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. 2023 Jul:144:56-59.
doi: 10.1016/j.pediatrneurol.2023.03.017. Epub 2023 Apr 4.

Cardiac Point-of-Care Ultrasound in Pediatric Neurocritical Care: A Case Series

Kaitlyn Boggs  1 , Matthew Kirschen  2 , Christie Glau  2 , Shih-Shan Lang Chen  3 , Adam S Himebauch  2 , Jimmy Huh  2 , Thomas Conlon  2
Affiliations

Cardiac Point-of-Care Ultrasound in Pediatric Neurocritical Care: A Case Series

Kaitlyn Boggs et al. Pediatr Neurol. 2023 Jul.

Abstract

Background: Pediatric brain injury is accompanied by hemodynamic perturbations complicating the optimization of cerebral physiology. Point-of-care ultrasound (POCUS) uses dynamic real-time imaging to complement the physical examination and identify hemodynamic abnormalities in preload, contractility, and afterload conditions, but the contribution of cardiac POCUS in the context of pediatric brain injury is unclear.

Methods: We reviewed cardiac POCUS images integrated in clinical care to examine those with neurological injury and hemodynamic abnormalities.

Results: We discuss three children with acute brain injury and myocardial dysfunction identified using cardiac POCUS by bedside clinicians.

Conclusions: Cardiac POCUS may have an important role in caring for children with neurologic injury. These patients received personalized care informed by POCUS data in attempts to stabilize hemodynamics and optimize clinical outcomes.

Keywords: Cardiac dysfunction; Neurological injury; POCUS; Pediatrics; Point-of-care ultrasound.

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Figures

FIGURE 1.
FIGURE 1.
(A-F) Suggested basic point-of-care ultrasound (POCUS) cardiac views acquired at the bedside for hemodynamic assessment. (A) Transverse view of the IVC and AO. (B) Longitudinal view of the IVC as it enters the RA. (C) Subcostal view of the heart. (D) Apical four-chamber view of the heart. (E) Parasternal short-axis view of the heart. (F) Parasternal long-axis view of the heart. RA, right atrium; RV, right ventricle; LA, left atrium; LV, left ventricle; IS, interventricular septum; MV, mitral valve; TV, tricuspid valve; AO, aorta; IVC, inferior vena cava; DA, descending aorta; AV, aortic valve.
FIGURE 2.
FIGURE 2.
Parasternal long-axis images in systole (A) and diastole (B). The distance between the anterior mitral leaflet and the interventricular septum (yellow annotation) during diastole is the E-point septal separation (EPSS). An increased EPSS may be due to the left ventricular dilation and/or systolic dysfunction, although this should be confirmed by other qualitative and quantitative methods of functional assessment using multiple cardiac views.
See this image and copyright information in PMC

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