{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T20:59:44Z","timestamp":1775077184113,"version":"3.50.1"},"reference-count":27,"publisher":"Ordem dos Medicos","issue":"4","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Acta Med Port"],"abstract":"<jats:p>Introduction: Available scoring systems for managing acute bronchiolitis lack accuracy in predicting severity and prognosis. Thoracic ultrasound may help fill this gap. This study evaluated changes in thoracic ultrasound parameters in children with acute bronchiolitis and their association with disease severity. Diaphragmatic ultrasound parameters were also compared between patients with and without invasive mechanical ventilation.Methods: A prospective observational study included children under 24 months admitted to a Pediatric Intensive Care Unit with acute bronchiolitis. Thoracic ultrasound assessed lung ultrasound score (LUS), diaphragmatic excursion (DE), diaphragmatic thickness (DT), and thickening fraction (DTf) on days one, three, and five. Clinical severity was assessed using the Bronchiolitis Score of Sant Joan de D\u00e9u (BROSJOD) and other indicators.Results: Twenty-six patients were enrolled. Lung ultrasound score decreased over time, while DE and DTf increased. On day one, LUS, DE, and DT positively correlated with BROSJOD (rs = 0.586, p = 0.005; rs = 0.599, p = 0.004; rs = 0.534, p = 0.013, respectively); DTf showed an inverse correlation (rs = -0.439, p = 0.047). By day five, only LUS remained significantly associated. LUS and DTf on day one varied with the fraction of inspired oxygen (FiO2) requirements. Lung ultrasound score on day one had an area under the curve of 0.806 for predicting FiO2 \u2265 50%, with a cut-off of 8.5 (sensitivity 63.6%, specificity 93.3%). Lower DT and DTf were consistently seen in patients requiring invasive mechanical ventilation (p &lt; 0.05). Conclusion: Lung ultrasound score and DTf correlated with disease severity from the first day in the Pediatric Intensive Care Unit, indicating their potential as early markers of disease worsening. Lower DT and DTf may suggest severe disease and the need for ventilatory support escalation. Thoracic ultrasound is a promising, non-invasive tool for monitoring children with acute bronchiolitis.<\/jats:p>","DOI":"10.20344\/amp.24309","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T16:04:24Z","timestamp":1775059464000},"page":"271-280","source":"Crossref","is-referenced-by-count":0,"title":["Thoracic Ultrasound in Pediatric Intensive Care: A Valuable Tool for Children with Acute Bronchiolitis"],"prefix":"10.20344","volume":"39","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-3912-6930","authenticated-orcid":false,"given":"Filipa","family":"Curinha","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-5318-3839","authenticated-orcid":false,"given":"Adriana","family":"Fernandes","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7576-461X","authenticated-orcid":false,"given":"Carla","family":"Pinto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1911-5177","authenticated-orcid":false,"given":"Maria Teresa","family":"Dion\u00edsio","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"8464","published-online":{"date-parts":[[2026,4,1]]},"reference":[{"key":"12486","doi-asserted-by":"crossref","unstructured":"Guarnieri V, Palmas G, Trapani S, Mollo A, Macucci C, Gambini I, et al. Exploring risk factors associated with intensive care unit admission in a retrospective cohort of 631 children with bronchiolitis. Pediatr Pulmonol. 2025;60: e27394.","DOI":"10.1002\/ppul.27394"},{"key":"12487","doi-asserted-by":"crossref","unstructured":"Osman S, Alaa Adeen A, Hetta O, Alsiraihi A, Bader M, Aloufi A, et al. Epidemiology and risk factor analysis of children with bronchiolitis admitted to the intensive care unit at a tertiary care center in Saudi Arabia. Children. 2023;10:646.","DOI":"10.3390\/children10040646"},{"key":"12488","unstructured":"Dire\u00e7\u00e3o-Geral da Sa\u00fade. Diagn\u00f3stico e tratamento da bronquiolite aguda em idade pedi\u00e1trica: Norma da DGS n.\u00ba 015\/2015. Lisboa: DGS; 2015."},{"key":"12489","doi-asserted-by":"crossref","unstructured":"Manti S, Staiano A, Orfeo L, Midulla F, Marseglia GL, Ghizzi C, et al. Update \u2013 2022 Italian guidelines on the management of bronchiolitis in infants. Ital J Pediatr. 2023;49:11.","DOI":"10.1186\/s13052-022-01392-6"},{"key":"12490","unstructured":"Servi\u00e7o de Urg\u00eancia Pedi\u00e1trica do Hospital Pedi\u00e1trico de Coimbra. Bronquiolite aguda: protocolo de abordagem e atua\u00e7\u00e3o. Coimbra: HPC; 2021."},{"key":"12491","unstructured":"Dunn JM, Zorc L, Tyler E, Pete DL, McAndrew K, Leach L. Pathway for evaluation and treatment of children with bronchiolitis. Philadelphia: Children\u2019s Hospital of Philadelphia; 2023."},{"key":"12492","doi-asserted-by":"crossref","unstructured":"Bobillo-Perez S, Sorribes C, Gebell\u00ed P, Lled\u00f3 N, Castilla M, Ramon M, et al. Lung ultrasound to predict pediatric intensive care admission in infants with bronchiolitis (LUSBRO study). Eur J Pediatr . 2021;180:3509\u201317.","DOI":"10.1007\/s00431-021-03978-4"},{"key":"12493","doi-asserted-by":"crossref","unstructured":"Granda E, Urbano M, Andr\u00e9s P, Corchete M, Cano A, Velasco R. Comparison of severity scales for acute bronchiolitis in real clinical practice. Eur J Pediatr. 2023;182:1619\u201326.","DOI":"10.1007\/s00431-023-04840-5"},{"key":"12494","doi-asserted-by":"crossref","unstructured":"Krishna D, Khera D, Toteja N, Sureka B, Choudhary B, Ganakumar VM, et al. Point-of-care thoracic ultrasound in children with bronchiolitis. Indian J Pediatr. 2022;89:1079\u201385.","DOI":"10.1007\/s12098-022-04117-z"},{"key":"12495","doi-asserted-by":"crossref","unstructured":"Smith JA, Stone BS, Shin J, Yen K, Reisch J, Fernandes N, et al. Association of outcomes in point-of-care lung ultrasound for bronchiolitis in the pediatric emergency department. Am J Emerg Med. 2024;75:22\u20138.","DOI":"10.1016\/j.ajem.2023.10.019"},{"key":"12496","doi-asserted-by":"crossref","unstructured":"Supino MC, Buonsenso D, Scateni S, Scialanga B, Mesturino MA, Bock C, et al. Point-of-care lung ultrasound in infants with bronchiolitis in the pediatric emergency department: a prospective study. Eur J Pediatr. 2019;178:623\u201332.","DOI":"10.1007\/s00431-019-03335-6"},{"key":"12497","doi-asserted-by":"crossref","unstructured":"La Regina DP, Bloise S, Pepino D, Iovine E, Laudisa M, Cristiani L, et al. Lung ultrasound in bronchiolitis. Pediatr Pulmonol. 2021;56:234\u20139.","DOI":"10.1002\/ppul.25156"},{"key":"12498","doi-asserted-by":"crossref","unstructured":"Di Mauro A, Cappiello AR, Ammirabile A, Abbondanza N, Bianchi FP, Tafuri S, et al. Lung ultrasound and clinical progression of acute bronchiolitis: a prospective observational single-center study. Medicina (Kaunas). 2020;56:314.","DOI":"10.3390\/medicina56060314"},{"key":"12499","doi-asserted-by":"crossref","unstructured":"Hern\u00e1ndez-Villarroel AC, Ruiz-Garc\u00eda A, Manzanaro C, Echevarr\u00eda-Zubero R, Bote-Gasc\u00f3n P, Gonzalez-Bertolin I, et al. Lung ultrasound: a useful prognostic tool in the management of bronchiolitis in the emergency department. J Pers Med. 2023;13:1624.","DOI":"10.3390\/jpm13121624"},{"key":"12500","doi-asserted-by":"crossref","unstructured":"Musolino AM, Tom\u00e0 P, De Rose C, Pitaro E, Boccuzzi E, De Santis R, et al. Ten years of pediatric lung ultrasound: a narrative review. Front Physiol. 2022;12:721951.","DOI":"10.3389\/fphys.2021.721951"},{"key":"12501","doi-asserted-by":"crossref","unstructured":"Kogias C, Prountzos S, Alexopoulou E, Douros K. Lung ultrasound systematic review shows its prognostic and diagnostic role in acute viral bronchiolitis. Acta Paediatr. 2023;112:222\u201332.","DOI":"10.1111\/apa.16578"},{"key":"12502","doi-asserted-by":"crossref","unstructured":"Di Mauro A, Ammirabile A, Quercia M, Panza R, Capozza M, Manzionna MM, et al. Acute bronchiolitis: is there a role for lung ultrasound? 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