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Ocular ultrasound demonstrating optic nerve sheath diameter measurement (ONSD). The sheath appears as a less bright (hypoechoic) structure compared to the surrounding tissue.
Source publication
Ultrasonography has been widely used in medicine for decades but often by specific users such as cardiologists, obstetricians, and radiologists. In the last several years, the use of this imaging modality has moved to the bedside, with clinicians performing and interpreting focused point of care ultrasonography to aid in immediate assessment and ma...
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Background
The widespread use of critical care ultrasound (CCUS) for the management of patients in intensive care units (ICUs) requires effective training. The effectiveness of long-term, specialized CCUS training courses is unclear. This study describes a simulation-based, 6-month CCUS training program and evaluates its efficacy.
Methods
Seven co...
Citations
... Despite a remarkable body of evidence, a routine use of US in pediatrics cannot be recognized yet [5,6]. Moreover, literature investigating US application almost entirely relies on the emergency and critical medicine experience [7] while deficient data exist for its use in different pediatric settings, such as non-intensive pediatric units or outpatient clinics. ...
Background
The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide.
Methods
A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022.
Results
There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants ( n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based ( n = 516, 66.9%) and provided from 1 to 5 years prior to the survey ( n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned ( n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room ( n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions ( n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents ( n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% ( n = 552) of cases. The most common barriers included the lack of a well-defined training program ( n = 627, 57.1%), unavailability of the US machine ( n = 196, 17.9%) and legal responsibility concern ( n = 175, 15.9%).
Conclusions
Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.
... If it demonstrates a positive impact, it could lead to a more widespread adoption of this diagnostic tool. 10 Rural healthcare setting A unique aspect of this study is its location in a rural healthcare setting. Rural areas often require more resources and access to advanced medical technology. ...
Background
Bedside echocardiography has emerged as a valuable diagnostic tool in intensive care units, aiding the prompt evaluation of cardiovascular function in critically ill patients. However, its application in the pediatric population, particularly within rural healthcare settings, still needs to be explored. This study aims to assess the influence of bedside echocardiography on the management and outcomes of critically ill pediatric patients admitted to a tertiary care center in rural Maharashtra, India.
Methods
A cross-sectional study will be conducted in the Pediatric Intensive Care Unit (PICU) of Acharya Vinoba Bhave Rural Hospital from July 2022 to July 2024 on 88 participants. The study will enroll critically ill pediatric patients aged one month to 18 years who meet the inclusion criteria. Data collection will involve comprehensive clinical assessments, echocardiography performed by pediatric cardiologists, and documentation of demographic information, clinical history, interventions, and outcomes. Statistical analyses will encompass descriptive statistics, correlation assessments, and significance testing.
Expected results
This study aims to elucidate the indications and necessity of echocardiography in pediatric patients, correlate echocardiographic findings with clinical interventions, and assess their impact on patient outcomes. It seeks to contribute valuable insights into the utility of bedside echocardiography in rural PICUs and its potential to inform clinical decision making.
... POCUS is safe, easy to use, and readily available at any time. US-guided CVC insertion has been widely used in recent years in PICUs and pediatric emergency services (1,2). ...
Objective: The aims of this study were to compare the results of ultrasound (US) guidance and the landmark (LM) technique for central venous catheter (CVC) placement in pediatric intensive care units (PICUs) as performed by clinicians. Material and Methods: The patients were divided into two groups according to the technique used: an LM group (459 patients) and a US-guided group (200 patients). We evaluated the success rate, the number of attempts, and the complication rates based on each patient’s age and weight. Results: The time required for the successful placement of the CVC was significantly different between the two groups: 10.9±10.8 min in the LM group and 8.1±7.6 min in the US-guided group (p=0.012). Additionally, the average number of attempts for successful catheterization was 1.8±0.8 in the US-guided group; and 2.5 ± 1.4 in the LM group (p=0.024). A total of 115 (17.3%) complications were noted: 24 (3.6%) in the US-guided group and 91 (13.7%) in the LM group (p=0.014). The frequency of complications decreased as the age and weight of the patients increased. When the inserted catheters used by ultrasound were evaluated, 59.5% of them were placed by clinicians who had ultrasound training while 40.5% were inserted by clinicians who did not have ultrasound training. There was no significant difference in the complication rate, number of punctures, and success rates between the ultrasound-trained and untrained clinicians (p=0.476). Conclusion: This is the largest multicenter study comparing the US-guided vs. LM technique for CVC placement in children. We believe that the US-guided CVC procedure is more safe and takes less time than the LM technique. Also, point-of-care ultrasound is useful, beneficial, and easily available for pediatric intensivists.
... Point-of-care critical ultrasound (POC-CUS) has played increasingly important roles in clinical critical care management and has been widely used in the fields of adults, children, and newborns [17][18][19][20][21][22]. It can even be said that without POC-CUS, the lives of many newborn infants would be difficult to save. ...
Point-of-care critical ultrasound (POC-CUS) screening plays an increasingly important role in the treatment of critically ill infants. Without POC-CUS, the lives of many infants would not be saved in time and correctly. A premature infant with systemic multiple organ system dysfunction caused by fungal sepsis was treated and nursed under the guidance of POC-CUS monitoring, and the infant was ultimately cured. This premature infant had systemic multiple organ system dysfunction and disseminated intravascular coagulation (DIC) caused by fungal sepsis. In the hypercoagulable state of early-stage DIC, cardiac thrombosis could be found using ultrasound screening. For this case, right renal artery thrombosis was found via renal artery Doppler ultrasound examination. Due to the severity of this disease, ultrasound-guided peripherally inserted central catheter (PICC) insertion and ultrasound checks of the PICC tip’s position were performed, which ensured the success of this one-time catheterization and shortened the catheterization time. Lung ultrasound is used for the diagnosis and differential diagnosis of pulmonary diseases, and to guide the application of mechanical ventilation. Because the abdominal circumference of the patient’s markedly enlarged abdominal circumference, bloody stool, and absence of bowel sounds, abdominal ultrasonography was performed, which revealed a markedly enlarged liver, significant peritoneal effusion, and necrotizing enterocolitis. Guided by POC-CUS monitoring, we had the opportunity to implement timely and effective treatment that ultimately saved this critically ill patient’s life. The successful treatment of this newborn infant fully reflects the importance of carrying out POC-CUS screening.
... Despite the increasing utilization of ultrasound as a means of diagnosing and treating severely ill pediatric patients, there remain numerous challenges that must be addressed before this approach can be universally implemented in all fields, particularly in terms of education, proficiency, and uniformity of application [4]. ...
... The thoracic cavity comprises three distinct zones, namely anterior [1,2,5,6], posterior [8][9][10][11], and lateral [3,4,7,12] pulmonary fields. The transducer scans all regions longitudinally and transversely, encompassing both the cranial-caudal and medial-lateral planes. ...
Background
Community-acquired pneumonia represents a noteworthy concern in terms of morbidity and mortality, particularly in countries with lower and middle-income levels. Accurate and timely diagnosis of pneumonia is crucial for optimal management. Chest CT is considered the gold standard imaging for diagnosis of pneumonia, but it is not always readily available and exposes children to radiation hazards, so it becomes important to find easily available and less hazardous imaging tools such as lung ultrasound to diagnose pneumonia.
A comparative investigation was carried out to assess the diagnostic capability of lung ultrasound in critically ill pediatric patients presenting with respiratory symptoms. Forty-two patients with community-acquired pneumonia from the pediatric intensive care unit were included.
Results
Lung ultrasound demonstrated high sensitivity (88.1%) and specificity in diagnosing pneumonia, outperforming chest X-ray (50%) and providing comparable results to chest CT (95.2%). In addition, 45.2% of patients required mechanical ventilation, and 69.1% were diagnosed with viral pneumonia.
Conclusion
The employment of lung ultrasound is deemed secure, accessible, transferable, and efficacious in the expeditious detection of community-acquired pneumonia and the subsequent monitoring of patients. Its high sensitivity and specificity make it a valuable imaging modality in pediatric pneumonia diagnosis, helping clinicians make informed decisions and improve patient outcomes.
... Another significant point is that POCUS is increasingly applicable in emergency and resuscitation units. [14,15] POCUS is a powerful bedside tool for rapid diagnosis and severity prediction, guiding accurate fluid responsiveness to reduce mortality in critically ill patients. [16,17] We performed consecutive POCUS in patients with severe dengue infection in the pediatric intensive care unit to examine fluid accumulation in the pleural and abdominal cavities, pericardial effusion, ventricular filling volume, systolic and diastolic dysfunctions, IVC distention, and the diameter ratio between the IVC and juxtaposed descending aorta (IVC/Ao). ...
Rationale:
Dengue obstructive shock syndrome is a fatal complication commonly observed in the late critical phase of dengue infection and is associated with a high mortality rate. The main pathogenesis involves a dramatic increase in chest pressure, owing to severe plasma leakage and mechanical respiratory support, hampering the heart's ability to pump effectively and impeding adequate blood venous return to the heart chambers. To date, there is a paucity of clinical data about Dengue obstructive shock syndrome reported.
Patient concerns:
The 2 reported patients presented with prolonged and decompensated dengue shock with critical multi-organ failures and mechanical ventilation. The patients' hemodynamics were profoundly affected by high pressure in the thoracic and abdominal cavities resulting from Dengue-induced severe plasma leakage and mechanical ventilation.
Diagnoses:
Clinical presentations, laboratory data, mini-fluid challenge test, and point-of-care (POCUS) were used to make diagnoses and guide management.
Interventions:
Clinical monitoring, judicious fluid (colloids and blood products) administration guided by repeated POCUS to properly assess the adequacy of the intravascular volume, homeostasis adjustments by plasma exchange, and continuous renal replacement therapies.
Outcomes:
The patients had favorable outcomes.
Lessons:
Our study highlights the clinical manifestations and management of children with dengue obstructive shock syndrome and underscores the importance of monitoring hemodynamics by consecutive POCUS at the bedside in order to make a timely diagnosis and assess intravascular fluid volume inadequacy accurately as well as closely monitor the fluid management responses.
... Clinicians are often challenged with prediction of PES since cannot be predicted by spontaneous breathing trial (13) . ...
... In addition, cardiac preload can be assessed by inferior vena cava (IVC) ultrasound [59,60]. While FoCUS also helps to diagnose congenital heart defects and regional wall motion abnormalities and assess stroke volume and pulmonary artery pressure at the bedside, these require a higher operator skill level and training [61,62]. ...
Point-of-care ultrasound (POCUS) has evolved in recent years in clinical practice, helping in early bedside diagnosis of important etiologies. Many medical schools and training programs are integrating POCUS into their curriculum. Especially with the technological advances of newer handheld ultrasound devices, POCUS has now become a component adjunct to clinical examination, in the clinic and bedside in critical care units. The diagnostic utility of POCUS lies both in early identification of critical kidney disease, and also extra-renal pathologies from a focused cardiac ultrasound, lung ultrasound, and integrated fluid assessment. There is a need to incorporate POCUS in training in pediatric nephrology and establish competency standard criteria. This review shall cover how POCUS helps in enhancing patient care in pediatric kidney disorders and critical children, and the recent advances.
... Although the present study elucidated the normal values and extents of variability in α and β angles, and FHC at each month during the first 6 months of life, its data differed from those of similar studies. This discrepancy results from variations in ultrasound equipment used at each study center, the position of the infant during the examination, the orientation of the ultrasound probe, and the time of measurement (22,23). Nevertheless, this study provides new insights on the developmental pattern of the hip joint in normal Chinese infants under 6 months of age and serves as an important reference for clinical diagnosis of DDH. ...
Objective
This large-sample observational study aims to analyze the morphological development of the hip joint in Chinese normal infants under 6 months of age by the Graf ultrasound method.
Methods
The clinical and ultrasound data of infants who underwent early screening for developmental dysplasia of the hip (DDH) in the authors' clinic from January 2011 to December 2019 were analyzed retrospectively. The standard Graf method was used to measure the hip joint α angle, β angle and femoral head coverage (FHC). The infants with Graf type I or IIa hips were included in this study. All infants were grouped by age. FHC, α and β angles were compared among different study groups.
Results
A total of 3,067 infants (6,134 hips) were included in the study. There were 1,164 males and 1,903 females with an average age of 77 days (1–180 days). The mean α angle was 62.4 ± 3.6° on the left and 63.2 ± 3.5° on the right ( P < 0.001). The mean β angle was 55.6 ± 4.5° on the left and 54.8 ± 4.5° on the right ( P < 0.001). The average FHC was 54.2 ± 4.6% and 54.8 ± 4.2%, accordingly ( P < 0.001). The α angle and FHC of females was significantly smaller than that of males ( P < 0.001). While the left β angle in females was slightly larger than males ( P = 0.014), there were no significant differences in the right β angle between the two sexes ( P = 0.150). During the first 3 postnatal months, the α angle and FHC increased while β angle decreased with age. However, the α and β angles and FHC were stable at a relatively constant level from the 4 to the 6 th postnatal month.
Conclusions
The normal infant hip reveals progressive maturation during the first 3 months after birth, and then enters a plateau period during the 4 to 6 th month. The development of hip joint in females and of the left side slightly lags behind that in males and of the right side, which is consistent with the observation that DDH is more common in females and on the left hips.
Many advances have been made in pediatric critical care medicine over the last several years. This chapter will provide a broad overview of the most relevant advances in the following domains: patient monitoring, organ systems-based practice, rehabilitation, palliative care, quality improvement, education, and existing health inequities in pediatric critical care. Specific advances in the field of pediatric critical care discussed here represent those that have either demonstrated or have the potential to demonstrate improvement in patient outcomes, in addition to advances that are enablers to the provision of safe, efficacious, timely and equitable patient-centered care.
