Integrated use of bedside lung ultrasound and echocardiography to manage pediatric patients with respiratory failure and shock in pediatric intensive care unit

Objective To evaluate the value of integrated use of bedside lung ultrasound and echocardiography in PICU. Methods Two cases with respiratory failure and shock were monitored using integrated bedside lung ultrasound and echocardiography.Breathing and circulation support solutions were adopted according to Bedside Lung Ultrasound in Emergency(BLUE) and Fluid Administration Limited by Lung Sonography(FALLS). Results Case 1 with acute lymphoblastic leukemia complicated with severe phneumonia was measured as"B-profile"throughout both lung fields which interpreted as pulmonary edema according to the BLUE protocol.He was diagnosed as acute respiratory distress syndrome later and supported by non-invasive ventilation according to the lung ultrasonography.After 4 days, the numbers of B line were significantly reduced with PaO2/FiO2>300 mmHg(1 mmHg=0.133 kPa) and the improvement in chest X radiography was found, ventilation was weaned accordingly.Case 2 was diagnosed as septic shock and acute respiratory distress syndrome with volume resuscitation and mechanical ventilation.According to FALLS protocol, we ruled out obstructive and cardiogenic shock, and assessed the variation in inferior vena cava diameter and aortic systolic velocity-time integral as a guide to fluid therapy.At the 8th hour in PICU, case 2 recovered from shock. Conclusion Integrated use of bedside lung ultrasound and echocardiography is clinically significant for the rescue of critically ill patient with respiratory failure and shock. Key words: Lung ultrasound; Respiratory failure; Shock; Critical care; Children,