Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia: a randomized clinical trial
Por:
Guitart-Pardellans C, Bobillo-Perez S, Rodríguez-Fanjul, J, Carrasco, JL, Brotons-de los Reyes P, López-Ramos MG, Cambra-Lasaosa FJ, Balaguer-Gargallo M and Jordán-García I
Publicada:
6 abr 2024
Resumen:
Background Pneumonia is a major public health problem with an impact on morbidity and mortality. Its management still represents a challenge. The aim was to determine whether a new diagnostic algorithm combining lung ultrasound (LUS) and procalcitonin (PCT) improved pneumonia management regarding antibiotic use, radiation exposure, and associated costs, in critically ill pediatric patients with suspected bacterial pneumonia (BP). Methods Randomized, blinded, comparative effectiveness clinical trial. Children < 18y with suspected BP admitted to the PICU from September 2017 to December 2019, were included. PCT was determined at admission. Patients were randomized into the experimental group (EG) and control group (CG) if LUS or chest X-ray (CXR) were done as the first image test, respectively. Patients were classified: 1.LUS/CXR not suggestive of BP and PCT < 1 ng/mL, no antibiotics were recommended; 2.LUS/CXR suggestive of BP, regardless of the PCT value, antibiotics were recommended; 3.LUS/CXR not suggestive of BP and PCT > 1 ng/mL, antibiotics were recommended. Results 194 children were enrolled, 113 (58.2%) females, median age of 134 (IQR 39-554) days. 96 randomized into EG and 98 into CG. 1. In 75/194 patients the image test was not suggestive of BP with PCT < 1 ng/ml; 29/52 in the EG and 11/23 in the CG did not receive antibiotics. 2. In 101 patients, the image was suggestive of BP; 34/34 in the EG and 57/67 in the CG received antibiotics. Statistically significant differences between groups were observed when PCT resulted < 1 ng/ml (p = 0.01). 3. In 18 patients the image test was not suggestive of BP but PCT resulted > 1 ng/ml, all of them received antibiotics. A total of 0.035 mSv radiation/patient was eluded. A reduction of 77% CXR/patient was observed. LUS did not significantly increase costs. Conclusions Combination of LUS and PCT showed no risk of mistreating BP, avoided radiation and did not increase costs. The algorithm could be a reliable tool for improving pneumonia management.
Filiaciones:
Guitart-Pardellans C:
Univ Barcelona, Hosp St Joan Deu, Paediat Intens Care Unit, Passeig St Joan Deu 2, Barcelona 08950, Spain
Univ Barcelona, Inst Recerca St Joan Deu, Immunol & Resp Disorders Pediat Crit Patient Res G, Barcelona, Spain
Inst Recerca St Joan Deu, Pediat Infect Dis Res Grp, Santa Rosa 39-57, Esplugues De Llogregat 08950, Spain
Bobillo-Perez S:
Univ Barcelona, Hosp St Joan Deu, Paediat Intens Care Unit, Passeig St Joan Deu 2, Barcelona 08950, Spain
Univ Barcelona, Inst Recerca St Joan Deu, Immunol & Resp Disorders Pediat Crit Patient Res G, Barcelona, Spain
Inst Recerca St Joan Deu, Pediat Infect Dis Res Grp, Santa Rosa 39-57, Esplugues De Llogregat 08950, Spain
Rodríguez-Fanjul, J:
Autonomous Univ Barcelona, Hosp Germans Trias i Pujol, Dept Pediat, Neonatal Intens Care Unit, Badalona, Spain
Carrasco, JL:
Univ Barcelona, Dept Basic Clin Practice, Barcelona, Spain
Brotons-de los Reyes P:
Consorcio Invest Biomed Red Epidemiol & Salud CIBE, Madrid, Spain
Univ Int Catalunya, Sch Med & Hlth Sci, Barcelona, Spain
López-Ramos MG:
Univ Barcelona, Hosp St Joan Deu, Pharm Dept, Barcelona, Spain
Cambra-Lasaosa FJ:
Univ Barcelona, Hosp St Joan Deu, Paediat Intens Care Unit, Passeig St Joan Deu 2, Barcelona 08950, Spain
Balaguer-Gargallo M:
Univ Barcelona, Hosp St Joan Deu, Paediat Intens Care Unit, Passeig St Joan Deu 2, Barcelona 08950, Spain
Univ Barcelona, Inst Recerca St Joan Deu, Immunol & Resp Disorders Pediat Crit Patient Res G, Barcelona, Spain
Inst Recerca St Joan Deu, Pediat Infect Dis Res Grp, Santa Rosa 39-57, Esplugues De Llogregat 08950, Spain
Jordán-García I:
Univ Barcelona, Hosp St Joan Deu, Paediat Intens Care Unit, Passeig St Joan Deu 2, Barcelona 08950, Spain
Univ Barcelona, Inst Recerca St Joan Deu, Immunol & Resp Disorders Pediat Crit Patient Res G, Barcelona, Spain
Inst Recerca St Joan Deu, Pediat Infect Dis Res Grp, Santa Rosa 39-57, Esplugues De Llogregat 08950, Spain
Consorcio Invest Biomed Red Epidemiol & Salud CIBE, Madrid, Spain
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