Клінічний досвід застосування стандартизованого національного протоколу УЗД легень у дітей для скринінгових обстежень в амбулаторних умовах та умовах відділень інтенсивної терапії

Abstract

The article highlights the use of ultrasound diagnostics (US) of the lungs for screening examination of paediatric patients, as it allows for a quick differential diagnosis, a comprehensive assessment of the course of the disease, especially in doubtful cases, a reduction in the time required for examination of patients, and timely adjustment of treatment. Screening ultrasound, combined with physical examination methods, is a kind of «sonographic stethoscope», the use of which simplifies, shortens and improves the diagnostic process and the choice of treatment tactics. Purpose - to prove the feasibility of using a standardised lung ultrasound protocol for screening paediatric patients with symptoms of respiratory system disorders in outpatient and day hospital settings. Materials and methods. The study involved 137 patients aged 4 months to 12 years old. The data of clinical picture, physical and laboratory examinations, computed tomography and lung radiography, semiotics of lung lesions were analysed. For the study, we used stationary ultrasound devices of high and expert class «Samsung» (South Korea), «Mindray» (China), «GE» (USA), which are equipped at the Kinder Clinic, Kyiv, and the National Specialised Children’s Hospital «OKHMATDYT», Kyiv. For paediatric age, a 4-12 mHz linear sensor was mostly used. Results. A total of 137 patients aged 4 months to 12 years were examined. Pneumonia was confirmed in 52 (38%) patients. Of the 137 patients, the polymerase chain reaction test was positive for COVID-19 in 11 (8%) cases and for influenza A in 3 (2.2%) cases. No signs of pneumonia were noted in 85 (62%) children, but 59 (69.4%) of the 85 patients had interstitial syndrome at the B+ and B++ levels, especially expressed in loci I-IV-VII. In the remaining 26 (30.6%) patients, lung ultrasound did not reveal any changes that would indicate disease. They also did not have clear clinical manifestations of acute respiratory viral infection. Separately, we analysed 7 doubtful cases (5.1% of the total) with no or one of the listed diagnostic criteria. Conclusions. This method is recommended for effective lung screening as an «ultrasound stethoscope» for paediatric patients to detect lung pathology, in particular, in the case of latent disease, and to reduce radiation exposure. It is a priority for dynamic monitoring of the course of the disease and the effectiveness of therapeutic tactics. This diagnostic method is affordable and effective for use by doctors of various specialties. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of all participating institutions. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.