Impact of routine bedside lung ultrasound implementation on chest x-ray requests for mechanically ventilated children: a before-after uncontrolled quality improvement project.

Lung imaging techniques are crucial for managing ventilated patients in pediatric intensive care units (PICUs). Bedside chest x-ray has limitations such as low sensitivity and radiation exposure risks. Recently, lung ultrasound has emerged as a promising technology offering advantages such as real-time monitoring and radiation-free imaging. However, the integration of lung ultrasound into clinical practice raises questions about its impact on chest x-ray prescriptions. This study aims to assess whether implementing lung ultrasound reduces reliance on chest x-rays for ventilated pediatric patients in the PICU. This before-and-after uncontrolled quality improvement project was conducted from January 2022 to December 2023 in a referral PICU. The study included three phases: retrospective evaluation, learning phase, and prospective evaluation. Patients aged under 14 years, intubated, and ventilated for ≤ 30 days were included. Lung ultrasound was performed using a standardized protocol, and chest x-rays were conducted as per clinical indications. During the study period, 430 patients were admitted to the PICU, with 142 requiring mechanical ventilation. Implementation of routine bedside lung ultrasound led to a 39% reduction in chest x-ray requests (p < 0.001). Additionally, there was a significant decrease in irradiation exposure and a 27% reduction in costs associated with chest x-rays.Conclusion: Routine bedside lung ultrasound is a valuable tool in the modern PICU, it reduces the number of chest x-rays, with reduced radiation exposure and a potential cost savings. What is known: • Bedside chest x-ray is the main imaging study in ventilated pediatric patients • Chest x-ray is a valuable tool in pediatric critical care but it is associated with irradiation exposure What is new: • Implementation of bedside lung ultrasound in pediatric critical care unites reduces the chest x-rays requests and therefore patient-irradiation.

Staphylococcus aureus costal osteomyelitis with complicated by pleural effusion in a 7-month-old infant: A misleading clinical presentation.

Osteomyelitis is a rare infectious disease in children, predominantly affecting long bones; however, its clinical presentation can be ambiguous if the location is atypical. Costal osteomyelitis is very rare in children and can mimic other pathologies. We present a case of a seven-month-old infant diagnosed with costal osteomyelitis complicated by rupture of a subperiosteal abscess into the pleura. His clinical condition improved with conservative treatment, which included chest drain insertion and intravenous antibiotic therapy without the need for surgical debridement. Rib osteomyelitis represents a potentially severe condition. Early detection is imperative to prevent the necessity for invasive therapies and mitigate long-term complications.

Spontaneous Hemopericardium Complicated by Tamponade in a Child With Moderate Hemophilia A: Case-Based Review.

Hemophilia A is the most common severe innate bleeding disorder. It is an X-linked recessive inherited bleeding disorder characterized by a qualitative and/or quantitative deficiency of factor VIII. The clinical manifestation of this disease is hemorrhaging that can affect every organ, in particular joints (hemarthrosis) and muscles (hematoma). Some serious but rare hemorrhages can be life-threatening, in particular hemorrhage of the central nervous system and hemopericardium. We report a rare case of spontaneous hemopericardium complicated by tamponade in a child with moderate hemophilia A treated with Factor VIII replacement infusion and pericardial drainage, with a favorable outcome. To our knowledge, this is the second case described in the literature of spontaneous hemopericardium occurring in a child with hemophilia A. Our case suggests that a dose of 50 IU/kg/8 h of factor VIII maintained for up to one day after removal of the pericardial drain seems to be sufficient to ensure correct hemostasis, though further evidence is needed to confirm this impression.