Point-of-Care Ultrasound in the Pediatric Intensive Care Unit

Luke Burton, Vidit Bhargava, Michele Kong, Luke Burton, Vidit Bhargava, Michele Kong

Abstract

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 management of their patients. The growth of point of care ultrasonography has been facilitated by advancement in ultrasound-related technology and emerging studies and protocols demonstrating its utility in clinical practice. However, considerable challenges remain before this modality can be adopted across the spectrum of disciplines, primarily as it relates to training, competency, and standardization of usage. This review outlines the history, current state, challenges and the future direction of point of care ultrasonography specifically in the field of pediatric critical care medicine.

Keywords: POCUS; critical care; pediatrics; point of care; ultrasound.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Burton, Bhargava and Kong.

Figures

Figure 1
Figure 1
Image demonstrating vascular imaging in short and longitudinal access and probe placement for obtaining images in the two planes. (A) Shows probe placement and imaging in longitudinal axis. (B) Demonstrating probe placement and imaging in short axis.
Figure 2
Figure 2
Quantitative estimation of left ventricle (LV) function using fractional shortening. The upper half of the image displays the placement of M-mode line through the left ventricle in a parasternal short axis view of the heart. The lower half of the image displays the M-mode output. Left ventricle systolic and diastolic diameters are measured to calculate fractional shortening. The scale represents the depth of imaging. LV, Left ventricle.
Figure 3
Figure 3
Pulse doppler waveform measuring peak aortic velocity and velocity time integral (VTi). The upper half of the image displays an apical 5 chamber view with pulse doppler gate at the aortic outflow tract. The lower half of the image displays doppler waveform (m/sec). The waveform is traced to estimate VTi and measure peak aortic velocity. RV, right ventricle; LV, left ventricle; RA, right atrium; LA, left atrium; VTi, velocity time integral.
Figure 4
Figure 4
(A) Lung ultrasound image showing multiple B lines (arrow). (B) Lung ultrasound image showing air bronchograms (arrow) giving a “speckled” appearance. (C) Lung ultrasound image obtained using a linear probe showing a single B line.
Figure 5
Figure 5
Right upper quadrant view of thoracic-abdominal cavity demonstrating liver, pleural effusion, consolidated lung and the spine sign.
Figure 6
Figure 6
A right upper quadrant view performed in a FAST exam with free fluid present between the liver and the kidney. The free fluid appears black (anechoic) on ultrasound.
Figure 7
Figure 7
Airway ultrasound image at the level of thyroid gland demonstrating laryngeal air column width (arrow). TG, thyroid gland; SM, strap muscles.
Figure 8
Figure 8
Ocular ultrasound demonstrating optic nerve sheath diameter measurement (ONSD). The sheath appears as a less bright (hypoechoic) structure compared to the surrounding tissue.

References

    1. Díaz-Gómez JL, Mayo PH, Koenig SJ. Point-of-care ultrasonography. N Engl J Med. (2021) 385:1593–602. 10.1056/NEJMra1916062
    1. Watkins LA, Dial SP, Koenig SJ, Kurepa DN, Mayo PH. The utility of point-of-care ultrasound in the pediatric intensive care unit. J Intensive Care Med. (2021). 10.1177/08850666211047824. [Epub ahead of print].
    1. Singh Y, Tissot C, Fraga MV, Yousef N, Cortes RG, et al. . International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS working group of the european society of paediatric and neonatal intensive care (ESPNIC). Crit Care. (2020) 24:65. 10.1186/s13054-020-2787-9
    1. McLario DJ, Sivitz AB. Point-of-care ultrasound in pediatric clinical care. JAMA Pediatr. (2015) 169:594–600. 10.1001/jamapediatrics.2015.22
    1. Adler AC, Brown KA, Conlin FT, Thammasitboon S, Chandrakantan A. Cardiac and lung point-of-care ultrasound in pediatric anesthesia and critical care medicine: uses, pitfalls, and future directions to optimize pediatric care. Pediatr Anesth. (2019) 29:790–8. 10.1111/pan.13684
    1. Lichtenstein D, Axler O. Intensive use of general ultrasound in the intensive care unit. Prospective study of 150 consecutive patients. Intensive Care Med. (1993) 19:353–5. 10.1007/BF01694712
    1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. (2011) 364:749–57. 10.1056/NEJMra0909487
    1. Kornblith AE, van Schaik S, Reynolds T. Useful but not used: pediatric critical care physician views on bedside ultrasound. Pediatr Emerg Care. (2015) 31:186–9. 10.1097/PEC.0000000000000376
    1. Srinivasan S, Cornell TT. Bedside ultrasound in pediatric critical care: a review. Pediatr Crit Care Med. (2011) 12:667–74. 10.1097/PCC.0b013e318223147e
    1. AHRQ issues critical analysis of patient safety practices . Qual Lett Healthc Lead. (2001) 13:8–12.
    1. Fraga MV, Stoller JZ, Glau CL, De Luca D, Rempell RG, et al. . Seeing is believing: ultrasound in pediatric procedural performance. Pediatrics. (2019) 144:e20191401. 10.1542/peds.2019-1401
    1. Lambert RL, Boker JR, Maffei FA. National survey of bedside ultrasound use in pediatric critical care. Pediatr Crit Care Med. (2011) 12:655–9. 10.1097/PCC.0b013e3182266a51
    1. Su E, Pustavoitau A, Hirshberg EL, Nishisaki A, Conlon T, Kantor DB, et al. . Establishing intensivist-driven ultrasound at the PICU bedside–it's about time*. Pediatr Crit Care Med. (2014) 15:649–52. 10.1097/PCC.0000000000000168
    1. Conlon TW, Himebauch AS, Fitzgerald JC, Chen AE, Dean AJ, Panebianco N, et al. . Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU. Pediatr Crit Care Med. (2015) 16:219–26. 10.1097/PCC.0000000000000340
    1. Conlon TW, Kantor DB, Su ER, Basu S, Boyer DL, Haileselassie B, et al. . Diagnostic bedside ultrasound program development in pediatric critical care medicine: results of a national survey. Pediatr Crit Care Med. (2018) 19:e561–8. 10.1097/PCC.0000000000001692
    1. Frankel HL, Kirkpatrick AW, Elbarbary M, Blaivas M, Desai H, Evans D, et al. . Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part i: general ultrasonography. Crit Care Med. (2015) 43:2479–502. 10.1097/CCM.0000000000001216
    1. Levitov A, Frankel HL, Blaivas M, Kirkpatrick AW, Su E, Evans D, et al. . Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients-part ii: cardiac ultrasonography. Crit Care Med. (2016) 44:1206–27. 10.1097/CCM.0000000000001847
    1. Lau CS, Chamberlain RS. Ultrasound-guided central venous catheter placement increases success rates in pediatric patients: a meta-analysis. Pediatr Res. (2016) 80:178–84. 10.1038/pr.2016.74
    1. Aouad-Maroun M, Raphael CK, Sayyid SK, Farah F, Akl EA. Ultrasound-guided arterial cannulation for paediatrics. Cochrane Database Syst Rev. (2016) 9:CD011364. 10.1002/14651858.CD011364.pub2
    1. Shojania KG, Duncan BW, McDonald KM, Wachter RM, Markowitz AJ. Making health care safer: a critical analysis of patient safety practices. Evid Rep Technol Assess (Summ). (2001) i–x, 1–668.
    1. de Souza TH, Brandao MB, Nadal JAH, Nogueira RJN. Ultrasound guidance for pediatric central venous catheterization: a meta-analysis. Pediatrics. (2018) 142:e20181719. 10.1542/peds.2018-1719
    1. Vezzani A, Manca T, Brusasco C, Santori G, Cantadori L, Ramelli A, et al. . A randomized clinical trial of ultrasound-guided infra-clavicular cannulation of the subclavian vein in cardiac surgical patients: short-axis versus long-axis approach. Intensive Care Med. (2017) 43:1594–601. 10.1007/s00134-017-4756-6
    1. Sommerkamp SK, Romaniuk VM, Wittin MD, Ford DR, Allison MG, Euerle BD. A comparison of longitudinal and transverse approaches to ultrasound-guided axillary vein cannulation. Am J Emerg Med. (2013) 31:478–81. 10.1016/j.ajem.2012.09.015
    1. Vinograd AM, Chen AE, Woodford AL, Fesnak S, Gaines S, Elci OU, et al. . Ultrasonographic guidance to improve first-attempt success in children with predicted difficult intravenous access in the emergency department: a randomized controlled trial. Ann Emerg Med. (2019) 74:19–27. 10.1016/j.annemergmed.2019.02.019
    1. de Carvalho Onofre PS, da Luz Gonçalves Pedreira M, Peterlini MA. Placement of peripherally inserted central catheters in children guided by ultrasound: a prospective randomized, and controlled trial. Pediatr Crit Care Med. (2012) 13:e282–7. 10.1097/PCC.0b013e318245597c
    1. Elli S, Pittiruti M, Pigozzo V, Cannizzo L, Giannini L, Siligato A, et al. . Ultrasound-guided tip location of midline catheters. J Vasc Access. (2020) 21:764–8. 10.1177/1129729820907250
    1. Rubortone SA, Costa S, Perri A, D'Andrea V, Vento G, Barone G. Real-time ultrasound for tip location of umbilical venous catheter in neonates: a pre/post intervention study. Ital J Pediatr. (2021) 47:68. 10.1186/s13052-021-01014-7
    1. Ren XL, Li HL, Liu J, Chen YJ, Wang M, Qiu RX. Ultrasound to localize the peripherally inserted central catheter tip position in newborn infants. Am J Perinatol. (2021) 38:122–5. 10.1055/s-0039-1694760
    1. Alonso-Quintela P, Oulego-Erroz I, Rodriguez-Blanco S, Muñiz-Fontan M, Lapeña-López-de Armentia S, Rodriguez-Nuñez A. Location of the central venous catheter tip with bedside ultrasound in young children: can we eliminate the need for chest radiography? Pediatr Crit Care Med. (2015) 16:e340–5. 10.1097/PCC.0000000000000491
    1. Kantor DB, Su E, Milliren CE, Conlon TW. Ultrasound guidance and other determinants of successful peripheral artery catheterization in critically ill children. Pediatr Crit Care Med. (2016) 17:1124–30. 10.1097/PCC.0000000000000936
    1. Froehlich CD, Rigby MR, Rosenberg ES, Li R, Roerig PL, Easley KA, et al. . Ultrasound-guided central venous catheter placement decreases complications and decreases placement attempts compared with the landmark technique in patients in a pediatric intensive care unit. Crit Care Med. (2009) 37:1090–6. 10.1097/CCM.0b013e31819b570e
    1. Glatstein MM, Zucker-Toledano M, Arik A, Scolnik D, Oren A, Reif S. Incidence of traumatic lumbar puncture: experience of a large, tertiary care pediatric hospital. Clin pediatr. (2011) 50:1005–9. 10.1177/0009922811410309
    1. Kessler D, Pahalyants V, Kriger J, Behr G, Dayan P. Preprocedural ultrasound for infant lumbar puncture: a randomized clinical trial. Acad Emerg Med. (2018) 25:1027–34. 10.1111/acem.13429
    1. Gottlieb M, Holladay D, Peksa GD. Ultrasound-assisted lumbar punctures: a systematic review and meta-analysis. Acad Emerg Med. (2019) 26:85–96. 10.1111/acem.13558
    1. Olowoyeye A, Fadahunsi O, Okudu J, Opaneye O, Okwundu C. Ultrasound imaging versus palpation method for diagnostic lumbar puncture in neonates and infants: a systematic review and meta-analysis. BMJ Paediatr Open. (2019) 3:e000412. 10.1136/bmjpo-2018-000412
    1. Pierce DB, Shivaram G, Koo KSH, Shaw DWW, Meyer KF, Monroe EJ. Ultrasound-guided lumbar puncture in pediatric patients: technical success and safety. Pediatr Radiol. (2018) 48:875–81. 10.1007/s00247-018-4091-2
    1. Singh Y. Echocardiographic evaluation of hemodynamics in neonates and children. Front Pediatr. (2017) 5:201. 10.3389/fped.2017.00201
    1. Conlon TW, Ishizuka M, Himebauch AS, Cohen MS, Berg RA, Nishisaki A. Hemodynamic bedside ultrasound image quality and interpretation after implementation of a training curriculum for pediatric critical care medicine providers. Pediatr Crit Care Med. (2016) 17:598–604. 10.1097/PCC.0000000000000737
    1. Via G, Hussain A, Wells M, Reardon R, El Barbary M, Noble VE, et al. . International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. (2014) 27:683.e1–33. 10.1016/j.echo.2014.05.001
    1. Spurney CF, Sable CA, Berger JT, Martin GR. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr. (2005) 18:313–9. 10.1016/j.echo.2004.10.016
    1. Kamra K, Punn R. Role of echocardiography in the assessment of right ventricular function in the pediatric population. Paediatr Anaesth. (2019) 29:530–8. 10.1111/pan.13641
    1. Su E, Dalesio N, Pustavoitau A. Point-of-care ultrasound in pediatric anesthesiology and critical care medicine. Can J Anaesth. (2018) 65:485–98. 10.1007/s12630-018-1066-6
    1. Klugman D, Berger JT. Echocardiography and focused cardiac ultrasound. Pediatr Crit Care Med. (2016) 17(8 Suppl. 1):S222–4. 10.1097/PCC.0000000000000815
    1. Yildizdas D, Aslan N. Ultrasonographic inferior vena cava collapsibility and distensibility indices for detecting the volume status of critically ill pediatric patients. J Ultrason. (2020) 20:e205–9. 10.15557/JoU.2020.0034
    1. Orso D, Paoli I, Piani T, Cilenti FL, Cristiani L, Guglielmo N. Accuracy of ultrasonographic measurements of inferior vena cava to determine fluid responsiveness: a systematic review and meta-analysis. J Intensive Care Med. (2020) 35:354–63. 10.1177/0885066617752308
    1. Basu S, Sharron M, Herrera N, Mize M, Cohen J. Point-of-care ultrasound assessment of the inferior vena cava in mechanically ventilated critically ill children. J Ultrasound Med. (2020) 39:1573–9. 10.1002/jum.15247
    1. Desgranges FP, Desebbe O, Pereira de Souza NE, Raphael D, Chassard D. Respiratory variation in aortic blood flow peak velocity to predict fluid responsiveness in mechanically ventilated children: a systematic review and meta-analysis. Paediatr Anaesth. (2016) 26:37–47. 10.1111/pan.12803
    1. Perez-Casares A, Cesar S, Brunet-Garcia L, Sanchez-de-Toledo J. Echocardiographic evaluation of pericardial effusion and cardiac tamponade. Front Pediatr. (2017) 5:79. 10.3389/fped.2017.00079
    1. Law MA, Borasino S, Kalra Y, Alten JA. Novel, long-axis in-plane ultrasound-guided pericardiocentesis for postoperative pericardial effusion drainage. Pediatr Cardiol. (2016) 37:1328–33. 10.1007/s00246-016-1438-z
    1. Kutty S, Attebery JE, Yeager EM, Natarajan S, Li L, Peng Q, et al. . Transthoracic echocardiography in pediatric intensive care: impact on medical and surgical management. Pediatr Crit Care Med. (2014) 15:329–35. 10.1097/PCC.0000000000000099
    1. Arnoldi S, Glau CL, Walker SB, Himebauch AS, Parikh DS, Udeh SC, et al. . Integrating focused cardiac ultrasound into pediatric septic shock assessment. Pediatr Crit Care Med. (2021) 22: 262–74. 10.1097/PCC.0000000000002658
    1. Yu K, Zhang S, Chen N, Chen M, Zhang W. Critical care ultrasound goal-directed versus early goal-directed therapy in septic shock. Intensive Care Med. (2021) 48:121–3. 10.1007/s00134-021-06538-4
    1. Singh Y, Villaescusa JU, da Cruz EM, Tibby SM, Bottari G, Saxena R, et al. . Recommendations for hemodynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascular dynamics section of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care. (2020) 24:620. 10.1186/s13054-020-03326-2
    1. Park DB, Presley BC, Cook T, Hayden GE. Point-of-care ultrasound for pediatric shock. Pediatr Emerg Care. (2015) 31:591–8; quiz 599–601. 10.1097/PEC.0000000000000519
    1. Poongundran P, Shann F, Shekerdemian L, Taylor A, van Sloten I, Delzoppo C, et al. . Three decades of pediatric intensive care: who was admitted, what happened in intensive care, and what happened afterward. Pediatr Crit Care Med. (2010) 11:549–55. 10.1097/PCC.0b013e3181ce7427
    1. World Health Organization Pneumonia Vaccine Trial Investigators' Group . Standardization Interpretation of Paediatric Chest Radiographs for the Diagnosis of Pneumonia in Epidemiological Studies. Geneva, Switzerland: World Health Organization; (2001).
    1. Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington L, et al. . Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. (2015) 135:714–22. 10.1542/peds.2014-2833
    1. Lichtenstein DA, Mezière GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. (2008) 134:117–25. 10.1378/chest.07-2800
    1. Sansone F, Attanasi M, Di Filippo P, Sferrazza Papa GF, Di Pillo S, Chiarelli F. Usefulness of lung ultrasound in paediatric respiratory diseases. Diagnostics. (2021) 11:1783. 10.3390/diagnostics11101783
    1. Zieleskiewicz L, Markarian T, Lopez A, Taguet C, Mohammedi N, Boucekine M, et al. . Comparative study of lung ultrasound and chest computed tomography scan in the assessment of severity of confirmed COVID-19 pneumonia. Intensive Care Med. (2020) 46:1707–13. 10.1007/s00134-020-06186-0
    1. Haaksma ME, Smit JM, Heldeweg MLA, Nooitgedacht JS, de Grooth HJ, Jonkman AH, et al. . Extended lung ultrasound to differentiate between pneumonia and atelectasis in critically ill patients: a diagnostic accuracy study. Crit Care Med. (2021). 10.1097/CCM.0000000000005303. [Epub ahead of print].
    1. Shah VP, Tunik MG, Tsung JW. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. (2013) 167:119–25. 10.1001/2013.jamapediatrics.107
    1. Basile V, Di Mauro A, Scalini E, Comes P, Lofu I, Mostert M, et al. . Lung ultrasound: a useful tool in diagnosis and management of bronchiolitis. BMC Pediatr. (2015) 15:63. 10.1186/s12887-015-0380-1
    1. Raimondi F, Rodriguez Fanjul J, Aversa S, Chirico G, Yousef N, De Luca D, et al. . Lung ultrasound for diagnosing pneumothorax in the critically ill neonate. J Pediatr. (2016) 175:74–8.e1. 10.1016/j.jpeds.2016.04.018
    1. DeSanti RL, Al-Subu AM, Cowan EA, Kamps NN, Lasarev MR, Schmidt J, et al. . Point-of-care lung ultrasound to diagnose the etiology of acute respiratory failure at admission to the PICU. Pediatr Crit Care Med. (2021) 22:722–32. 10.1097/PCC.0000000000002716
    1. Volpicelli G, Elbarbary M, Blaivas M, Lichtenstein DA, Mathis G, Kirkpatrick AW, et al. . International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. (2012) 38:577–91. 10.1007/s00134-012-2513-4
    1. Havelock T, Teoh R, Laws D, Gleeson F. Pleural procedures and thoracic ultrasound: british thoracic society pleural disease guideline (2010). Thorax. (2010) 65(Suppl. 2):ii61–76. 10.1136/thx.2010.137026
    1. Mercaldi CJ, Lanes SF. Ultrasound guidance decreases complications and improves the cost of care among patients undergoing thoracentesis and paracentesis. Chest. (2013) 143:532–8. 10.1378/chest.12-0447
    1. Barnes TW, Morgenthaler TI, Olsen EJ, Hesley GK, Decker PA, Ryu JH. Sonographically guided thoracentesis and rate of pneumothorax. J Clin Ultrasound. (2005) 33:442–6. 10.1002/jcu.20163
    1. Mayo PH, Goltz HR, Tafreshi M, Doelken P. Safety of ultrasound-guided thoracentesis in patients receiving mechanical ventilation. Chest. (2004) 125:1059–62. 10.1378/chest.125.3.1059
    1. Weber MD, Lim JKB, Glau C, Conlon T, James R, Lee JH. A narrative review of diaphragmatic ultrasound in pediatric critical care. Pediatr Pulmonol. (2021) 56:2471–83. 10.1002/ppul.25518
    1. Glau CL, Conlon TW, Himebauch AS, Yehya N, Weiss SL, Berg RA, et al. . Progressive diaphragm atrophy in pediatric acute respiratory failure. Pediatr Crit Care Med. (2018) 19:406–11. 10.1097/PCC.0000000000001485
    1. Glau CL, Conlon TW, Himebauch AS, Yeyha N, Weiss SL, Berg RA, et al. . Diaphragm atrophy during pediatric acute respiratory failure is associated with prolonged noninvasive ventilation requirement following extubation. Pediatr Crit Care Med. (2020) 21:e672–8. 10.1097/PCC.0000000000002385
    1. Valverde Montoro D, García Soler P, Hernández Yuste A, Camacho Alonso JM. Ultrasound assessment of ventilator-induced diaphragmatic dysfunction in mechanically ventilated pediatric patients. Paediatr Respir Rev. (2021) 40:58–64. 10.1016/j.prrv.2020.12.002
    1. Xue Y, Zhang Z, Sheng CQ, Li YM, Jia FY. The predictive value of diaphragm ultrasound for weaning outcomes in critically ill children. BMC Pulm Med. (2019) 19:270. 10.1186/s12890-019-1034-0
    1. Abdel Rahman DA, Saber S, El-Maghraby A. Diaphragm and lung ultrasound indices in prediction of outcome of weaning from mechanical ventilation in pediatric intensive care unit. Indian J Pediatr. (2020) 87:413–20. 10.1007/s12098-019-03177-y
    1. Sik N, Çitlenbik H, Öztürk A, Yilmaz D, Duman M. Point of care diaphragm ultrasound: an objective tool to predict the severity of pneumonia and outcomes in children. Pediatr Pulmonol. (2021) 56:1666–72. 10.1002/ppul.25352
    1. Buonsenso D, Supino MC, Giglioni E, Battaglia M, Mesturino A, Scateni S, et al. . Point of care diaphragm ultrasound in infants with bronchiolitis: a prospective study. Pediatr Pulmonol. (2018) 53:778–86. 10.1002/ppul.23993
    1. Blackbourne LH, Soffer D, Mckenney M, Amortegui J, Schulman CI, Crookes B, et al. . Secondary ultrasound examination increases the sensitivity of the FAST exam in blunt trauma. J Trauma. (2004) 57:934–8. 10.1097/01.TA.0000149494.40478.E4
    1. Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. (2006) 48:227–35. 10.1016/j.annemergmed.2006.01.008
    1. Holmes JF, Kelley KM, Wootton-Gorges SL, Utter GH, Abramson LP, Rose JS, et al. . Effect of abdominal ultrasound on clinical care, outcomes, and resource use among children with blunt torso trauma: a randomized clinical trial. JAMA. (2017) 317:2290–6. 10.1001/jama.2017.6322
    1. Shwe S, Witchey L, Lahham S, Kunstadt E, Shniter I, Fox JC. Retrospective analysis of eFAST ultrasounds performed on trauma activations at an academic level-1 trauma center. World J Emerg Med. (2020) 11:12–7. 10.5847/wjem.j.1920-8642.2020.01.002
    1. Tessi C, Burek CM, Sager C, Szklarz MT, Vasquez M, Lopez Imizcoz F, et al. . Bladder volume assessment in pediatric patients with neurogenic bladder: is ultrasound an accurate method? Urology. (2021) 147:250–5. 10.1016/j.urology.2020.10.005
    1. Bevan C, Buntsma D, Stock A, Griffiths T, Donath S, Babl FE. Assessing bladder volumes in young children prior to instrumentation: accuracy of an automated ultrasound device compared to real-time ultrasound. J Acad Emerg Med. (2011) 18:816–21. 10.1111/j.1553-2712.2011.01130.x
    1. Schallom M, Prentice D, Sona C, Vyers K, Arroyo C, Wessman B, et al. . Accuracy of measuring bladder volumes with ultrasound and bladder scanning. Am J Crit Care. (2020) 29:458–67. 10.4037/ajcc2020741
    1. Daniel SJ, Bertolizio G, McHugh T. Airway ultrasound: point of care in children-the time is now. Paediatr Anaesth. (2020) 30:347–52. 10.1111/pan.13823
    1. Hamilton CE, Su E, Tawfik D, Fernandez E, Veten A, Conlon T, et al. . Assessment of vocal cord motion using laryngeal ultrasound in children: a systematic review and meta-analysis. Pediatr Crit Care Med. (2021) 22:e532–9. 10.1097/PCC.0000000000002734
    1. El Amrousy D, Elkashlan M, Elshmaa, Ragab A. Ultrasound-Guided laryngeal air column width difference as a new predictor for postextubation stridor in children. Crit Care Med. (2018) 46:e496–501. 10.1097/CCM.0000000000003068
    1. Galiciano J, Bush AJ, Godambe SA. Use of bedside ultrasonography for endotracheal tube placement in pediatric patients: a feasibility study. Pediatrics. (2007) 120:1297–303. 10.1542/peds.2006-2959
    1. Alonso Quintela P, Oulego Erroz I, Mora Matilla M, Rodriguez Blanco S, Mata Zubillaga D, Regueras Santos L. [Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation]. Anales de pediatria. (2014) 81:283–8. 10.1016/j.anpede.2014.01.002
    1. Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. (2010) 113:819–24. 10.1097/ALN.0b013e3181ef6757
    1. Tessaro MO, Salant EP, Arroyo AC. Tracheal rapid ultrasound saline test (T.R.U.S.T.) for confirming correct endotracheal tube depth in children. Resuscitation. (2015) 89:8–12. 10.1016/j.resuscitation.2014.08.033
    1. Kerrey BT, Geis GL, Quinn AM, Hornung RW, Ruddy RM. A prospective comparison of diaphragmatic ultrasound and chest radiography to determine endotracheal tube position in a pediatric emergency department. Pediatrics. (2009) 123:e1039–44. 10.1542/peds.2008-2828
    1. Senussi MH, Kantamneni PC, Latifi M, Omranian AP, Krveshi L, Barakat AF, et al. . Protocolized tracheal and thoracic ultrasound for confirmation of endotracheal intubation and positioning: a multicenter observational study. Crit Care Explor. (2020) 2:e0225. 10.1097/CCE.0000000000000225
    1. Jaeel P, Sheth M, Nguyen J. Ultrasonography for endotracheal tube position in infants and children. Eur J Pediatr. (2017) 176:293–300. 10.1007/s00431-017-2848-5
    1. Gomes SH, Simoes AM, Nunes AM, Pereira MV, Teoh WH, Costa PS, et al. . Useful ultrasonographic parameters to predict difficult laryngoscopy and difficult tracheal intubation-a systematic review and meta-analysis. Front Med. (2021) 8:671658. 10.3389/fmed.2021.671658
    1. Sever F, Özmert S. Evaluation of the relationship between airway measurements with ultrasonography and laryngoscopy in newborns and infants. Paediatr Anaesth. (2020) 30:1233–9. 10.1111/pan.14026
    1. Kochanek PM, Tasker RC, Carney N, Totten AM, Adelson PD, Selden NR, et al. . Guidelines for the management of pediatric severe traumatic brain injury, third edition: update of the brain trauma foundation guidelines, executive summary. Neurosurgery. (2019) 84:1169–78. 10.1093/neuros/nyz051
    1. Bertuetti R, Gritti P, Pelosi P, Robba C. How to use cerebral ultrasound in the ICU. Minerva Anestesiol. (2020) 86:327–40. 10.23736/S0375-9393.19.13852-7
    1. Hall MK, Sabbaj A, Spiro D, Meckler GD. Optic nerve sheath ultrasound for the evaluation of children with suspected ventriculo-peritoneal shunt failure. Ann Emerg Med. (2009) 54:S87–8. 10.1016/j.annemergmed.2009.06.309
    1. Bhargava V, Tawfik D, Tan YJ, Dunbar T, Haileselassie B, Su E. Ultrasonographic optic nerve sheath diameter measurement to detect intracranial hypertension in children with neurological injury: a systematic review. Pediatr Crit Care Med. (2020) 21:e858–68. 10.1097/PCC.0000000000002453
    1. Biggs A, Lovett M, Moore-Clingenpeel M, O'Brien N. Optic nerve sheath diameter does not correlate with intracranial pressure in pediatric neurocritical care patients. Childs Nerv Syst. (2021) 37:951–7. 10.1007/s00381-020-04910-1
    1. Reeves SL, Madden B, Freed GL, Dombkwoski KJ. Transcranial doppler screening among children and adolescents with sickle cell anemia. JAMA Pediatrics. (2016) 170:550–6. 10.1001/jamapediatrics.2015.4859
    1. LoRovere KL, O'Brien NF, Tasker RC. Current opinion and use of transcranial doppler ultrasonography in traumatic brain injury in the pediatric intensive care unit. J Neurotrauma. (2016) 33:2105–14. 10.1089/neu.2015.4344
    1. LaRovere KL, Tasker RC, Wainright M, Reuter-Rice K, Appavu B, Miles D, et al. . Transcranial doppler ultrasound during critical illness in children: survey of practices in pediatric neurocritical care centers. Pediatr Crit Care Med. (2020) 21:67–74. 10.1097/PCC.0000000000002118
    1. O'Brien NF, Reuter-Rice K, Wainright MS, Kaplan Sl, Appavu B, Erklauer JC, et al. . Practice recommendations for transcranial doppler ultrasonography in critically ill children in the pediatric intensive care unit: a multidisciplinary expert consensus statement. J Pediatr Intensive Care. (2021) 10:133–42. 10.1055/s-0040-1715128
    1. Van Kalsbeek D, Enroth K, Lyden E, Rupp ME, Smith CJ. Improving hospital-based point-of-care ultrasound cleaning practices using targeted interventions: a pre-post study. Ultrasound J. (2021) 13:43. 10.1186/s13089-021-00244-4
    1. Frazee BW, Fahimi J, Lambert L, Nagdev A. Emergency department ultrasonographic probe contamination and experimental model of probe disinfection. Ann Emerg Med. (2011) 58:56–63. 10.1016/j.annemergmed.2010.12.015
    1. Shokoohi H, Armstrong P, Tansek R. Emergency department ultrasound probe infection control: challenges and solutions. Open Access Emerg Med. (2015):7:1–9. 10.2147/OAEM.S50360
    1. Marigliano A, D'Errico MM, Pellegrini I, Savini S, Prospero E, Barbadoro P. Ultrasound echocardiographic gel contamination by Burkholderia cepacia in an Italian hospital. J Hosp Infect. (2010) 76:360–1. 10.1016/j.jhin.2010.07.017
    1. Westerway SC, Basseal JM, Brockway A, Hyett JA, Carter DA. Potential infection control risks associated with ultrasound equipment—a bacterial perspective. Ultrasound Med Biol. (2017) 43:421–6. 10.1016/j.ultrasmedbio.2016.09.004
    1. Lee AS, White E, Monahan LG, Jensen SO, Chan R, van Hal SJ. Defning the role of the environment in the emergence and persistence of vanA vancomycin-resistant enterococcus (VRE) in an intensive care unit: a molecular epidemiological study. Infect Control Hosp Epidemiol. (2018) 39:668–75. 10.1017/ice.2018.29
    1. van Doremalen N, Bushmaker T, Morris D. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. (2020) 382:1564–7. 10.1056/NEJMc2004973
    1. AIUM Official Statement: Guidelines for Cleaning and Preparing Externaland Internal-Use Ultrasound Transducers and Equipment Between Patients as Well as Safe Handling and Use of Ultrasound Coupling Gel. American Institute of Ultrasound in Medicine; (2020). Available online at: (accessed December 7, 2020).
    1. ACEP Policy Statement: Guideline for Ultrasound Transducer Cleaning and Disinfection. (2018). Available online at: (accessed December 12, 2020).
    1. ACEP Guideline on COVID-19: Ultrasound Machine and Transducer Cleaning. (2020). Available online at: (accessed December 12, 2020).
    1. Basseal J, Westerway S, Juraja M. Guidelines for reprocessing ultrasound transducers. Australas J Ultrasound Med. (2017) 20:30–40118. 10.1002/ajum.12042
    1. Mullins K, Burnham K, Henricson EK, Cohen S, Fair J, Ray JW. Identification and analysis of bacterial contamination of ultrasound transducers and multiuse ultrasound transmission gel bottle tips before and after the aseptic cleansing technique. J Ultrasound Med. (2020) 39:1957–63. 10.1002/jum.15300
    1. Mullaney PJ, Munthali P, Vlachou P, Jenkins D, Rathod A, Entwisle J. How clean is your probe? Microbiological assessment of ultrasound transducers in routine clinical use, and cost-efective ways to reduce contamination. Clin Radiol. (2007) 62:694–8. 10.1016/j.crad.2007.01.002
    1. Ultrasound guidelines: emergency point-of-care point-of-care and clinical ultrasound guidelines in medicine . Ann Emerg Med. (2017) 69:e27–54. 10.1016/j.annemergmed.2016.08.457
    1. Fagley RE, Haney MF, Beraud AS, Comfere T, Kohl BA, Merkel MJ, et al. . Critical care basic ultrasound learning goals for american anesthesiology critical care trainees: recommendations from an expert group. Anesth Analg. (2015) 120:1041–53. 10.1213/ANE.0000000000000652
    1. Damewood SC, Leo M, Bailitz J, Gottlieb M, Liu R, Hoffmann B, et al. . Tools for measuring clinical ultrasound competency: recommendations from the ultrasound competency work group. AEM Educ Train. (2019) 4(Suppl. 1). 10.1002/aet2.10368
    1. Castro G. Top 10 Health Technology Hazards for. (2020). Available online at: (accessed March 11, 2020).
    1. Su E, Soni NJ, Blaivas M, Bhargava V, Steffen K, Haileselassie B. Regulating critical care ultrasound, it is all in the interpretation. Pediatr Crit Care Med. (2021) 22:e253–8. 10.1097/PCC.0000000000002600
    1. Conlon TW, Kantor DB, Hirshberg EL, Fraga MV, Glau CL, Horowitz R, et al. . A call to action for the pediatric critical care community. Pediatr Crit Care Med. (2021) 22:e410–4. 10.1097/PCC.0000000000002691
    1. Su E, Pustavoitau A. Pediatric critical care ultrasound education: the importance of a common denominator. Pediatr Crit Care Med. (2015) 16:292–4. 10.1097/PCC.0000000000000342
    1. Galusko V, Bodger O, Ionescu A. A systematic review of pocket-sized imaging devices: small and mighty? Echo Res Pract. (2018) 5:113–38. 10.1530/ERP-18-0030
    1. Baribeau Y, Sharkey A, Chaudhary O, Krum S, Fatima H, Mahmood F, et al. . handheld point-of-care ultrasound probes: the new generation of POCUS. J Cardiothorac Vasc Anesth. (2020) 34:3139–45. 10.1053/j.jvca.2020.07.004
    1. Lee L, DeCara JM. Point-of-care ultrasound. Curr Cardiol Rep. (2020) 22:149. 10.1007/s11886-020-01394-y
    1. Narang A, Bae R, Hong H, Thomas Y, Surette S, Cadieu C, et al. . Utility of a deep-learning algorithm to guide novices to acquire echocardiograms for limited diagnostic use. JAMA Cardiol. (2021) 6:624–32. 10.1001/jamacardio.2021.0185
    1. Sjogren AR, Leo MM, Feldman J, Gwin JT. Image segmentation and machine learning for detection of abdominal free fluid in focused assessment with sonography for trauma examinations: a pilot study. J Ultrasound Med. (2016) 35:2501–9. 10.7863/ultra.15.11017
    1. Roy S, Menapace W, Oei S, Luijten B, Fini E, Saltori C, et al. . Deep learning for classification and localization of Covid-19 markers in point-of-care lung ultrasound. IEEE Trans Med Imaging. (2020) 39:2676–87. 10.1109/TMI.2020.2994459

Source: PubMed

Szponzorok és közreműködők

Egészségi állapot

Kábítószer-beavatkozások

3
Iratkozz fel