Prognostic Role of Lung‐Ultrasound Score in Acute Bronchiolitis Patients Treated With High Flow Nasal Cannula: A Prospective Study

Abstract

ABSTRACTIntroductionLung ultrasound (LUS) has emerged as a reliable, noninvasive tool for bedside assessment of acute bronchiolitis (AB) in infants. Its role in guiding therapeutic decisions is increasingly recognized.AimsThis study aimed to determine the predictive value of LUS in identifying infants with AB at risk of HFNC therapy failure.Materials and MethodsThis prospective, single‐center study was conducted in the pediatric department of Fattouma Bourguiba Hospital in Monastir from January 2022 to March 2024. Infants under 12 months hospitalized with moderate to severe AB and requiring HFNC therapy were enrolled. LUS was performed within 3–6 h of HFNC initiation and repeated 24 h later. Clinical and laboratory data, including the Wang score and LUS findings, were analyzed to predict HFNC failure.ResultsAmong 124 enrolled infants, 98 (79%) responded successfully to HFNC therapy, while 26 (21%) failed. Baseline characteristics, including age, weight, and clinical symptomes, were comparable between groups, except for a higher Wang score in the failure group (p = 0.008). LUS scores were significantly higher in the failure group on both day 1 and day 2 (p < 0.001), with a more pronounced score progression (p < 0.001). ROC analysis identified a LUS score > 7 on day 1 and > 9 on day 2 as predictive thresholds for HFNC failure. Multivariate analysis confirmed the day 2 LUS score as an independent predictor of HFNC failure (p = 0.022).ConclusionLUS is a valuable prognostic tool in infants with AB undergoing HFNC therapy. Incorporating LUS into routine clinical assessments may help predict therapy failure early, allowing timely escalation of care.