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Background <p>Excessive intravenous fluid administration can prolong invasive mechanical ventilation (IMV) in critically ill children. In ventilated adults, lung point-of-care ultrasound (POCUS) is increasingly used to assess fluid status. We aimed to assess the correlation between B-lines on daily lung POCUS in ventilated children, contemporaneous oxygenation markers and cumulative fluid balance.</p> Methods <p>This prospective single-centre observational cohort study was conducted between March 2023 and May 2024. Doctors and physiotherapists utilised POCUS to measure B-line scores (BLS) across 8 zones in children expected to remain ventilated beyond 24&#xa0;h. Daily scans were conducted until ventilation liberation or IMV day 7. Contemporaneous oxygen saturation (SpO2):fraction of inspired oxygen (FiO2) (SF) ratio and fluid balance (cumulative fluid balance [CFB] and clinical oedema) were measured. Mixed effects linear regression was used to assess the association between daily B-line scores and SF ratio, CFB and oedema.</p> Results <p>Thirty seven children were enrolled (78 scans) with median age 18 months (IQR 9–44). The most common admission reason was respiratory (76%, <i>n</i> = 28). Scans took a median of 10&#xa0;min (IQR 5–10). Median B-line score was 4 (IQR 2–9). Median IMV duration was 92.5&#xa0;h (IQR 54–132). In mixed-effects linear models adjusting for patient-level predictors (age, PIM3 score), there was a significant association between SF ratio and BLS (<i>p</i> = 0.004), but no significant association between CFB and BLS (<i>p</i> = 0.6) or oedema.</p> Conclusion <p>This study describes the use of bedside POCUS assessment to serially assess fluid status in ventilated children. B-line scores correlated with SF ratio, although not with measured fluid balance or oedema. Larger studies are needed to definitively establish clinical utility in this setting.</p>

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Serial fluid overload assessment in critically ill children using chest ultrasound (FOCUS): a prospective cohort study

  • 期刊论文

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  • 发表日期：

    2025年7月17日

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  • Emma C. Alexander,
  • Nur Mohammed Zahari,
  • Deborah Ezra,
  • Steven Tran,
  • Manisha Kumar,
  • Sarah Rosen,
  • Thomas Bycroft,
  • Rebecca Mitting,
  • Padmanabhan Ramnarayan

摘要

Background

Excessive intravenous fluid administration can prolong invasive mechanical ventilation (IMV) in critically ill children. In ventilated adults, lung point-of-care ultrasound (POCUS) is increasingly used to assess fluid status. We aimed to assess the correlation between B-lines on daily lung POCUS in ventilated children, contemporaneous oxygenation markers and cumulative fluid balance.

Methods

This prospective single-centre observational cohort study was conducted between March 2023 and May 2024. Doctors and physiotherapists utilised POCUS to measure B-line scores (BLS) across 8 zones in children expected to remain ventilated beyond 24 h. Daily scans were conducted until ventilation liberation or IMV day 7. Contemporaneous oxygen saturation (SpO2):fraction of inspired oxygen (FiO2) (SF) ratio and fluid balance (cumulative fluid balance [CFB] and clinical oedema) were measured. Mixed effects linear regression was used to assess the association between daily B-line scores and SF ratio, CFB and oedema.

Results

Thirty seven children were enrolled (78 scans) with median age 18 months (IQR 9–44). The most common admission reason was respiratory (76%, n = 28). Scans took a median of 10 min (IQR 5–10). Median B-line score was 4 (IQR 2–9). Median IMV duration was 92.5 h (IQR 54–132). In mixed-effects linear models adjusting for patient-level predictors (age, PIM3 score), there was a significant association between SF ratio and BLS (p = 0.004), but no significant association between CFB and BLS (p = 0.6) or oedema.

Conclusion

This study describes the use of bedside POCUS assessment to serially assess fluid status in ventilated children. B-line scores correlated with SF ratio, although not with measured fluid balance or oedema. Larger studies are needed to definitively establish clinical utility in this setting.