Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit

Abstract

Purpose of review: This review summarizes the diverse uses of point-of-care ultrasound (POCUS) in critically ill children with congenital and acquired heart disease. Diagnostic utility and practicality of POCUS is reviewed. Importantly, the role of POCUS in the medical management of children in the cardiac intensive care unit is highlighted.

Recent findings: The use of POCUS in critically ill pediatric patients has emerged as an essential diagnostic tool that enhances the physical examination and influences delivery of care. Assessment of a wide range of body systems and pathologies has been impacted by the use of POCUS. Recent studies have demonstrated the use of POCUS for evaluation of cardiac tamponade, pneumonia, vocal cord function, and loss of muscle mass in critically ill children (Hamilton et al. Pediatr Crit Care Med 22(10):e532-e539, 2021; Hoffmann et al. Pediatr Crit Care Med 22(10):889-897, 2021; Najgrodzka et al. Ultrasound Q 35(2):157 163, 2019; Alerhand et al. Pediatr Ann 50(10):e424-e431, 2021).

Summary: POCUS is a non-invasive, low-risk, imaging modality that can be used to diagnose and help guide management of critically ill children in the cardiac intensive care unit. POCUS can be performed by an intensivist at the patient's bedside with real-time interpretation, leading to rapid clinical decision-making and the hope of improving patient outcomes.

Supplementary information: The online version contains supplementary material available at 10.1007/s40746-022-00250-1.

Keywords: Congenital heart disease; Diagnostic ultrasound; PICU; POCUS; Pediatric cardiac critical care; Point-of-care ultrasound.

Fig. 1

Pericardial effusion (PE) shown in subcostal cardiac POCUS view. RV = right ventricle; LV = left ventricle [32]

Fig. 2

Normal lung POCUS findings. A A-lines (white arrows). B Seashore sign in M-mode

Fig. 3

Abnormal lung POCUS findings. A Lung hepatization (white asterisk) and air bronchograms (white arrows). B B-lines (white arrows)

Fig. 4

POCUS images of pleura. A Pleural effusion (white asterisk) with lung hepatization (white arrow) and liver (white star) is shown. B Stratosphere sign of pneumothorax via M-mode

Fig. 5

POCUS views to evaluate the diaphragm (white arrow). A subcostal transverse view and B longitudinal, posterior, mid-axillary view

Fig. 6

IVC distention (A) and collapse (B), as depicted by yellow arrow, in subcostal, long-axis, POCUS view of the IVC [82]

Fig. 7

Subcutaneous edema demonstrated via abdominal skin POCUS in long-axis, mid-axillary line. Red vertical line = subcutaneous edema; green star = abdominal muscle; white star = liver [93]

Fig. 8

Short-axis POCUS view of quadriceps femoris muscle. Red line – subcutaneous tissue. Green star – rectus femoris muscle. Red arrow – femur [93]