{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:19:00Z","timestamp":1787750340511,"version":"build-2784847793"},"reference-count":16,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"3","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Backgrounds:<\/jats:title>\n                    <jats:p>Postoperative pneumonia significantly prolongs mechanical ventilation (MV) and intensive care unit (ICU) stay after pediatric cardiac surgery. Lung ultrasound (LUS) offers superior diagnostic accuracy compared with chest radiography, but its longitudinal impact on clinical outcomes remains unclear. We evaluated the effect of structured LUS implementation on pneumonia detection, antibiotic stewardship, and ventilatory outcomes in a pediatric cardiac surgical ICU (PCSICU).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This retrospective three-era study included all bronchoalveolar lavage (BAL) episodes performed for suspected postoperative pneumonia between 2019 and 2025. Patients were grouped as pre-LUS (2019\u20132020), LUS introduction (2021\u20132022), and established LUS (2023\u20132025). Outcomes included BAL positivity, antibiotic escalation, reintubation, and MV duration. In the established LUS era, pneumonia severity was classified using a structured 12-zone protocol into low-, moderate-, and high-yield categories. Categorical variables were compared using Chi-square tests and MV duration using Kruskal\u2013Wallis with Bonferroni correction.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 313 BAL episodes were analyzed (48, 125, and 140 across the three eras). BAL positivity declined significantly from 70.8% in the pre-LUS era to 42.4% and 43.6% in the later eras (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.0018). Among BAL-positive cases, antibiotic escalation increased progressively (52.9%, 62.3%, and 88.5%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.00027), while blind escalation among BAL-negative patients decreased markedly (50.0%, 20.8%, and 8.9%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.00060). Median MV duration decreased significantly from 95.5 h to 46.5 h across three eras (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.00030). Higher LUS yield categories were strongly associated with BAL positivity (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001), reintubation (P = 0.0336), and Tier-3 antibiotic escalation.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Structured LUS adoption improved early pneumonia detection, antibiotic stewardship, and postoperative ventilatory outcomes. Routine LUS integration may significantly improve multidomain outcomes in PCSICUs.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/apc.apc_11_26","type":"journal-article","created":{"date-parts":[[2026,6,22]],"date-time":"2026-06-22T13:00:16Z","timestamp":1782133216000},"page":"282-287","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Lung ultrasound-driven improvements in pneumonia detection, antibiotic stewardship, and ventilation outcomes: A three-era study in a pediatric cardiac surgical intensive care unit"],"prefix":"10.4103","volume":"19","author":[{"given":"Rajesh Madavathazathil","family":"Gopalakrishnan","sequence":"first","affiliation":[{"name":"Department of Pediatric Cardiac Anesthesia and Intensive Care, Amrita Institute of Medical Sciences and Research, Faridabad, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. R.","family":"Meghalakshmi","sequence":"additional","affiliation":[{"name":"Department of Respiratory Therapy, Amrita Institute of Medical Sciences and Research, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Dhar","sequence":"additional","affiliation":[{"name":"Department of Pediatric Cardiac Anesthesia and Intensive Care, Amrita Institute of Medical Sciences and Research, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra Chaithanyam","family":"Bijukumar","sequence":"additional","affiliation":[{"name":"Department of Mathematics, Amrita Vishwa Vidyapeetham, Kollam, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georg","family":"Gutjahr","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Amrita Institute of Medical Sciences and Research, Kochi, Kerala, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,6,23]]},"reference":[{"key":"R1-20260626","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/2110-5820-4-1","article-title":"Lung ultrasound in the critically ill","volume":"4","author":"Lichtenstein","year":"2014","journal-title":"Ann Intensive Care"},{"key":"R2-20260626","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1016\/j.rmed.2017.05.007","article-title":"Lung ultrasound as a diagnostic tool for radiographically-confirmed pneumonia in low resource settings","volume":"128","author":"Ellington","year":"2017","journal-title":"Respir Med"},{"key":"R3-20260626","doi-asserted-by":"crossref","first-page":"714","DOI":"10.1542\/peds.2014-2833","article-title":"Lung ultrasound for the diagnosis of pneumonia in children: A 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association for European paediatric and congenital cardiology imaging working group","volume":"3","author":"Cantinotti","year":"2025","journal-title":"Eur Heart J Imaging Methods Pract"},{"key":"R7-20260626","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.63682\/jns.v13i1.9048","article-title":"Role of lung ultrasound in detection of respiratory diseases in the paediatric intensive care unit","volume":"13","author":"Imran","year":"2025","journal-title":"J Neonatal Surg"},{"key":"R8-20260626","doi-asserted-by":"crossref","first-page":"721951","DOI":"10.3389\/fphys.2021.721951","article-title":"Ten years of pediatric lung ultrasound: A narrative review","volume":"12","author":"Musolino","year":"2022","journal-title":"Front Physiol"},{"key":"R9-20260626","first-page":"361","article-title":"Usefulness of lung ultrasound in the evaluation of children with lower respiratory tract infection in the emergency room","volume":"80","author":"Gastelum-Bernal","year":"2023","journal-title":"Bol Med Hosp Infant Mex"},{"key":"R10-20260626","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.ajem.2023.02.035","article-title":"Point-of-care lung ultrasound score for predicting escalated care in children with respiratory distress","volume":"68","author":"Giorno","year":"2023","journal-title":"Am J Emerg Med"},{"key":"R11-20260626","doi-asserted-by":"crossref","first-page":"191","DOI":"10.1186\/s12890-018-0750-1","article-title":"Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis","volume":"18","author":"Biagi","year":"2018","journal-title":"BMC Pulm Med"},{"key":"R12-20260626","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1097\/MOP.0000000000001484","article-title":"Diagnostic testing and antibiotic stewardship for pneumonia in children worldwide: Current developments and next steps","volume":"37","author":"van de 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