Estimating Preterm Lung Volume: A Comparison of Lung Ultrasound, Chest Radiography, and Oxygenation - 22/08/23
, Sheryle R. Rogerson, MBBS, DDU, CCPU 1, 4, 5, Gillian W.C. Foo, MBBS 1, 3, Jacqui Keene, MBBS, DDU 6, Niranjan Thomas, MBBS, MD 3, 4, Penny P.L. Kee, MBBS, BMedSci, CCPU 3, 5, Amir Zayegh, MBBS, CCPU 1, 4, Susan M. Donath, BSc (Hons), GDipCS MA 2, David G. Tingay, PhD 2, 7, 8, Peter G. Davis, MD 1, 2, 4, Brett J. Manley, PhD 1, 2, 4Abstract |
Objective |
To determine the relationship between lung ultrasound (LUS) examination, chest radiograph (CXR), and radiographic and clinical evaluations in the assessment of lung volume in preterm infants.
Study design |
In this prospective cohort study LUS was performed before CXR on 70 preterm infants and graded using (1) a LUS score, (2) an atelectasis score, and (3) measurement of atelectasis depth. Radiographic diaphragm position and radio-opacification were used to determine global and regional radiographic atelectasis. The relationship between LUS, CXR, and oxygenation was assessed using receiver operator characteristic and correlation analysis.
Results |
LUS scores, atelectasis scores, and atelectasis depth did not correspond with radiographic global atelectasis (area under receiver operator characteristics curves, 0.54 [95% CI, 0.36-0.71], 0.49 [95% CI, 0.34-0.64], and 0.47 [95% CI, 0.31-0.64], respectively). Radiographic atelectasis of the right upper, right lower, left upper, and left lower quadrants was predicted by LUS scores (0.75 [95% CI, 0.59-0.92], 0.75 [95% CI, 0.62-0.89], 0.69 [95% CI, 0.56-0.82], and 0.63 [95% CI, 0.508-0.751]) and atelectasis depth (0.66 [95% CI, 0.54-0.78], 0.65 [95% CI, 0.53-0.77], 0.63 [95% CI, 0.50-0.76], and 0.56 [95% CI, 0.44-0.70]). LUS findings were moderately correlated with oxygen saturation index (ρ = 0.52 [95% CI, 0.30-0.70]) and saturation to fraction of inspired oxygen ratio (ρ = −0.63 [95% CI, –0.76 to –0.46]). The correlation between radiographic diaphragm position, the oxygenation saturation index, and peripheral oxygen saturation to fraction of inspired oxygen ratio was very weak (ρ = 0.36 [95% CI, 0.11-0.59] and ρ = −0.32 [95% CI, –0.53 to –0.07], respectively).
Conclusions |
LUS assessment of lung volume does not correspond with radiographic diaphragm position preterm infants. However, LUS predicted radiographic regional atelectasis and correlated with oxygenation. The relationship between radiographic diaphragm position and oxygenation was very weak. Although LUS may not replace all radiographic measures of lung volume, LUS more accurately reflects respiratory status in preterm infants.
Trial registration |
Australian New Zealand Clinical Trials Registry: ACTRN12621001119886.
Le texte complet de cet article est disponible en PDF.Keywords : lung ultrasound, lung volume, neonate, ventilation, chest radiograph
Abbreviations : AUC, CXR, FiO2, LLQ, LUQ, LUS, MAP, OSI, ρ, RLQ, ROC, RUQ, S/F ratio, SpO2
Plan
| Funding support: This study is supported by the Victorian Government Operational Infrastructure Support Program (Melbourne, Australia). A.S. is supported by a research grant from the Australasian Society of Ultrasound in Medicine (Grant ID RG 2022/1), a PhD Scholarship from the Centre of Research Excellence in Newborn Medicine (NHMRC, Australia; GNT1153176), and the Research Training Program, University of Melbourne, Victoria, Australia. D.G.T. is supported by a NHMRC Investigator Grant (GNT2008212). P.G.D. is supported by a NHMRC Practitioner Fellowship (GNT556600). B.J.M. is supported by a NHMRC Fellowship grant (GNT2016662). |
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| The study was approved by The Royal Children's Hospital (Melbourne, Australia) Human Research Ethics Committee (HREC/73509/RCHM-2021) in accordance with National Health and Medical Research Council guidelines. Local research governance approval was granted at all participating sites. |
Vol 259
Article 113437- août 2023 Retour au numéro
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