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Background: Pneumonia is one of the most common serious infections in children. Scoring systems have been adopted to quantify the severity of the disease, but they were based on clinical findings that can vary according to the subjective assessment of the clinician. We hypothesized that diaphragm ultrasound (DUS) parameters may be a new useful tool to objectively score the severity of the disease and predict outcomes in children with pneumonia., Methods: Children diagnosed with pneumonia, aged between 1 month and 18 years, were prospectively evaluated in the pediatric emergency department. The Pediatric Respiratory Severity Score was used to indicate the severity of the disease and DUS was performed. Diaphragm thickness at the end of inspiration and expiration, thickening fraction (TF), diaphragm excursion, inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were calculated., Results: There were 96 patients enrolled in the study. Inspiratory slope and ES measurements had positive correlations with respiratory rate and length of stay in the hospital and negative correlations with oxygen saturation levels. Furthermore, TF values were negatively correlated with respiratory rate and length of stay in the emergency department. Patients with higher clinical scores had increased IS and ES and decreased TF values., Conclusion: DUS can be a promising and useful tool to assess diaphragmatic dysfunction in patients diagnosed with pneumonia. Diaphragm parameters, especially TF, IS, and ES, may provide objective and reliable information to predict the severity of the illness, the need for respiratory support, and outcomes., (© 2021 Wiley Periodicals LLC.)

Background: The aim of this study was to evaluate diaphragmatic parameters in bronchiolitis patients and identify correlations between clinical and sonographic severity scores and outcomes to develop a more objective and useful tool in the emergency department., Methods: Children aged between 1 and 24 months and diagnosed with acute bronchiolitis were included in the study. The Modified Respiratory Distress Assessment Instrument (mRDAI) score was used to quantify the clinical severity of the disease. Lung ultrasound was performed and a bronchiolitis ultrasound score (BUS) was calculated. Diaphragm ultrasound was then performed and diaphragm thickness at the end of inspiration and expiration, thickening fraction, diaphragm excursion (EXC), inspiratory slope (IS), expiratory slope (ES), and total duration time of the respiratory cycle were measured., Results: There were 104 patients evaluated in this study. The mRDAI score and BUS had a significant positive correlation. There was a positive correlation between IS and respiratory rate at admission. As the clinical score increased, IS, ES, and EXC measurements rose and they were positively correlated. Values of IS, ES, and EXC were higher in the moderate-severe group than the mild group for both mRDAI and BUS scores. Inspiratory slope values were correlated with the length of stay in the hospital., Conclusion: Values of IS and ES were correlated with clinical and sonographic severity scores. Moreover, IS was a good predictor of outcome. Diaphragm ultrasound appears to be an objective and useful tool to help the physician make decisions regarding the evaluation and management of bronchiolitis., (© 2021 Wiley Periodicals LLC.)

Aim: High-flow nasal cannula (HFNC) is a new treatment option for pediatric respiratory distress and we aimed to assess early predictive factors of unresponsiveness to HFNC therapy in a pediatric emergency department (ED)., Method: Patients who presented with respiratory distress and were treated by HFNC, were included. The age, gender, weight, medical history, diagnosis, vital signs, oxygen saturation/fraction of inspired oxygen (SpO 2 /FiO 2 ) ratio, modified Respiratory Distress Assessment Instrument (mRDAI) scores, medical interventions, duration of HFNC therapy, time to escalation, adverse effects, and laboratory test results were obtained from medical and nursing records. The requirement of a higher level of respiratory support due to unchanged or increased RR compared to initial RR, incipient, or progressive respiratory acidosis, incipient hemodynamic instability was defined as unresponsiveness to HFNC., Results: The study enrolled 154 children with a median age of 10 months (interquartile range [IQR], 5.7-22.5 months). The diagnosis was acute bronchiolitis in 59 patients (38.3%), bacterial pneumonia in 64 patients (41.6%), and atypical or viral pneumonia in 31 patients (20.1%). Twenty-five patients (16.2%) were in the unresponsive group, and the median time for escalating respiratory support was 7 h (IQR: 4-20 h). The unresponsive group had lower SpO 2 and SpO 2 /FiO 2 (SF) ratio on admission, lower venous pH, and higher partial pressure of carbon dioxide (pCO 2 ) (P = 0.002, P = 0.012, and P = 0.001, respectively). Also the alteration of RR, mRDAI score, and SF ratio at the first hour was greater in the responsive group. The cut-off value of SF ratio at the first hour of HFNC was 195 for unresponsiveness., Conclusion: The low initial SpO 2 and SF ratio, respiratory acidosis, and SF ratio less than 195 at the first hours of treatment were related to unresponsiveness to HFNC therapy in our pediatric emergency department., (© 2018 Wiley Periodicals, Inc.)