Application Value Of Lung Ultrasound In Children With Severe Community Acquired Pneumonia

BackgroundCommunity acquired pneumonia is the leading cause of death among children under 5 years.Because children are young and have low immunity,they are more likely to develop into severe community-acquired pneumonia,threatening their lives and increasing the burden on their families.At present,the imaging examination of children with severe community-acquired pneumonia is mainly chest CT and chest X-ray.Because of its radiation,it is blocked in clinical practice.In recent years,lung ultrasound has gradually applied lung disease as an emerging technology,but few studies have been conducted on children with severe community acquired pneumonia.ObjectiveTo analyze the clinical characteristics of children with severe community-acquired pneumonia,to sum up lung ultrasound findings and to show the benefit of lung ultrasound in diagnosing severe community acquired pneumonia in comparison with chest X-rays.Methods1.Research object: Collecting children hospitalized in the Pediatric Intensive Care Unit(PICU)of the first affiliated Hospital of Xinxiang Medical University from December 2016 to December 2018 and clinically diagnosed as severe community acquired pneumonia in children.All the children were examined by lung ultrasound and chest X-ray within 24 hours of admission.2.Chest X-ray: Taking the supine position and shooting the chest X-ray at the bedside.Chest X-ray was evaluated first by a radiologist on duty and then again by a radiology expert.3.Lung ultrasound: In calm or quiet state,selected Esaote MyLab AIpha portable ultrasonic diagnostic instrument,the frequency of 3-12 MHz linear probe.Each side of the chest wall to the side of parastemal line,linea axillaris anterior,posterior axillary line,midclavicular line and double nipple line is divided into anterior superior,inferoanterior,armpit,supra-axillary,posterior upper,posterior inferior total of 12 regions.Lung ultrasound was examined and reported by two professionally trained ultrasound physicians.4.Statistical analysis.Conduct statistical analysis with SPSS 22.0.Measurement data are represented by mean±standard variation((?)± s)and median(M),deviation and continuous variables as number and percentages.The sensitivity,specificity,correct index and diagnostic coincidence rate of lung ultrasound and chest X-ray were calculated.Approximate u test was used to analyze the difference of sensitivity,specificity,correct index and diagnostic coincidence rate between the two methods.The difference was statistically significant(P < 0.05).Results1.The age of severe community acquired pneumonia was mainly in infants less than 1 year old,especially in children less than 3 months old,accounting for 53.1%.2.In this study,84 strains were obtained,of which 49 strains(58.3%)were most common with Streptococcus pneumoniae,followed by Staphylococcus aureus,followed by Haemophilus influenzae.32 strains of virus(38%)were mainly infected with respiratory syncytial virus.Three other pathogens(3.5%)were infected with Mycoplasma pneumoniae.3.Characteristics of lung ultrasound in children with severe community acquired pneumonia: A-lines off,multiple or confluent B-lines,waterfall sign,lung consolidation,air bronchograms and pleural effusion.4.lung ultrasound can detect abnormal changes in 124 patients,chest X-ray can detect abnormal changes in 122 patients.CXR showed normal in 2 patients,while LUS suggested multiple B-lines and lung consolidation.In 1 patient,CXR suggested peribronchial thickening,LUS suggest small amount of B-lines.CXR and LUS in 1 patient showed normal.5.Lung Ultrasound was detected in 74 cases of lung consolidation,and 64 cases were detected in the chest X-ray.The comparison between the two groups was not statistically significant(P=0.217,<0.05).According to the gold standard of chest CT results,the sensitivity,correct index and coincidence rate of lung ultrasound in diagnosing lung consolidation were higher than those in X-ray diagnosis,and the difference was statistically significant(P<0.05).6.17 cases of pleural effusion were detected by lung ultrasound,and 1 case of pleural effusion was detected by chest X-ray.The comparison between the two groups was statistically significant(P=0.011,<0.05).Pleural effusion was found in 2 cases,lung ultrasound in 7 cases and chest X-ray in 0 cases in 53 cases with chest CT.7.In the lung ultrasound results,the consolidated group and the non-consolidated group were compared with pathogen,simple bacterial infection,simple virus infection and mixed infection,it was not statistically significant(P>0.05).Conclusions1.This study shows that the lung ultrasoundimaginng features of severe community acquired pneumonia in children were A-lines off,multiple or confluent B-lines,waterfall sign,lung consolidation,air bronchograms and pleural effusion.2.In terms of pulmonary consolidation and pleural effusions,Lung ultrasound is superior to chest X-ray.It has the advantages of simplicity,no radiation and can be carried out by the bedside,can be used in the diagnosis of severe community-acquired pneumonia in children,more suitable for intensive care unit,reduce radiation exposure,but there is no significant characteristics in pathogenic.