Utility of lung ultrasound in hospitalised patients with acute bronchiolitis. A prospective study.

Utility of lung ultrasound in hospitalised patients with acute bronchiolitis. A prospective study. | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL This is a preprint and has not been peer reviewed. Data may be preliminary. 8 March 2025 V1 Latest version Share on Utility of lung ultrasound in hospitalised patients with acute bronchiolitis. A prospective study. Authors : Jorge Bartual Bardisa 0000-0003-3455-9163 [email protected] , Rosmari Vazquez-Gomis , and José Pastor Rosado Authors Info & Affiliations https://doi.org/10.22541/au.174145324.47471832/v1 193 views 112 downloads Contents Abstract Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract BACKGROUND: Acute bronchiolitis is the first episode of respiratory distress in children under 24 months, characterised by wheezing and crackling rales. Diagnosis is clinical, with no routine supplementary tests recommended. This study aims to determine the utility of lung ultrasound in predicting the course of acute bronchiolitis in patients that require hospitalisation. METHODS: A prospective observational and analytical study was conducted with 100 patients aged 0-2 years, hospitalised in the Infant Hospitalisation Unit, Neonatology, or Neonatal Intensive Care Unit (NICU) with a diagnosis of acute bronchiolitis. Two lung ultrasounds were performed, one at admission and one at discharge, scored using the Pulmonary Score by Zoido Garrote et al 3 . RESULTS: A threshold of 12.5 points (Sensitivity 90%, Specificity 89.7%, AUC 0.96) was set for initiating respiratory support and 17.5 points for ICU admission (S 83.3%, E 93.9%, AUC 0.95). There was a significant correlation between the Pulmonary Score and clinical severity scales, days of respiratory support, hospitalisation duration, and FiO2 requirement. CONCLUSIONS: The Pulmonary Score could be a useful indicator for predicting the need for respiratory support or intensive care in acute bronchiolitis patients. More multicenter studies with larger sample sizes are needed to further investigate the utility of lung ultrasound and the Pulmonary Score in acute bronchiolitis. Utility of lung ultrasound in hospitalised patients with acute bronchiolitis. A prospective study. Prospective observational and analytical study. Jorge Bartual Bardisa a , Rosmari Vázquez Gomis b , José Pastor Rosado b a Department of Paediatrics, Hospital Universitario Torrevieja, Alicante, Spain. b Department of Paediatrics, Hospital General Universitario de Elche, Elche, Spain. It is the institution where research was primarily done Correspondence regarding this manuscript should be directed to: - Jorge Bartual Bardisa - Address: Department of Paediatrics. Hospital Univesitario de Torrevieja. Carretera CV 95, s/n. 03186, Torrevieja, Alicante - Teléfono: 965 695 495 - E-mail: [email protected] Keywords: Acute bronchiolitis; Lung ultrasound; Respiratory support; Oxygen therapy; Infants; Intensive Care Unit. Abbreviations: AB: Acute bronchiolitis. RSV: Respiratory syncytial virus. PICU: Paediatric Intensive Care Unit. NICU: Neonatal Intensive Care Unit. ARDS: Acute Respiratory Distress Syndrome. WDMF: Modified Wood-Downes Scale by Farrés. HSJD: Sant Joan de Déu Hospital Scale. PA: Pleural abnormality. IS: Interstitial syndrome. SP: Subpleural consolidations. NC: Nasal cannula. HFOT: High-flow oxygen therapy. NIMV: Non-invasive mechanical ventilation. IMV: Invasive mechanical ventilation. not-yet-known not-yet-known not-yet-known unknown Author´s contribution Dr. Bartual is the principal investigator of this project, being responsible for the design of the study, performing ultrasounds, collecting data, analyzing them and writing this article. Dra. Vázquez has been an active part of the study design and data analysis, as well as the writing of the manuscript. not-yet-known not-yet-known not-yet-known unknown Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors not-yet-known not-yet-known not-yet-known unknown Conflict of interest The authors declare not to have any conflicts of interest that may be considered to influence directly or indirectly the content of the manuscript. Artificial intelligence involvement The authors declare that no artificial intelligence software or tool was used in the development of this article. Abstract: BACKGROUND: Acute bronchiolitis is the first episode of respiratory distress in children under 24 months, characterised by wheezing and crackling rales. Diagnosis is clinical, with no routine supplementary tests recommended. This study aims to determine the utility of lung ultrasound in predicting the course of acute bronchiolitis in patients that require hospitalisation. METHODS: A prospective observational and analytical study was conducted with 100 patients aged 0-2 years, hospitalised in the Infant Hospitalisation Unit, Neonatology, or Neonatal Intensive Care Unit (NICU) with a diagnosis of acute bronchiolitis. Two lung ultrasounds were performed, one at admission and one at discharge, scored using the Pulmonary Score by Zoido Garrote et al 3 . RESULTS: A threshold of 12.5 points (Sensitivity 90%, Specificity 89.7%, AUC 0.96) was set for initiating respiratory support and 17.5 points for ICU admission (S 83.3%, E 93.9%, AUC 0.95). There was a significant correlation between the Pulmonary Score and clinical severity scales, days of respiratory support, hospitalisation duration, and FiO2 requirement. CONCLUSIONS: The Pulmonary Score could be a useful indicator for predicting the need for respiratory support or intensive care in acute bronchiolitis patients. More multicenter studies with larger sample sizes are needed to further investigate the utility of lung ultrasound and the Pulmonary Score in acute bronchiolitis. not-yet-known not-yet-known not-yet-known unknown INTRODUCTION Acute bronchiolitis (AB) is the first episode of acute respiratory distress in children under 24 months, typically following a viral upper respiratory tract infection, representing one of the most common paediatric conditions1-2. Approximately 2-3% of affected infants will require hospitalisation, making it the leading cause of hospital admissions in children under 12 months and accounting for up to 18% of all paediatric hospitalisations1-2. Acute bronchiolitis is generally caused by viruses, with respiratory syncytial virus (RSV) being the most frequent aetiological agent, responsible for 70-80% of cases. It can affect up to 75% of infants in their first year of life, with a peak incidence between 2 and 3 months of age. About 2-3% of children with their first infection will require hospitalisation, with 2-6% needing intensive care. In industrialised countries, mortality is around 0-1.5%, but globally, RSV infections result in 66,000 to 199,000 annual deaths, making it the second leading cause of death after malaria in children aged 1-12 months1-2. Diagnosis is clinical, and routine supplementary tests (complete blood count, acute-phase reactants, chest X-ray) are not recommended due to lack of evidence. Predicting which patients will have a more unfavourable clinical course is challenging. Clinical severity scales are frequently used to assess the episode’s severity at a specific time but do not predict the clinical course2. Bedside lung ultrasound could help identify patients at risk of a more unfavourable clinical course, allowing for anticipation of complications and preparation of resources (early oxygen therapy or respiratory support, PICU transfer)3. The utility of lung ultrasound has been evaluated in paediatrics4-6 for acute bronchiolitis and other conditions such as pneumonia, ARDS, pleural effusion, or pneumothorax7-10. However, few studies have focused on its utility in severe acute bronchiolitis11-13. This study aims to determine the utility of lung ultrasound in patients with acute bronchiolitis in our area. Study Design A prospective observational and analytical study was designed for paediatric patients aged 0-2 years admitted to the Infant Hospitalisation Unit, Neonatology, or NICU of our hospital with a diagnosis of acute Bronchiolitis. Parents/legal guardians were provided with the study information and consent forms. The project was reviewed and approved by the Hospital’s Research Ethics Committee (registration code PI 104/2021) and written informed consent for participation and publication of results was obtained from parents or legal guardians. The study was conducted according to the principles established in the Declaration of Helsinki, the Council of Europe’s Convention on Human Rights and Biomedicine, Spanish legislation (Law 14/2007 of July 3 on Biomedical Research), and data protection regulations (Organic Law 3/2018 of December 5 on Personal Data Protection and guarantee of digital rights (LOPD-GDD)). Patient involvement Patients or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research. Participants Based on data from previous years in our unit, a sample size of 44 patients was calculated using the EPIDATE program for a confidence level of 95%. Inclusion criteria were patients aged 0-2 years with a diagnosis of mild, moderate, or severe acute bronchiolitis requiring hospitalisation, with signed consent from parents or legal guardians. The diagnosis of acute bronchiolitis was established following the classic McConnochie criteria 4 : Patients under 2 years of age, presenting with a first episode of respiratory distress, tachypnea, and retractions, along with wheezing or fine crackles on pulmonary auscultation. Exclusion criteria included patients with previous wheezing episodes between 0-2 years, premature infants with a history of bronchopulmonary dysplasia, and lack of informed consent. Procedures Two lung ultrasounds were performed during hospitalisation: one at admission and one at discharge. Each ultrasound was scored using the Pulmonary Score by Zoido Garrote et al 3 . The score analysed 2 anterior (parasternal line and anterior axillary line) and 3 posterior lung fields (paravertebral line, posterior axillary line, and subscapular line). Points were assigned based on findings: • Pleural Abnormalities (AP): thickening or absence of sliding, 1 point. Maximum 10 points. • Interstitial Syndrome (IS): focal (less than 3 B-lines in an intercostal space) 1 point; diffuse (more than 3 B-lines in an intercostal space or two adjacent spaces with white lung image) 2 points. Maximum 20 points. • Subpleural Consolidations (SC): 1cm 2 points. Maximum 20 points. The total maximum score was 50 points. The ultrasounds are performed by the principal investigator and a collaborator, having received training in lung ultrasound prior to the initiation of the study. A CHISUN-1 portable black-and-white ultrasound machine with a 3-5 MHz convex probe was used for all patients. Data Collection Demographic and clinical variables such as age, sex, weight, height, BMI, risk factors for severe acute bronchiolitis (age <6 weeks, gestational age <35 weeks, chronic cardiorespiratory disease, absence of exclusive breastfeeding), symptom duration, and clinical severity scores ( Modified Wood-Downes and Sant Joan de Déu Hospital Scales ) were collected. Additionally, Pulmonary Score at admission and Pulmonary Score at discharge, respiratory support type, FiO2, and total days of respiratory support and hospitalisation were recorded. not-yet-known not-yet-known not-yet-known unknown Data Analysis Data analysis was performed using R software version 4.2.3. Categorical variables were described using absolute numbers (n) and percentages (%), analysed with the Chi-square test and Yate’s correction if necessary. Continuous variables were compared using the mean and standard deviation (SD) for normally distributed data or the median with interquartile range (Iq25-Iq75) for non-normally distributed data, analysed with the T-Student test or Mann-Whitney U test, respectively. Correlations were established using Spearman’s correlation coefficient, and cut-off points were determined through ROC curve analysis. A p-value of <0.05 was considered statistically significant. RESULTS Out of 102 patients, 2 were excluded due to chronic respiratory disease, leaving 100 included in the study. Demographic and clinical characteristics are shown in Table 1. The median age was 1 month, and the median weight was 4805g. 59% (n=59) were males and 41% (n=41) females. 21% (n=21) of patients were hospitalized in the Neonatology or NICU for being under 1 month old, although it is worth noting that all of them were older than 15 days. The remaining 79% (n=79) were admitted to the Infant Hospitalisation Unit. At admission, the median duration of bronchiolitis was 2 days. No significant differences were found between sexes regarding age, anthropometry, clinical severity, ultrasound score, and treatment at admission. Similarly, no significant differences were found in the need for respiratory support or hospitalisation duration. Regarding risk factors for severe acute bronchiolitis, 69% (n=69) of patients had at least one, with a significantly higher incidence in males (79.7% n=47 vs. 53.7% n=22, p=0.008), particularly the absence of exclusive breastfeeding (42.4% n=25 vs. 17.1% n=7, p=0.009). Table 2 presents variables collected during hospitalisation. The median scores were 5 and 6 on the Wood-Downes and Sant Joan de Déu scales, respectively, with most bronchiolitis classified as moderate on both scales (77% n=77 and 56% n=56). At admission, 70% (n=70) of patients received some treatment other than respiratory support, mainly bronchodilators (33% n=33) and intravenous fluid therapy (37% n=37). Lung ultrasounds were performed within 24-48 hours of admission, with a median (IQ25-IQ75) Pulmonary Score of 14 points (11-17) for the cohort. The most affected lung areas were the posterior fields, with interstitial syndrome (IS) having a median (IQ25-IQ75) score of 8 points (6-10.2); subpleural consolidations (SP) 4 points (2-5); and pleural abnormalities (PA) 3 points (1-4). Figure 1 shows images of these findings, extracted from the ultrasounds performed on the patients in the study. 71% (n=71) of patients required respiratory support at admission, primarily high-flow oxygen therapy (HFOT) (54% n=54), with a median duration of 4 days. Patients not requiring support had a median (IQ25-IQ75) Pulmonary Score of 10 points (8-11) compared to 16 points (14-18) for those who did, with the difference being statistically significant (p 0.21, with a median of 0.26. ROC curve analysis established a lung ultrasound score cut-off of 12.5 for indicating the initiation of respiratory support, with a good sensitivity and specificity (Figure 2). Cut-off points for different modes of respiratory support and ultrasound scores are shown in Table 3. 18% (n=18) of patients required ICU admission. The median (IQ25-IQ75) Pulmonary Score for these patients was 24 points (19-26). 11.1% (n=2) were transferred to the reference paediatric ICU, and 88.9% (n=16) remained in the hospital’s NIC. The cut-off between the Pulmonary Score and ICU admission was 17.5 points (Figure 3). The correlations between the Pulmonary Score and the severity scales and hospitalisation days and respiratory support are shown in figures 4 and 5. A significant correlation was also found between the ultrasound score and the need for additional FiO2 (Spearman’s rho 0.36, p=0.0016). Finally, multivariate analysis using a robust linear regression model evaluating sex, weight, age, and risk factors for severe bronchiolitis as potential factors associated with increased Pulmonary Score found no statistically significant factors (Table 4). At discharge, the median (IQ25-IQ75) Pulmonary Score was 6 points (5-8), and patients had a median hospitalisation duration of 5 days. DISCUSSION Bronchiolitis is prevalent among infants in the first two years of life, primarily those under 12 months. In this study, most patients were under one year old, with a median age of 1 month, predominantly male. This contrasts with literature data where the peak age of incidence is 2-3 months 15 . However, 21% (n=21) of our patients were from Neonatology and/or NICU. Clinical practice guidelines do not recommend nebulised treatments or corticosteroids due to lack of evidence of its utility 15 , but they are still used in many cases, including our hospital. The study did not analyse possible correlations between the Pulmonary Score and treatments due to the lack of evidence and the subjective nature of treatment decisions based on the clinical moment and attending physician. Regarding severity assessment, previous studies demonstrate the utility of scales in evaluating acute bronchiolitis 16-17 . In this study, there was a significant correlation between these scales and the ultrasound score, suggesting it could be an additional tool for initial severity assessment. Zoido Garrote et al. 3 suggest that the Pulmonary Score ”could have some value in identifying patients who will require more days of hospitalisation and oxygen therapy.” In this study, ROC curve analysis showed that a score above 12.5 could be a good indicator of the need for respiratory support, with around 90% sensitivity and specificity. Patients with higher scores required more additional FiO2, in a statistically significant manner, indicating that greater initial lung involvement on ultrasound could be linked to increased supplemental oxygen needs. Significant correlations were also found between the Pulmonary Score and days of respiratory support and hospitalisation, suggesting that patients with worse ultrasound results will need more days of hospital treatment. The cut-off points obtained for nasal cannula and HFOT showed high sensitivity but low specificity, with AUCs below 0.75, indicating low discriminatory power for these cut-off points. Therefore, a score above 12.5 indicates a higher probability of needing respiratory support without determining the most appropriate type. A score above 17.5 showed good sensitivity and specificity for considering the start of non-invasive mechanical ventilation (NIMV), coinciding with the ICU requirement cut-off, while a score above 21 indicated the need for invasive mechanical ventilation (IMV). However, few patients received NIMV (n=8) and IMV (n=6), necessitating a larger sample and further study of ultrasound in these cases. Zoido Garrote et al. 3 reported a median score of 17 points in patients requiring ICU transfer. In this study, the median (IQ25-IQ75) was 24 (19-26) points, possibly due to the inclusion of NICU patients with significant initial ultrasound involvement. The cut-off established was 17.5 points, indicating that a higher score could alert the need for ICU admission with 93% specificity. However, sensitivity was around 83%, so some patients requiring intensive care could score lower. It’s essential to remember that complementary tests and imaging techniques assist but the patient’s clinical situation mainly determines the course of action. Regarding the relationship between the Pulmonary Score and ICU, it’s noteworthy that only two patients were transferred to the paediatric ICU, with most ICU admissions being neonatal patients. Further study is needed to determine if older children requiring PICU have more significant ultrasound findings or if the same cut-off applies. Finally, multivariate analysis found no significant variables, suggesting that age, sex, weight at admission, or the presence of severe acute bronchiolitis risk factors were not confounding factors. In conclusion, despite acute bronchiolitis being a condition where routine complementary tests are not recommended, lung ultrasound could play an important role in cases with uncertain evolution or when more information is needed to establish the best therapeutic option. Further studies are necessary to continue evaluating the utility of lung ultrasound in acute bronchiolitis. Limitations The findings should be interpreted considering the study’s limitations. Ultrasounds were performed within 24-48 hours of admission, representing different stages of the disease for each patient. Given that bronchiolitis peaks around the 3rd-4th day of evolution, some ultrasounds might show more involvement than others. The median evolution duration was 2 days. Although not recommended, treatments like bronchodilators, corticosteroids, or adrenaline, if administered to some patients, they could potentially affect clinical impact and ultrasound scores. Ultrasound is an observer-dependent technique in generally uncooperative patients (neonates and infants), complicating interpretation and possibly underestimating or overestimating the score. The investigator performing the score might anticipate specific findings in patients with more symptoms, potentially biasing results. Zoido Garrote et al. 3 noted that scoring up to 10 lung areas might complicate clinical applicability, especially in urgent situations. They suggested simplifying the score in future studies by omitting pleural abnormalities, which we also recommend. CONCLUSIONS 1. In our population, there was a statistically significant higher presence of risk factors in male patients, particularly the absence of exclusive breastfeeding. 2. A Pulmonary Score above 12.5 points is, in our study, a good indicator of the need for respiratory support initiation with around 90% sensitivity and specificity. 3. In our patient group, a score above 17.5 points is associated with a higher need for intensive care, especially in neonates, with near 94% specificity. 4. In our population, there is a statistically significant correlation between the Pulmonary Score and clinical severity scales, hospitalisation days, respiratory support days, and additional FiO2 requirement. 5. More multicenter studies with larger sample sizes are needed to further investigate the utility of lung ultrasound and the Pulmonary Score in acute bronchiolitis. Bibliography 1. García García ML, Korta Murua J, Callejón Callejón A. Bronquiolitis aguda viral. Protoc diagn ter pediatr. 2017; 1: 85-102. 2. Jiménez García R, Andina Martínez D, Palomo Guerra B, Escalada Pellitero S, de la Torre Espí M. Impacto en la práctica clínica de un nuevo protocolo de bronquiolitis aguda. An Pediatr (Barc). 2019; 90 (2): 79-85. 3. Zoido Garrote E, García Aparicio C, Torrez Villarroel CC, Pedro Vega A, Muñiz Fontán M, Oulego Erroz I. Utilidad de la ecografía pulmonar precoz en bronquiolitis aguda leve-moderada: estudio piloto. An Pediatr (Barc). 2019; 90 (1): 10-18. 4. Cattarossi L. Lung ultrasound: Its role in neonatology and pediatrics. Early Human Development. 2013; 89: 17-19. 5. Trinavarant P, Riccabona M. Potential of ultrasound in the pediatric chest. Eur J Radiol. 2014; 83: 1507-1518. 6. Chen SW, Zhang MY, Liu J. Application of lung ultrasonography in the diagnosis of childhood lung diseases. Chin Med J (Engl). 2015; 128: 2672-2678 7. Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children. Radiol Med. 2008; 113: 190-198. 8. Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in children: A meta-analysis. Pediatrics. 2015;135: 714-722. 9. Reali F, Papa GFS, Carlucci P, Fracasso P, Marco FD, Mandelli M, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneumonia in hospitalized children? Respiration. 2014; 88: 112-115. 10. Moreno-Aguilar G, Lichtenstein D. Lung ultrasound in the critically ill (LUCI) and the lung point: A sign specific to pneumothorax which cannot be mimicked. Crit Care. 2015;19:311 11. Basile V, Di Mauro A, Scalini E, Comes P, Lofù I, Mostert M, et al. Lung ultraosund: A useful tool in diagnosis and management of bronchiolitis. BMC Pediatr. 2015; 15(1): 1-8 12. Cohen JS, Hughes N, Tat S, Chamberlain JM, Teach SJ, Boniface K. The utility of bedside lung ultrasound findings in bronchiolitis. Pediatr Emerg Care. 2017; 33: 97-100 13. Taveira M, Yousef N, Miatello J, Roy C, Claude C, Boutillier B, et al. Can a simple lung ultrasound score predict length of ventilation for infants with severe acute viral bronchiolitis? Arch Pediatr. 2018; 25(2): 112-117. 14. McConnochie KM. Bronchiolitis: What’s in the name? Am J Dis Child. 1993; 137:11-3. 15. Sim Nebot M, Claret Teruel G, Luaces Cubells C, Estrada Sabadell MD, Pou Fernández J. Guía de práctica clínica sobre la bronquiolitis aguda: recomendaciones para la práctica clínica. An Pediatr (Barc). 2010; 73 (4): 208.e1-208.e10 16. Ramos Fernández J, Cordón Martínez A, Galindo Zavala R, Urda Cardona A. Validación de una escala clínica de gravedad de la bronquiolitis aguda. An Pediatr (Barc). 2014; 81: 3-8. 17. Balaguer M, Alejandre C, Vila D, Esteban E, Carrasco JL, Cambra FJ, et al. Bronchiolitis Score of Sant Joan de Déu: BROSJOD Score, validation and usefulness. Pediatr Pulmonol. 2017; 52: 533-9 APPENDIX Tables: Sex: n (%) Males 59(59) Females 41(41) Median age (months) 1(1- 3) Patients 1 month, n (%) 79(79) Median weight (grams) 4805 (3977.5-6067.5) Median weight Z-Score -0.55 (-1.1-0.3) Median length (cm) 57.5 (53-63) Median length Z-Score 0.19 (-0.8-1) Mean BMI (kg/m2) 14.7 (2.2) Median BMI Z-Score -0.8 (1.4) Severe acute bronchiolitis risk factors, n (%) Yes 69 (69) No 31 (31) Risk factors distribution (n=69 patients) Age < 6 weeks 44 (63.8) GA < 35 weeks 6 (8.7) Chronic C-R disease 1 (1.4) Absence of exclusive breastfeeding 32 (46.4) Median symptom duration (days) 2 (1-3) Continuous variables with normal distribution are expressed as mean and standard deviation (SD), and those with non-normal distribution as median and interquartile range (IQ25-IQ75) Median Wood-Downes scale 5 (4-6) Mild, n (%) 14 (14) Moderate, n (%) 77 (77) Severe, n (%) 9 (9) Median Sant Joan de Déu scale 6 (5-8) Mild, n (%) 37 (37) Moderate, n (%) 56 (56) Severe, n (%) 7 (7) Median Pulmonary Ultrasound Score Pleural Abnormalities (0-10) 3 (1-4) Interstitial Syndrome (0-20) 8 (6-10) Subpleural Consolidations (0-20) 4 (2-5) Global Score (0-50) 14 (11-17) Treatment at admission, n (%) Yes 71 (71) No 29 (29) Treatment received, n (% of 71 patients) 3% hypertonic saline 8 (11.3) Bronchodilators 33 (46.5) Corticosteroids 19 (26.8) Nebulised adrenaline 20 (28.2) IV fluid therapy 37 (52.1) Antibiotics 12 (16.9) Respiratory support, n (%) Yes 71 (71) No 29 (29) Type of support, n (% of 71 patients) Nasal cannula/mask 3 (4.2) High flow 54 (76.1) Non-invasive mechanical ventilation 8 (11.3) Invasive mechanical ventilation 6 (8.5) Additional FiO2 requirement, n (% of 71 patients) 53 (74.6) Median FiO2 0.26 (0.22-0.3) ICU requirement, n (%) 18 (18) PICU, n (% of 18 patients) 2 (11.1) NICU (% of 18 patients) 16 (88.9) Median Score for ICU patients 24 (19-26) Continuous variables with non-normal distribution are expressed as median and interquartile range (IQ25-IQ75). RESPIRATORY SUPPORT CUT-OFF POINT SENSITIVITY SPECIFICITY AUC NC 13.5 100% 56.7% 0.73 HFOT 12.5 90% 60.8% 0.67. NIMV 17.5 87.5% 85.8% 0.91 IMV 21 100% 92.5% 0.98 NC: Nasal Cannula; HFOT: High Flow Oxygen Therapy; NIMV: Non-invasive Mechanical Ventilation; VMI: Invasive Mechanical Ventilation p-value Age 0.75 Severe acute bronchiolitis RF 0,074 Sex 0.31 Weight at admission 0.88 RF: Risk Factors Figures: Figure 1. Images extracted from the ultrasounds performed on the study patients, showing the main findings that contribute to the Pulmonary Score. a) Diffuse interstitial syndrome, with small subpleural condensations. b) Diffuse interstitial syndrome, with pleural thickening. c) Subpleural consolidation >1 cm Figure 2. ROC curve for respiratory support. A lung ultrasound score cut-off of 12.5 presents a sensitivity of 90% and specificity of 89.7% for the initiation of respiratory support, with an area under the curve of 0.96. Figure 3 . ROC curve for ICU requirement. A lung ultrasound score cut off of 17.5 presents a sensitivity of 83.3% and specificity of 93.9% for the need of intensive care, with an area under the curve of 0.95. Figure 4. Scatter plots of correlation with clinical severity scales. A significant correlation was found between the Pulmonary Score and the Wood-Downes (Spearman’s rho 0.52, p<0.001) and Sant Joan de Déu scales (Spearman’s rho 0.59, p<0.001). Figure 5 . Scatter plots of correlation with hospitalisation day and respiratory support days. There were significant correlations between the Pulmonary Score and total hospitalisation days (Spearman’s rho 0.52, p<0.001) and days of respiratory support (Spearman’s rho 0.60, p<0.001). Information & Authors Information Version history V1 Version 1 08 March 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Keywords acute bronchiolitis intensive care unit lung ultrasound oxygen therapy respiratory support Authors Affiliations Jorge Bartual Bardisa 0000-0003-3455-9163 [email protected] Hospital Universitario de Torrevieja View all articles by this author Rosmari Vazquez-Gomis Hospital General Universitario de Elche View all articles by this author José Pastor Rosado Hospital General Universitario de Elche View all articles by this author Metrics & Citations Metrics Article Usage 193 views 112 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Jorge Bartual Bardisa, Rosmari Vazquez-Gomis, José Pastor Rosado. Utility of lung ultrasound in hospitalised patients with acute bronchiolitis. A prospective study.. Authorea . 08 March 2025. DOI: https://doi.org/10.22541/au.174145324.47471832/v1 If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download. For more information or tips please see 'Downloading to a citation manager' in the Help menu . Format Please select one from the list RIS (ProCite, Reference Manager) EndNote BibTex Medlars RefWorks Direct import Tips for downloading citations document.getElementById('citMgrHelpLink').addEventListener('click', function() { popupHelp(this.href); return false; }); $(".js__slcInclude").on("change", function(e){ if ($(this).val() == 'refworks') $('#direct').prop("checked", false); $('#direct').prop("disabled", ($(this).val() == 'refworks')); }); View Options View options PDF View PDF Figures Tables Media Share Share Share article link Copy Link Copied! Copying failed. Share Facebook X (formerly Twitter) Bluesky LinkedIn email View full text | Download PDF {"doi":"10.22541/au.174145324.47471832/v1","type":"Article"} Now Reading: Share Figures Tables Close figure viewer Back to article Figure title goes here Change zoom level Go to figure location within the article Download figure Toggle share panel Toggle share panel Share Toggle information panel Toggle information panel Go to previous graphic Go to next graphic Go to previous table Go to next table All figures All tables View all material View all material xrefBack.goTo xrefBack.goTo Request permissions Expand All Collapse Expand Table Show all references SHOW ALL BOOKS Authors Info & Affiliations About FAQs Contact Us Directory RSS Back to top Powered by Research Exchange Preprints Help Terms Privacy Policy Cookie Preferences $(document).ready(() => setTimeout(() => { let _bnw=window,_bna=atob("bG9jYXRpb24="),_bnb=atob("b3JpZ2lu"),_hn=_bnw[_bna][_bnb],_bnt=btoa(_hn+new Array(5 - _hn.length % 4).join(" ")); $.get("/resource/lodash?t="+_bnt); },4000)); (function(){function c(){var b=a.contentDocument||a.contentWindow.document;if(b){var d=b.createElement('script');d.innerHTML="window.__CF$cv$params={r:'a02515cf9a111640',t:'MTc3OTg4NTU5Ng=='};var a=document.createElement('script');a.src='/cdn-cgi/challenge-platform/scripts/jsd/main.js';document.getElementsByTagName('head')[0].appendChild(a);";b.getElementsByTagName('head')[0].appendChild(d)}}if(document.body){var a=document.createElement('iframe');a.height=1;a.width=1;a.style.position='absolute';a.style.top=0;a.style.left=0;a.style.border='none';a.style.visibility='hidden';document.body.appendChild(a);if('loading'!==document.readyState)c();else if(window.addEventListener)document.addEventListener('DOMContentLoaded',c);else{var e=document.onreadystatechange||function(){};document.onreadystatechange=function(b){e(b);'loading'!==document.readyState&&(document.onreadystatechange=e,c())}}}})();