The Role of Focused Echocardiography in Pediatric Intensive Care: A Critical Appraisal

Heloisa Amaral Gaspar, Samira Saady Morhy, Heloisa Amaral Gaspar, Samira Saady Morhy

Abstract

Echocardiography is a key tool for hemodynamic assessment in Intensive Care Units (ICU). Focused echocardiography performed by nonspecialist physicians has a limited scope, and the most relevant parameters assessed by focused echocardiography in Pediatric ICU are left ventricular systolic function, fluid responsiveness, cardiac tamponade and pulmonary hypertension. Proper ability building of pediatric emergency care physicians and intensivists to perform focused echocardiography is feasible and provides improved care of severely ill children and thus should be encouraged.

Figures

Figure 1
Figure 1
Calculation of left ventricular fractional shortening by the M mode. (a) Parasternal short-axis view in a patient with normal ejection fraction. (b) Parasternal long-axis view in a patient with viral myocarditis and cardiogenic shock, with reduced ejection fraction. EDD: left ventricle end-diastolic diameter; ESD: left ventricle end-systolic diameter; RV: right ventricle. FS = EDD − ESD/EDD × 100.
Figure 2
Figure 2
Stroke volume (SV) calculation. (a) Measurement of LV outflow tract diameter (LVOTD) using the parasternal long-axis view, and (b) use of pulsed Doppler for the measurement of velocity-time integral (VTI), as obtained in the 5-chamber apical view. Cardiac output (CO) = SV × HR; SV = VTI × LVOT area, where LVOT area =  π(LVOT  diameter/2)2.
Figure 3
Figure 3
M mode echocardiography from subcostal view in a five-year-old patient in septic shock for urinary tract infection under mechanical ventilation, with sustained hypotension after volume expansion with 60 mL/kg of saline solution. Bedside echocardiography showed significant respiratory changes in IVC diameter, which, along with other clinical and monitoring data, suggested that fluid resuscitation should be maintained. dIVC = 90%, where dIVC = (Dmax − Dmin)/Dmin  × 100.
Figure 4
Figure 4
Cardiac tamponade with large pericardial effusion and diastolic collapse of the right ventricle (arrow). LA: left atrium; LV: left ventricle; PE: pericardial effusion. RA: right atrium; RV: right ventricle.
Figure 5
Figure 5
(a) Four-chamber apical view demonstrating normal heart. (b) Significant right chambers dilatation with straightened ventricular septum plus small pericardial effusion. LA: left atrium; LV: left ventricle; RA: right atrium; RV: right ventricle.
Figure 6
Figure 6
Newborn under invasive mechanical ventilation for hypoxemia in the first day of life. Apical view showing tricuspid regurgitation on color Doppler in blue (a) and on continuous wave Doppler (b). RV-RA gradient of 82 mmHg and the pulmonary artery systolic pressure is estimated at 92 mmHg (RV-RA gradient pressure added to the RA pressure).

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Source: PubMed

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