Scientific Letter
Bedside lung ultrasound in paediatric intensive care
Utilidad de la ecografía pulmonar a pie de cama en cuidados intensivos pediátricos
A. Coca Pérez
, J.L. Vázquez Martínez, C. Pérez Caballero Macarrón, R. Tapia Moreno, S. Stanescu
Corresponding author
Unidad de Cuidados Intensivos Pediátricos, Hospital Ramón y Cajal, Madrid, Spain
Read
8739
Timeswas read the article
2611
Total PDF
6128
Total HTML
Share statistics
array:24 [ "pii" => "S2341287915002859" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.11.006" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1886" "copyright" => "Asociación Española de Pediatría" "copyrightAnyo" => "2015" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2016;84:57-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 3027 "formatos" => array:3 [ "EPUB" => 163 "HTML" => 2248 "PDF" => 616 ] ] "Traduccion" => array:1 [ "es" => array:19 [ "pii" => "S1695403315002246" "issn" => "16954033" "doi" => "10.1016/j.anpedi.2015.05.006" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1886" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2016;84:57-9" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 4427 "formatos" => array:3 [ "EPUB" => 132 "HTML" => 3631 "PDF" => 664 ] ] "es" => array:11 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Carta científica</span>" "titulo" => "Utilidad de la ecografía pulmonar a pie de cama en cuidados intensivos pediátricos" "tienePdf" => "es" "tieneTextoCompleto" => "es" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "59" ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Bedside lung ultrasound in paediatric intensive care" ] ] "contieneTextoCompleto" => array:1 [ "es" => true ] "contienePdf" => array:1 [ "es" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figura 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1364 "Ancho" => 2917 "Tamanyo" => 285426 ] ] "descripcion" => array:1 [ "es" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Caso 5: (a) Exploración ecográfica con PEEP 5. Consolidación pulmonar, objetivándose signo <span class="elsevierStyleItalic">«tissue-like»</span> y broncograma regular y paralelo (líneas hiperecogénicas[^]) en región superior, media y lateral. (b) Exploración ecográfica con PEEP 8. Iguales hallazgos ecográficos. (c) Exploración ecográfica tras reclutamiento alveolar con PEEP 11. Signo de consolidación en región superior, con pulmón normalmente aireado en región media e inferior (se visualizan líneas A).</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "A. Coca Pérez, J.L. Vázquez Martínez, C. Pérez Caballero Macarrón, R. Tapia Moreno, S. Stanescu" "autores" => array:5 [ 0 => array:2 [ "nombre" => "A." "apellidos" => "Coca Pérez" ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Vázquez Martínez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Pérez Caballero Macarrón" ] 3 => array:2 [ "nombre" => "R. Tapia" "apellidos" => "Moreno" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Stanescu" ] ] ] ] ] "idiomaDefecto" => "es" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S2341287915002859" "doi" => "10.1016/j.anpede.2015.11.006" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915002859?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315002246?idApp=UINPBA00005H" "url" => "/16954033/0000008400000001/v5_201703300053/S1695403315002246/v5_201703300053/es/main.assets" ] ] "itemSiguiente" => array:19 [ "pii" => "S2341287915002872" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.11.007" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1983" "copyright" => "Asociación Española de Pediatría" "documento" => "article" "crossmark" => 1 "subdocumento" => "fla" "cita" => "An Pediatr (Barc). 2016;84:60.e1-60.e13" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 8299 "formatos" => array:3 [ "EPUB" => 308 "HTML" => 7109 "PDF" => 882 ] ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Spanish Association of Paediatrics</span>" "titulo" => "Immunisation schedule of the Spanish Association of Paediatrics: 2016 recommendations" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "es" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "60.e1" "paginaFinal" => "60.e13" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Calendario de vacunaciones de la Asociación Española de Pediatría (CAV-AEP): Recomendaciones 2016" ] ] "contieneResumen" => array:2 [ "en" => true "es" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0035" "etiqueta" => "Figure 7" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr7.jpeg" "Alto" => 1122 "Ancho" => 1667 "Tamanyo" => 150318 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0105" class="elsevierStyleSimplePara elsevierViewall">Dosage of the influenza vaccine by age and vaccination history.<a class="elsevierStyleCrossRef" href="#bib0385"><span class="elsevierStyleSup">37</span></a></p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "D. Moreno-Pérez, F.J. Álvarez García, J. Arístegui Fernández, M.J. Cilleruelo Ortega, J.M. Corretger Rauet, N. García Sánchez, A. Hernández Merino, T. Hernández-Sampelayo Matos, M. Merino Moína, L. Ortigosa del Castillo, J. Ruiz-Contreras" "autores" => array:12 [ 0 => array:2 [ "nombre" => "D." "apellidos" => "Moreno-Pérez" ] 1 => array:2 [ "nombre" => "F.J." "apellidos" => "Álvarez García" ] 2 => array:2 [ "nombre" => "J." "apellidos" => "Arístegui Fernández" ] 3 => array:2 [ "nombre" => "M.J." "apellidos" => "Cilleruelo Ortega" ] 4 => array:2 [ "nombre" => "J.M." "apellidos" => "Corretger Rauet" ] 5 => array:2 [ "nombre" => "N." "apellidos" => "García Sánchez" ] 6 => array:2 [ "nombre" => "A." "apellidos" => "Hernández Merino" ] 7 => array:2 [ "nombre" => "T." "apellidos" => "Hernández-Sampelayo Matos" ] 8 => array:2 [ "nombre" => "M." "apellidos" => "Merino Moína" ] 9 => array:2 [ "nombre" => "L. Ortigosa" "apellidos" => "del Castillo" ] 10 => array:2 [ "nombre" => "J." "apellidos" => "Ruiz-Contreras" ] 11 => array:1 [ "colaborador" => "on behalf of Comité Asesor de Vacunas de la Asociación Española de Pediatría (CAV-AEP)" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315003859" "doi" => "10.1016/j.anpedi.2015.10.001" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315003859?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915002872?idApp=UINPBA00005H" "url" => "/23412879/0000008400000001/v3_201703220337/S2341287915002872/v3_201703220337/en/main.assets" ] "itemAnterior" => array:19 [ "pii" => "S2341287915001179" "issn" => "23412879" "doi" => "10.1016/j.anpede.2015.05.019" "estado" => "S300" "fechaPublicacion" => "2016-01-01" "aid" => "1894" "copyright" => "Asociación Española de Pediatría" "documento" => "simple-article" "crossmark" => 1 "subdocumento" => "crp" "cita" => "An Pediatr (Barc). 2016;84:56-7" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:2 [ "total" => 2067 "formatos" => array:3 [ "EPUB" => 138 "HTML" => 1462 "PDF" => 467 ] ] "en" => array:10 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "<span class="elsevierStyleSmallCaps">d</span>-Lactic acidosis in a ten months old infant with short bowel syndrome: Early suspicion equals early treatment" "tienePdf" => "en" "tieneTextoCompleto" => "en" "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "56" "paginaFinal" => "57" ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Acidosis d-láctica en un niño de diez meses afecto de un síndrome de intestino corto: la rápida sospecha equivale a un rápido tratamiento" ] ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "P. Obando Pacheco, V.M. Navas López, R. Yahyaoui Macías, C. Sierra Salinas" "autores" => array:4 [ 0 => array:2 [ "nombre" => "P." "apellidos" => "Obando Pacheco" ] 1 => array:2 [ "nombre" => "V.M." "apellidos" => "Navas López" ] 2 => array:2 [ "nombre" => "R." "apellidos" => "Yahyaoui Macías" ] 3 => array:2 [ "nombre" => "C." "apellidos" => "Sierra Salinas" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "es" => array:9 [ "pii" => "S1695403315002325" "doi" => "10.1016/j.anpedi.2015.05.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => false "ES2" => false "LATM" => false ] "gratuito" => false "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "es" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S1695403315002325?idApp=UINPBA00005H" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915001179?idApp=UINPBA00005H" "url" => "/23412879/0000008400000001/v3_201703220337/S2341287915001179/v3_201703220337/en/main.assets" ] "en" => array:16 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Scientific Letter</span>" "titulo" => "Bedside lung ultrasound in paediatric intensive care" "tieneTextoCompleto" => true "saludo" => "Dear Editor," "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "57" "paginaFinal" => "59" ] ] "autores" => array:1 [ 0 => array:4 [ "autoresLista" => "A. Coca Pérez, J.L. Vázquez Martínez, C. Pérez Caballero Macarrón, R. Tapia Moreno, S. Stanescu" "autores" => array:5 [ 0 => array:4 [ "nombre" => "A." "apellidos" => "Coca Pérez" "email" => array:1 [ 0 => "pdacoca@gmail.com" ] "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor0005" ] ] ] 1 => array:2 [ "nombre" => "J.L." "apellidos" => "Vázquez Martínez" ] 2 => array:2 [ "nombre" => "C." "apellidos" => "Pérez Caballero Macarrón" ] 3 => array:2 [ "nombre" => "R." "apellidos" => "Tapia Moreno" ] 4 => array:2 [ "nombre" => "S." "apellidos" => "Stanescu" ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Unidad de Cuidados Intensivos Pediátricos, Hospital Ramón y Cajal, Madrid, Spain" "identificador" => "aff0005" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Utilidad de la ecografía pulmonar a pie de cama en cuidados intensivos pediátricos" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3232 "Ancho" => 3250 "Tamanyo" => 1024896 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>: (a) M-mode. Stratosphere sign: linear pattern at both sides of the pleural line (*), indicating the absence of lung sliding. (b) M-mode. Lung point: transition from the normal lung (right side, linear granular pattern) to the pneumothorax (left side, linear pattern). (c) M-mode after resolution of pneumothorax. Seashore sign: combination of a linear patter and a granular pattern at either side of the pleural line (*), indicating normal lung sliding. <span class="elsevierStyleItalic">Case 2</span>: (a) right-sided pleural effusion (quad sign) with consolidated underlying lung parenchyma (tissue-like sign) and bronchograms (hyperechoic foci [^]). (b) Resolution of effusion after chest tube placement. Lung consolidation above the diaphragm (*), difficult to differentiate from the liver (arrow). (c) Left hemithorax: basal pleural effusion and consolidated underlying lung (tissue-like sign and bronchograms [^]). (d) Left hemithorax: lung parenchyma consolidation, with detection of tissue-like sign and shred sign (pattern of consolidation with an irregular lower border indicating where the consolidated parenchyma makes contact with the normal lung tissue [arrows]). <span class="elsevierStyleItalic">Case 3</span>: coalescing B lines in (a) anterior and superior (AS) regions of right hemithorax, (b) anterior and inferior (AI) right hemithorax, (c) AS left hemithorax, (d) AI left hemithorax. Diagnosis of bilateral diffuse interstitial syndrome. (e) Ideal areas for ultrasound examination for the diagnosis of diffuse interstitial lung syndrome. AS, AI, lateral superior (LS), lateral inferior (LI), right (D), left (I). <span class="elsevierStyleItalic">Case 4</span>: M-mode (a) Right diaphragm: maximal diaphragmatic excursion between inspiration and expiration of 0.88<span class="elsevierStyleHsp" style=""></span>cm (50% compared to contralateral excursion). (b) Left diaphragm: 1.63<span class="elsevierStyleHsp" style=""></span>cm. (c and d) Left and right diaphragm after resolution of paralysis (1.96 vs 1.92<span class="elsevierStyleHsp" style=""></span>cm).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">In recent years, the use of point-of-care ultrasound (PoCUS), understood as the bedside ultrasound examination of the patient by the physician in charge, has been increasing in paediatric patients for the investigation of pulmonary, pleural and diaphragmatic disease, following its use in adult patients, in whom the technique has been developing for more than a decade, and whose ultrasound semiotics can be safely extrapolated to the paediatric age group. The unossified costal cartilage and sternum and thinner adipose subcutaneous tissue in children provide ideal acoustic windows.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1,2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">There are limitations to plain chest radiography, such as poor image quality, the presence of artefacts, the time required to obtain the image and the exposure to ionising radiation. There are also limitations to chest computed tomography (CT), the gold standard for the diagnosis of respiratory pathology, including its high cost, reduced availability, higher exposure to radiation and difficulty involved in transporting the patient outside the unit.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> Thus, PoCUS is emerging as the ideal diagnostic tool in the paediatric intensive care unit (PICU): quick, non-invasive, repeatable, offering real-time information and without exposure to radiation, with sensitivities and specificities that approximate those of computed tomography (CT).<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present five clinical cases of common diseases in the PICU in which PoCUS was a useful diagnostic tool and guided changes to the therapeutic approach.</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case 1</span><p id="par0020" class="elsevierStylePara elsevierViewall">Infant aged 2 months admitted for bronchiolitis. After being intubated, the patient had difficulty with oxygenation and ventilation, leading to suspicion of a secondary pneumothorax. PoCUS: sonographic signs of right-sided pneumothorax (absence of lung sliding, stratosphere sign, absence of B lines, presence of lung point). After insertion of a pleural drainage tube, the resolution of pneumothorax was detected by ultrasound. The use of PoCUS prevented diagnostic and treatment delays (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Case 2</span><p id="par0025" class="elsevierStylePara elsevierViewall">Male aged 5 years with pleural effusion associated with right lower lobe pneumonia on the fifth day of antibiotic treatment. PoCUS: right-sided pleural effusion (quad sign) and consolidation of the underlying lung parenchyma (tissue-like sign or hepatisation and bronchograms). A pleural drainage tube was placed, and the draining fluid had normal characteristics. These findings led to performance of a contralateral PoCUS, which revealed a small volume of pleural effusion and consolidation of the underlying lung parenchyma. Following the sonographic diagnosis of bilateral pneumonia, testing for atypical pathogens was requested, the results of which were positive for <span class="elsevierStyleItalic">Mycoplasma pneumoniae</span> and adenovirus. PoCUS was useful in guiding the thoracocentesis and the aetiologic diagnosis, and in finding evidence of consolidation that had not been detected by plain radiography (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Case 3</span><p id="par0030" class="elsevierStylePara elsevierViewall">Male aged 17 years with a history of operated tetralogy of Fallot admitted to the unit for respiratory difficulty and cyanosis following resection of a nasal polyp. At admission, the patient presented with mild tachycardia, tachypnoea, cyanosis, intercostal and suprasternal retractions and rales. PoCUS: pattern of coalescing B lines in anterior regions of both lungs (bilateral diffuse interstitial syndrome). In light of these findings, the tachycardia was reassessed, leading to diagnosis of atrial flutter with 2:1 conduction. The use of PoCUS allowed the diagnosis of acute pulmonary oedema secondary to arrhythmia in a patient with a prior history of ventriculotomy and a difficult-to-interpret ECG (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Case 4</span><p id="par0035" class="elsevierStylePara elsevierViewall">Male aged 7 years that had received a diagnosis of severe Ebstein's anomaly and admitted following surgical closure of atrial septal defect, tricuspid valve repair and a bidirectional Glenn procedure. The patient had a complicated postoperative course with extubation failure requiring rescue noninvasive ventilation. PoCUS: reduced movement of right diaphragm by 50% compared to the left (postoperative phrenic nerve palsy). Given the possible need of diaphragmatic plication due to univentricular physiology, PoCUS was performed daily, showing progressive improvement and ultimately resolution. The use of PoCUS allowed the harmless monitorisation of diaphragmatic function and the adoption of a conservative approach (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>).</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Case 5</span><p id="par0040" class="elsevierStylePara elsevierViewall">Infant aged one month admitted for bronchiolitis and on mechanical ventilation. The patient experienced sudden desaturation with a high peak inspiratory pressure (volume-targeted mode of ventilation) and hypoventilation in the left hemithorax. PoCUS: visualisation of consolidation in entire left lung (superior, medial and basal regions), suggestive of atelectasis in the existing clinical context and consistent with the presence of regular parallel bronchograms. Alveolar recruitment measures were initiated, increasing the positive-end expiratory pressure (PEEP) from 5 to 8<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O. One hour later the patient had shown clinical but not sonographic improvement. The PEEP was increased again from 8 to 11<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O. One hour later, PoCUS revealed a nearly full resolution of the atelectasis, with sonographic signs of a normally aerated lung in the medial and basal regions and consolidation persisting only in the apical region. The use of PoCUS allowed the rapid and differential diagnosis of a severe complication, in addition to guiding the complex alveolar recruitment manoeuvre (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>).</p><elsevierMultimedia ident="fig0010"></elsevierMultimedia><p id="par0045" class="elsevierStylePara elsevierViewall">The cases presented here demonstrate the usefulness and safety of PoCUS carried out by the paediatric intensivist, with a potentially beneficial impact on the diagnosis and treatment of severely ill children contingent on an appropriate standardised training.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a></p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:6 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Case 1" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Case 2" ] 2 => array:2 [ "identificador" => "sec0015" "titulo" => "Case 3" ] 3 => array:2 [ "identificador" => "sec0020" "titulo" => "Case 4" ] 4 => array:2 [ "identificador" => "sec0025" "titulo" => "Case 5" ] 5 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Coca Pérez A, Vázquez Martínez JL, Pérez Caballero Macarrón C, Tapia Moreno R, Stanescu S. Utilidad de la ecografía pulmonar a pie de cama en cuidados intensivos pediátricos. An Pediatr (Barc). 2016;84:57–59.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3232 "Ancho" => 3250 "Tamanyo" => 1024896 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Case 1</span>: (a) M-mode. Stratosphere sign: linear pattern at both sides of the pleural line (*), indicating the absence of lung sliding. (b) M-mode. Lung point: transition from the normal lung (right side, linear granular pattern) to the pneumothorax (left side, linear pattern). (c) M-mode after resolution of pneumothorax. Seashore sign: combination of a linear patter and a granular pattern at either side of the pleural line (*), indicating normal lung sliding. <span class="elsevierStyleItalic">Case 2</span>: (a) right-sided pleural effusion (quad sign) with consolidated underlying lung parenchyma (tissue-like sign) and bronchograms (hyperechoic foci [^]). (b) Resolution of effusion after chest tube placement. Lung consolidation above the diaphragm (*), difficult to differentiate from the liver (arrow). (c) Left hemithorax: basal pleural effusion and consolidated underlying lung (tissue-like sign and bronchograms [^]). (d) Left hemithorax: lung parenchyma consolidation, with detection of tissue-like sign and shred sign (pattern of consolidation with an irregular lower border indicating where the consolidated parenchyma makes contact with the normal lung tissue [arrows]). <span class="elsevierStyleItalic">Case 3</span>: coalescing B lines in (a) anterior and superior (AS) regions of right hemithorax, (b) anterior and inferior (AI) right hemithorax, (c) AS left hemithorax, (d) AI left hemithorax. Diagnosis of bilateral diffuse interstitial syndrome. (e) Ideal areas for ultrasound examination for the diagnosis of diffuse interstitial lung syndrome. AS, AI, lateral superior (LS), lateral inferior (LI), right (D), left (I). <span class="elsevierStyleItalic">Case 4</span>: M-mode (a) Right diaphragm: maximal diaphragmatic excursion between inspiration and expiration of 0.88<span class="elsevierStyleHsp" style=""></span>cm (50% compared to contralateral excursion). (b) Left diaphragm: 1.63<span class="elsevierStyleHsp" style=""></span>cm. (c and d) Left and right diaphragm after resolution of paralysis (1.96 vs 1.92<span class="elsevierStyleHsp" style=""></span>cm).</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Figure 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 1364 "Ancho" => 2917 "Tamanyo" => 250686 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleItalic">Case 5</span>: (a) Ultrasound examination at PEEP 5<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O. Lung consolidation with detection of tissue-like sign and regular and parallel bronchograms (hyperechoic lines [^]) in the superior, medial and lateral regions. (b) Ultrasound examination at PEEP 8<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O. The findings were the same. (c) Ultrasound examination after alveolar recruitment at PEEP 11<span class="elsevierStyleHsp" style=""></span>cm H<span class="elsevierStyleInf">2</span>O. Evidence of consolidation in the apical region of the lung, with normal aeration in medial and basal lung regions (visualisation of A lines).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Ultrasounds of the pediatric chest-the ins and outs" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "N. Supakul" 1 => "B. Karmazyn" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1053/j.sult.2012.12.001" "Revista" => array:6 [ "tituloSerie" => "Semin Ultrasound CT MR" "fecha" => "2013" "volumen" => "34" "paginaInicial" => "274" "paginaFinal" => "285" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23768893" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0035" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "International evidence-based recommendations for point-of-care lung ultrasound" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "G. Volpicceli" 1 => "M. Elbarbary" 2 => "M. Blaivas" 3 => "D.A. Lichtenstein" 4 => "G. Mathis" 5 => "A.W. Kirkpatrick" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00134-012-2513-4" "Revista" => array:6 [ "tituloSerie" => "Intensive Care Med" "fecha" => "2012" "volumen" => "38" "paginaInicial" => "577" "paginaFinal" => "591" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22392031" "web" => "Medline" ] ] ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0040" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical review: bedside lung ultrasound in critical care practice" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "B. Bouhemad" 1 => "M. Zhang" 2 => "Q. Lu" 3 => "J.J. Rouby" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1186/cc5668" "Revista" => array:6 [ "tituloSerie" => "Crit Care" "fecha" => "2007" "volumen" => "11" "paginaInicial" => "205" "paginaFinal" => "213" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17316468" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasound in the critically ill" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "D.A. Lichtenstein" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:5 [ "tituloSerie" => "Neth J Crit Care" "fecha" => "2012" "volumen" => "16" "paginaInicial" => "43" "paginaFinal" => "51" ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Lung ultrasonography and pediatric cardiac surgery: first experience with a new toll for postoperative lung complications" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "V. Vitale" 1 => "Z. Ricci" 2 => "P. Cogo" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/j.athoracsur.2014.01.060" "Revista" => array:6 [ "tituloSerie" => "Ann Thorac Surg" "fecha" => "2014" "volumen" => "97" "paginaInicial" => "e121" "paginaFinal" => "e124" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24694455" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/23412879/0000008400000001/v3_201703220337/S2341287915002859/v3_201703220337/en/main.assets" "Apartado" => array:4 [ "identificador" => "38181" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/23412879/0000008400000001/v3_201703220337/S2341287915002859/v3_201703220337/en/main.pdf?idApp=UINPBA00005H&text.app=https://analesdepediatria.org/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2341287915002859?idApp=UINPBA00005H" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 8 | 13 |
| 2024 October | 60 | 46 | 106 |
| 2024 September | 55 | 33 | 88 |
| 2024 August | 61 | 60 | 121 |
| 2024 July | 59 | 33 | 92 |
| 2024 June | 57 | 35 | 92 |
| 2024 May | 66 | 48 | 114 |
| 2024 April | 65 | 26 | 91 |
| 2024 March | 48 | 33 | 81 |
| 2024 February | 55 | 38 | 93 |
| 2024 January | 60 | 20 | 80 |
| 2023 December | 93 | 16 | 109 |
| 2023 November | 78 | 30 | 108 |
| 2023 October | 58 | 30 | 88 |
| 2023 September | 57 | 17 | 74 |
| 2023 August | 58 | 31 | 89 |
| 2023 July | 79 | 23 | 102 |
| 2023 June | 74 | 27 | 101 |
| 2023 May | 64 | 20 | 84 |
| 2023 April | 59 | 27 | 86 |
| 2023 March | 68 | 26 | 94 |
| 2023 February | 45 | 19 | 64 |
| 2023 January | 58 | 21 | 79 |
| 2022 December | 88 | 35 | 123 |
| 2022 November | 81 | 45 | 126 |
| 2022 October | 98 | 38 | 136 |
| 2022 September | 57 | 39 | 96 |
| 2022 August | 59 | 46 | 105 |
| 2022 July | 69 | 38 | 107 |
| 2022 June | 53 | 46 | 99 |
| 2022 May | 68 | 44 | 112 |
| 2022 April | 63 | 44 | 107 |
| 2022 March | 79 | 58 | 137 |
| 2022 February | 64 | 39 | 103 |
| 2022 January | 81 | 33 | 114 |
| 2021 December | 81 | 56 | 137 |
| 2021 November | 83 | 56 | 139 |
| 2021 October | 82 | 59 | 141 |
| 2021 September | 93 | 64 | 157 |
| 2021 August | 62 | 51 | 113 |
| 2021 July | 51 | 31 | 82 |
| 2021 June | 81 | 54 | 135 |
| 2021 May | 65 | 51 | 116 |
| 2021 April | 163 | 39 | 202 |
| 2021 March | 99 | 35 | 134 |
| 2021 February | 64 | 39 | 103 |
| 2021 January | 56 | 28 | 84 |
| 2020 December | 32 | 27 | 59 |
| 2020 November | 69 | 24 | 93 |
| 2020 October | 77 | 27 | 104 |
| 2020 September | 51 | 28 | 79 |
| 2020 August | 60 | 7 | 67 |
| 2020 July | 59 | 30 | 89 |
| 2020 June | 72 | 27 | 99 |
| 2020 May | 85 | 30 | 115 |
| 2020 April | 64 | 32 | 96 |
| 2020 March | 69 | 14 | 83 |
| 2020 February | 47 | 27 | 74 |
| 2020 January | 49 | 20 | 69 |
| 2019 December | 35 | 36 | 71 |
| 2019 November | 54 | 12 | 66 |
| 2019 October | 58 | 20 | 78 |
| 2019 September | 51 | 16 | 67 |
| 2019 August | 48 | 22 | 70 |
| 2019 July | 33 | 16 | 49 |
| 2019 June | 52 | 29 | 81 |
| 2019 May | 100 | 55 | 155 |
| 2019 April | 144 | 30 | 174 |
| 2019 March | 70 | 34 | 104 |
| 2019 February | 88 | 28 | 116 |
| 2019 January | 63 | 32 | 95 |
| 2018 December | 66 | 41 | 107 |
| 2018 November | 104 | 38 | 142 |
| 2018 October | 122 | 44 | 166 |
| 2018 September | 60 | 28 | 88 |
| 2018 August | 4 | 0 | 4 |
| 2018 July | 2 | 0 | 2 |
| 2018 June | 6 | 0 | 6 |
| 2018 May | 11 | 0 | 11 |
| 2018 April | 48 | 0 | 48 |
| 2018 March | 45 | 0 | 45 |
| 2018 February | 42 | 0 | 42 |
| 2018 January | 44 | 0 | 44 |
| 2017 December | 32 | 0 | 32 |
| 2017 November | 46 | 0 | 46 |
| 2017 October | 44 | 0 | 44 |
| 2017 September | 28 | 0 | 28 |
| 2017 August | 27 | 0 | 27 |
| 2017 July | 30 | 0 | 30 |
| 2017 June | 48 | 13 | 61 |
| 2017 May | 48 | 10 | 58 |
| 2017 April | 116 | 10 | 126 |
| 2017 March | 18 | 5 | 23 |
| 2017 February | 45 | 9 | 54 |
| 2017 January | 35 | 11 | 46 |
| 2016 December | 40 | 14 | 54 |
| 2016 November | 57 | 5 | 62 |
| 2016 October | 53 | 3 | 56 |
| 2016 September | 73 | 6 | 79 |
| 2016 August | 54 | 6 | 60 |
| 2016 July | 28 | 10 | 38 |
Show all
