Lung ultrasound and procalcitonin, improving antibiotic management and avoiding radiation exposure in pediatric critical patients with bacterial pneumonia : a randomized clinical trial
Guitart, Carmina (Institut de Recerca Pediàtrica Hospital San Joan de Déu de Barcelona)
Bobillo-Perez, Sara (Institut de Recerca Pediàtrica Hospital San Joan de Déu de Barcelona)
Rodríguez-Fanjul, Javier (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Carrasco, José Luís (Universitat de Barcelona)
Brotons, Pedro (Universitat Internacional de Catalunya)
López-Ramos, Maria Goretti (Hospital Sant Joan de Déu (Barcelona, Catalunya))
Cambra, Francisco José (Hospital Sant Joan de Déu (Barcelona, Catalunya))
Balaguer, Mònica (Institut de Recerca Pediàtrica Hospital San Joan de Déu de Barcelona)
Jordan, Iolanda (Hospital Sant Joan de Déu (Barcelona, Catalunya))
Universitat Autònoma de Barcelona

Fecha:	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. Clinical Trial Registration: NCT04217980.
Ayudas:	Ministerio de Economía y Competitividad PI16/01040
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Publicado en:	European Journal of Medical Research, Vol. 29 Núm. 1 (december 2024) , p. 222, ISSN 2047-783X

DOI: 10.1186/s40001-024-01712-y
PMID: 38581075

13 p, 1.7 MB

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Documentos de investigación > Documentos de los grupos de investigación de la UAB > Centros y grupos de investigación (producción científica) > Ciencias de la salud y biociencias > Institut d'Investigació en Ciencies de la Salut Germans Trias i Pujol (IGTP)
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