J Pediatr Intensive Care 2022; 11(03): 177-182
DOI: 10.1055/s-0041-1725123
Review Article

Lung Ultrasound versus Chest X-Ray for the Detection of Fluid Overload in Critically Ill Children: A Systematic Review

1   Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
,
Jerica Gee
1   Department of Pediatrics, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
,
John W. Cyrus
2   Health Sciences Library, VCU Libraries, Virginia Commonwealth University, Richmond, Virginia, United States
,
Gregory Goldstein
3   Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
,
Kara Greenfield
3   Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
,
Mark Marinello
3   Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
,
3   Division of Pediatric Critical Care Medicine, Children's Hospital of Richmond at VCU, Richmond, Virginia, United States
› Author Affiliations

Abstract

Fluid overload is a common complication of critical illness, associated with increased morbidity and mortality. Pulmonary fluid status is difficult to evaluate clinically and many clinicians utilize chest X-ray (CXR) to identify fluid overload. Adult data have shown lung ultrasound (LUS) to be a more sensitive modality. Our objective was to determine the performance of LUS for detecting fluid overload, with comparison to CXR, in critically ill children. We conducted a systematic review using multiple electronic databases and included studies from inception to November 15, 2020. The sensitivity and specificity of each test were evaluated. Out of 1,209 studies screened, 4 met eligibility criteria. Overall, CXR is reported to have low sensitivity (44–58%) and moderate specificity (52–94%) to detect fluid overload, while LUS is reported to have high sensitivity (90–100%) and specificity (94–100%). Overall, the quality of evidence was moderate, and the gold standard was different in each study. Our systematic review suggests LUS is more sensitive and specific than CXR to identify pulmonary fluid overload in critically ill children. Considering the clinical burden of fluid overload and the relative ease of obtaining LUS, further evaluation of LUS to diagnose volume overload is warranted.

Supplementary Material



Publication History

Received: 17 December 2020

Accepted: 23 January 2021

Article published online:
23 March 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Mah KE, Hao S, Sutherland SM. et al. Fluid overload independent of acute kidney injury predicts poor outcomes in neonates following congenital heart surgery. Pediatr Nephrol 2018; 33 (03) 511-520
  • 2 Bellos I, Iliopoulos DC, Perrea DN. Association of postoperative fluid overload with adverse outcomes after congenital heart surgery: a systematic review and dose-response meta-analysis. Pediatr Nephrol 2020; 35 (06) 1109-1119
  • 3 Rondón G, Saliba RM, Chen J. et al. Impact of fluid overload as new toxicity category on hematopoietic stem cell transplantation outcomes. Biol Blood Marrow Transplant 2017; 23 (12) 2166-2171
  • 4 Chen J, Li X, Bai Z. et al. Association of fluid accumulation with clinical outcomes in critically ill children with severe sepsis. PLoS One 2016; 11 (07) e0160093
  • 5 Alobaidi R, Morgan C, Basu RK. et al. Association between fluid balance and outcomes in critically ill children: a systematic review and meta-analysis. JAMA Pediatr 2018; 172 (03) 257-268
  • 6 Arikan AA, Zappitelli M, Goldstein SL, Naipaul A, Jefferson LS, Loftis LL. Fluid overload is associated with impaired oxygenation and morbidity in critically ill children. Pediatr Crit Care Med 2012; 13 (03) 253-258
  • 7 Selewski DT, Goldstein SL. The role of fluid overload in the prediction of outcome in acute kidney injury. Pediatr Nephrol 2018; 33 (01) 13-24
  • 8 Goldstein SL, Somers MJG, Baum MA. et al. Pediatric patients with multi-organ dysfunction syndrome receiving continuous renal replacement therapy. Kidney Int 2005; 67 (02) 653-658
  • 9 Selewski DT, Cornell TT, Lombel RM. et al. Weight-based determination of fluid overload status and mortality in pediatric intensive care unit patients requiring continuous renal replacement therapy. Intensive Care Med 2011; 37 (07) 1166-1173
  • 10 Hazle MA, Gajarski RJ, Yu S, Donohue J, Blatt NB. Fluid overload in infants following congenital heart surgery. Pediatr Crit Care Med 2013; 14 (01) 44-49
  • 11 Lane PH, Mauer SM, Blazar BR, Ramsay NK, Kashtan CE. Outcome of dialysis for acute renal failure in pediatric bone marrow transplant patients. Bone Marrow Transplant 1994; 13 (05) 613-617
  • 12 Hassinger AB, Wald EL, Goodman DM. Early postoperative fluid overload precedes acute kidney injury and is associated with higher morbidity in pediatric cardiac surgery patients. Pediatr Crit Care Med 2014; 15 (02) 131-138
  • 13 Sinitsky L, Walls D, Nadel S, Inwald DP. Fluid overload at 48 hours is associated with respiratory morbidity but not mortality in a general PICU: retrospective cohort study. Pediatr Crit Care Med 2015; 16 (03) 205-209
  • 14 Allinovi M, Saleem M, Romagnani P, Nazerian P, Hayes W. Lung ultrasound: a novel technique for detecting fluid overload in children on dialysis. Nephrol Dial Transplant 2017; 32 (03) 541-547
  • 15 Long E, O'Brien A, Duke T, Oakley E, Babl FE. Pediatric Research in Emergency Departments International Collaborative. Effect of fluid bolus therapy on extravascular lung water measured by lung ultrasound in children with a presumptive clinical diagnosis of sepsis. J Ultrasound Med 2019; 38 (06) 1537-1544
  • 16 Kaskinen AK, Martelius L, Kirjavainen T, Rautiainen P, Andersson S, Pitkänen OM. Assessment of extravascular lung water by ultrasound after congenital cardiac surgery. Pediatr Pulmonol 2017; 52 (03) 345-352
  • 17 Moher D, Liberati A, Tetzlaff J, Altman DG. PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. BMJ 2009; 339: b2535
  • 18 Hayden JA, van der Windt DA, Cartwright JL, Côté P, Bombardier C. Assessing bias in studies of prognostic factors. Ann Intern Med 2013; 158 (04) 280-286
  • 19 Tang C, Hsieh K. Sonographic evidence of pulmonary edema in pediatric patients with congenital heart disease. Pediatr Pulmonol 2017; 52 (Suppl. 46) S155-S156
  • 20 Gupta D, Sachdev A, Khatri A. To study the correlation between chest radiograph and lung sonography in children admitted to pediatric intensive care unit. Pediatr Crit Care Med J Soc Crit Care Med World Fed Pediatr Intensive Crit Care Soc 2018; 19 (6S) 231
  • 21 Cantinotti M, Ait Ali L, Scalese M. et al. Lung ultrasound reclassification of chest X-ray data after pediatric cardiac surgery. Paediatr Anaesth 2018; 28 (05) 421-427
  • 22 Girona-Alarcón M, Cuaresma-González A, Rodríguez-Fanjul J. et al. LUCAS (lung ultrasonography in cardiac surgery) score to monitor pulmonary edema after congenital cardiac surgery in children. J Matern Fetal Neonatal Med 2022; 35 (06) 1213-1218
  • 23 Covic A, Siriopol D, Voroneanu L. Use of lung ultrasound for the assessment of volume status in CKD. Am J Kidney Dis 2018; 71 (03) 412-422
  • 24 Miglioranza MH, Gargani L, Sant'Anna RT. et al. Lung ultrasound for the evaluation of pulmonary congestion in outpatients: a comparison with clinical assessment, natriuretic peptides, and echocardiography. JACC Cardiovasc Imaging 2013; 6 (11) 1141-1151
  • 25 Picano E, Pellikka PA. Ultrasound of extravascular lung water: a new standard for pulmonary congestion. Eur Heart J 2016; 37 (27) 2097-2104
  • 26 Maw AM, Hassanin A, Ho PM. et al. Diagnostic accuracy of point-of-care lung ultrasonography and chest radiography in adults with symptoms suggestive of acute decompensated heart failure: a systematic review and meta-analysis. JAMA Netw Open 2019; 2 (03) e190703
  • 27 Sakka SG, Reuter DA, Perel A. The transpulmonary thermodilution technique. J Clin Monit Comput 2012; 26 (05) 347-353
  • 28 Monnet X, Teboul J-L. Transpulmonary thermodilution: advantages and limits. Crit Care 2017; 21 (01) 147
  • 29 Lemson J, Backx AP, van Oort AM, Bouw TPWJM, van der Hoeven JG. Extravascular lung water measurement using transpulmonary thermodilution in children. Pediatr Crit Care Med 2009; 10 (02) 227-233
  • 30 Proulx F, Lemson J, Choker G, Tibby SM. Hemodynamic monitoring by transpulmonary thermodilution and pulse contour analysis in critically ill children. Pediatr Crit Care Med 2011; 12 (04) 459-466
  • 31 Khan S, Trof RJ, Groeneveld ABJ. Transpulmonary dilution-derived extravascular lung water as a measure of lung edema. Curr Opin Crit Care 2007; 13 (03) 303-307
  • 32 Singh Y, Villaescusa JU, da Cruz EM. et al. Recommendations for hemodynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24 (01) 620
  • 33 Hopewell S, McDonald S, Clarke M, Egger M. Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database Syst Rev 2007; (02) MR000010
  • 34 Cumpston M, Li T, Page MJ. et al. Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev 2019; 10: ED000142