Use of Lung Ultrasound to Diagnose the Etiology of Respiratory Failure in a PICU.

Respiratory failure is one of the most common conditions requiring admission to the pediatric
intensive care unit(PICU). As such, chest radiography has emerged as the most commonly
utilized tool in the assessment of lung pathology despite evidence that it may not be the
most accurate. Since the seminal article by Lichtenstein in 2007, lung ultrasound has emerged
as an alternative to chest radiography in the assessment of critically ill adults. Likewise,
pediatric lung ultrasound has a growing body of research to support its use in commonly
encountered lung pathology including pneumonia, asthma, bronchiolitis, acute chest syndrome,
pleural effusions, and pneumothorax. Despite the rapidly growing body evidence, there remains
no literature to support its use in other commonly encountered conditions including, foreign
body aspiration, pulmonary edema/acute respiratory distress syndrome, or acute respiratory
failure, and despite its growing use, it remains an unstudied tool in the PICU.

In the proposed study, we will evaluate whether point-of-care lung ultrasound is accurate in
determining the etiology of acute respiratory failure on admission to the PICU.

Specifically we aim:

1. To determine the sensitivity and specificity of point-of-care lung ultrasound
examination in identifying the etiology of acute pediatric respiratory failure on
admission to the PICU.

2. To determine the inter-observer reliability of point-of-care lung ultrasound examination
findings in acute pediatric respiratory failure among trainee and expert sonographers.

3. Compare point-of-care lung ultrasound with chest radiography in the rate of detection of
pneumothorax and pleural effusion.