Prognostic Value of a New Lung Ultrasound Score to Predict Intensive Care Unit Stay in Pediatric Cardiac Surgery

Massimiliano Cantinotti; Raffaele Giordano; Marco Scalese; Pietro Marchese; Eliana Franchi; Cecilia Viacava; Sabrina Molinaro; Nadia Assanta; Martin Koestenberger; Shelby Kutty; Luna Gargani; Lamia Ait-Ali

doi:10.1016/j.athoracsur.2019.06.057

Prognostic Value of a New Lung Ultrasound Score to Predict Intensive Care Unit Stay in Pediatric Cardiac Surgery

Ann Thorac Surg. 2020 Jan;109(1):178-184. doi: 10.1016/j.athoracsur.2019.06.057. Epub 2019 Aug 7.

Authors

Affiliations

¹ Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy; Institute of Clinical Physiology, National Research Institute, Pisa, Italy.
² Adult and Pediatric Cardiac Surgery, University of Naples Federico II, Naples, Italy. Electronic address: r.giordano81@libero.it.
³ Institute of Clinical Physiology, National Research Institute, Pisa, Italy.
⁴ Fondazione CNR-Regione Toscana G. Monasterio (FTGM), Massa, Pisa, Italy.
⁵ Division of Pediatric Cardiology, Department of Pediatrics, Medical University Graz, Austria.
⁶ Helen B. Taussig Heart Center, Johns Hopkins Hospital and School of Medicine, Baltimore, Maryland.

PMID: 31400328
DOI: 10.1016/j.athoracsur.2019.06.057

Abstract

Background: Lung ultrasound (LUS) in pediatric cardiac surgery is gaining consensus. We (1) evaluated the prognostic value of a new LUS-score in pediatric cardiac surgery, and (2) compared LUS-score to conventional risk factors including age, The Society of Thoracic Surgeons/European Association of Cardio-Thoracic Surgery (STAT) score, cardiopulmonary bypass time, and prognostic biomarkers including brain natriuretic peptide and cystatin-C.

Methods: LUS examinations were performed in 237 children (median age, 0.55 years; interquartile range, 0.09-4.15 years) at 12 to 36 hours after surgery. For each hemithorax, 3 areas (anterior/lateral/posterior) were evaluated in the upper and lower halves, constituting 12 total scanning areas. For each site a score was assigned: 0 (rare B lines), 1 (separated B lines), 2 (coalescent B lines), 3 (loss of aeration), and total LUS score was calculated as sum of all sites. The primary endpoints were intensive care unit length of stay and extubation time.

Results: The mean total LUS score was 12.88 ± 6.41 (range, 0-26) and was higher in newborns (16.77 ± 5.25) compared with older children (5.36 ± 5.57; P < .001). On univariate analysis, LUS score was associated inversely with age (beta 0.26; P = .004) and body surface area (beta 3.41 P = .006) and positively with brain natriuretic peptide (beta 1.65; P < .001) and cystatin-C (beta 2.41; P < .001). The LUS score, when added as continuous predictor to a conventional risk model (age, STAT score, and cardiopulmonary bypass time) emerged significant both for intensive care unit length of stay (beta 0.145, P = .047) and extubation time (beta 1.644; P = .024). When single quadrants were analyzed, only anterior LUS score was significant (intensive care unit length of stay beta, 0.471; P = .020; extubation time beta 5.530; P = .007).

Conclusions: Our data show the prognostic incremental value of a new LUS score over traditional risk factors in pediatric cardiac surgery.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Cardiac Surgical Procedures*
Child, Preschool
Humans
Infant
Infant, Newborn
Intensive Care Units
Length of Stay*
Lung / diagnostic imaging*
Predictive Value of Tests
Prognosis
Prospective Studies
Risk Assessment
Risk Factors
Ultrasonography