Abstract
<title>Abstract</title> <p>Purpose This study evaluated the associations of lung ultrasound score (LUS) and Radiographic Assessment of Lung Edema (RALE) score with oxygenation index (OI) in children with acute respiratory distress syndrome (ARDS) and explored their apparent prognostic performance for ICU mortality. Methods This prospective observational study included children aged 2 months to 16 years with ARDS defined by the Pediatric Acute Lung Injury Consensus Conference-2 criteria in a tertiary pediatric intensive care unit in Vietnam. LUS, RALE score, and OI were assessed within 48 h of ARDS diagnosis (T1) and 48 h later (T2). Associations among LUS, RALE score, and OI were evaluated using Spearman correlation and multivariable linear regression. Exploratory logistic regression models were used to assess ICU mortality. Results Forty-two children were included. LUS correlated significantly with OI at both T1 (r = 0.65, p < 0.001) and T2 (r = 0.74, p < 0.001). RALE score was also correlated with OI at T1 (r = 0.41, p = 0.007) and T2 (r = 0.65, p < 0.001). LUS and RALE score were significantly correlated at both time points. In multivariable linear regression, both LUS and RALE score were independently associated with log-transformed OI. In exploratory mortality models, pre-existing comorbidity was the only independent predictor of ICU mortality. Conclusion In children with ARDS, LUS was significantly associated with oxygenation impairment and RALE score. Structured lung ultrasound may serve as a radiation-free bedside adjunct to chest radiography for serial assessment of pediatric ARDS.</p>