Abstract
Fluid overload is a common complication of critical illness, associated with increased
morbidity and mortality. Pulmonary fluid status is difficult to evaluate clinically
and many clinicians utilize chest X-ray (CXR) to identify fluid overload. Adult data
have shown lung ultrasound (LUS) to be a more sensitive modality. Our objective was
to determine the performance of LUS for detecting fluid overload, with comparison
to CXR, in critically ill children. We conducted a systematic review using multiple
electronic databases and included studies from inception to November 15, 2020. The
sensitivity and specificity of each test were evaluated. Out of 1,209 studies screened,
4 met eligibility criteria. Overall, CXR is reported to have low sensitivity (44–58%)
and moderate specificity (52–94%) to detect fluid overload, while LUS is reported
to have high sensitivity (90–100%) and specificity (94–100%). Overall, the quality
of evidence was moderate, and the gold standard was different in each study. Our systematic
review suggests LUS is more sensitive and specific than CXR to identify pulmonary
fluid overload in critically ill children. Considering the clinical burden of fluid
overload and the relative ease of obtaining LUS, further evaluation of LUS to diagnose
volume overload is warranted.
Keywords
child - critical illness - X-rays - ultrasonography - lung - radiography - fluid overload
