severe respiratory disease in Peruvian children living at sea level. Respiratory Group in Peru. Arch Pediatr Adolesc Med. 1995 Nov;149(11):1259-63. doi:10.1001/archpedi.1995.02170240077012.PMID: 7581759.\u003c/li\u003e\n\u003cli\u003eChisti MJ, Salam MA, Bardhan PK, Faruque AS, Shahid AS, Shahunja KM, Das SK, Hossain MI,Ahmed T.Severe Sepsis in Severely Malnourished Young Bangladeshi Children with Pneumonia: A Retrospective Case Control Study. PLoS One. 2015 Oct 6;10(10):e0139966. doi:10.1371/journal.pone.0139966.PMID:26440279;PMCID: PMC4595075.\u003c/li\u003e\n\u003cli\u003eGoenka U, Jajodia S, Jash D, Ghosh S, Bandyopadhyay S.Acute exogenous lipoid pneumonia: Unusual presentation as cavitating lung disease with pneumothorax. Respir Med Case Rep. 2022 Jan 29;36:101593. doi:10.1016/j.rmcr.2022.101593.PMID: 35145844; PMCID: PMC8818583.\u003c/li\u003e\n\u003cli\u003eTan ZX, Mehta B, Kusel K, Seow J, Zelesco M, Abbott S, Simons R, Boardman G, Welman CJ, Ayonrinde OT.Hepatic steatosis: Qualitative and quantitative sonographic assessment in comparison to histology.Australas J Ultrasound Med. 2024 Apr 25;27(3):179-188. doi: 10.1002/ajum.12381. PMID: 39328258; PMCID: PMC11423484.\u003c/li\u003e\n\u003cli\u003eLu B,Shi J,Cheng T,et al. Chemokine ligand 14 correlates with immune cell infiltration in the gastric cancer microenvironment in predicting unfavorable prognosis. Front Pharmacol.15:1397656.Published 2024. doi:10.3389/fphar.2024.1397656 https://pubmed.ncbi.nlm.nih.gov/38887558/.\u003c/li\u003e\n\u003cli\u003eZhai Y, Hai D, Zeng L, et al. Artificial intelligence-based evaluation of prognosis in cirrhosis. J Transl Med.2024;22(1):933. Published 2024 Oct 14. doi:10.1186/s12967-024-05726-2 https://pubmed.ncbi.nlm.nih.gov/39402630/.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Cardiopulmonary ultrasound, Children, Severe pneumonia, X-ray examination, Disease evaluation","lastPublishedDoi":"10.21203/rs.3.rs-7334438/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7334438/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eSevere pneumonia poses a significant health threat to children, contributing to high morbidity rates and substantial economic burden.This study investigates the clinical value of combined cardiac and pulmonary ultrasound in assessing cardiopulmonary function in children with severe pneumonia at different treatment stages. Severe pneumonia remains a critical health issue among young children, with timely and accurate assessment of cardiopulmonary function being essential for effective management.A prospective observational design was employed, involving 60 children aged 3 to 5 years diagnosed with severe pneumonia, who underwent both combined cardiac and pulmonary ultrasound and conventional chest X-ray examinations. The results demonstrated significant dynamic changes in cardiopulmonary function throughout the treatment phases, with key indicators such as left ventricular ejection fraction (LVEF), left ventricular fractional shortening (LVFS), and tricuspid annular plane systolic excursion (TAPSE) showing marked improvement post-treatment (P\u0026lt;0.05), while the E/e′ ratio significantly decreased. Additionally, a negative correlation was found between lung ultrasound scores and chest X-ray grading (r=-0.736; r=-0.573; r=-0.609, P\u0026lt;0.001), highlighting the potential of ultrasound in prognostic evaluation. The study underscores the advantages of using combined cardiac and pulmonary ultrasound for dynamic monitoring of cardiopulmonary function in severe pneumonia cases. However, limitations such as a small sample size and absence of long-term follow-up warrant consideration. In conclusion, this research supports the incorporation of combined ultrasound techniques in clinical practice for better assessment and management of severe pneumonia in pediatric patients, suggesting further exploration of its applicability in other respiratory diseases.\u003c/p\u003e","manuscriptTitle":"The Importance of Dynamic Monitoring of Cardiopulmonary Ultrasound in Evaluating Severe Pneumonia in Pediatric Patients","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-10-08 07:15:33","doi":"10.21203/rs.3.rs-7334438/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2025-09-25T05:20:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"54869558784040343387554327568490764774","date":"2025-09-25T04:56:42+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-09-24T11:19:13+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-16T06:31:26+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-08-29T06:39:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-08-28T10:54:21+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pediatrics","date":"2025-08-28T10:51:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pediatrics","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bped","sideBox":"Learn more about [BMC Pediatrics](http://bmcpediatr.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bped/default.aspx","title":"BMC Pediatrics","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b758b732-79c8-49b0-b977-2ad9362d3f3a","owner":[],"postedDate":"October 8th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-08T07:15:33+00:00","versionOfRecord":[],"versionCreatedAt":"2025-10-08 07:15:33","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7334438","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7334438","identity":"rs-7334438","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}