Point-of-care ultrasound in pediatric anesthesiology and critical care medicine

Abstract

Ultrasound has increasingly become a clinical asset in the hands of the anesthesiologist and intensivist who cares for children. Though many applications for ultrasound parallel adult modalities, children as always are not simply small adults and benefit from the application of ultrasound to their management in various ways. Body composition and size are important factors that affect ultrasound performance in the child, as are the pathologies that may uniquely afflict children and aspects of procedures unique to this patient population. Ultrasound simplifies vascular access and other procedures by visualizing structures smaller than those in adults. Maturation of the thoracic cage presents challenges for the clinician performing pulmonary ultrasound though a greater proportion of the thorax can be seen. Moreover, ultrasound may provide unique solutions to sizing the airway and assessing it for cricothyroidotomy. Though cardiac ultrasound and neurosonology have historically been performed by well-developed diagnostic imaging services, emerging literature stresses the utility of clinician ultrasound in screening for pathology and providing serial observations for monitoring clinical status. Use of ultrasound is growing in clinical areas where time and diagnostic accuracy are crucial. Implementation of ultrasound at the bedside will require institutional support of education and credentialing. It is only natural that the pediatric anesthesiologist and intensivist will lead the incorporation of ultrasound in the future practice of these specialties.

Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice

“…Direct neurosonology of the brain and its vessels is complicated by view obstruction from bone, although this is commonly performed through open fontanelles and represents the first-line neuroimaging technique commonly performed in NICUs. 94 It is…”

“…Measurement of the optical nerve sheath diameter is suggestive of papilledema and increased intracranial pressure (Fig 12); however, sources conflict on threshold measurements, and papilledema may persist despite normalization of intracranial pressure. 94 Despite having some elasticity, the sheath may become stretched over time, as seen in both shunted and nonshunted patients with a history of obstructive hydrocephalus. 98 Conceivably, other patients with chronic papilledema, such as those with pseudotumor cerebri and craniosynostosis, would also have wider baseline optic nerve sheath diameters.…”

Where Does Innovation in Critical Care Ultrasound Come From? Perhaps a Look in the Mirror*

“…Uniting the phenomenon of pleural mirroring in pneumothorax and the imaging characteristics of incompletely ossified ribs in neonates, the authors present the first series to date examining the diagnostic utility of rib mirroring as an indicator for pneumothorax. Also having been described as “figure-of-eight sign” ( 6 ), the finding appears as exact mirroring of the ovoid cartilaginous ribs of the neonate across the pleura in pneumothorax appearing as a series of “eights.” The mirroring phenomenon occurs due to stark density differences between pneumothorax air and tissues of the chest wall causing ultrasound reflection at the pleural boundary. Due to lengthening of the ultrasound beam as it rebounds between the probe and pleural line, the machine believes that reflections are deeper than reality when the beam returns to the probe.…”

Point-of-care ultrasound: a protean opportunity for perioperative care

“…Are POCUS skills transferable between adult and pediatric populations? 12 If POCUS skills are fundamental entrustable professional activities for graduating specialists, how do we train thousands of providers already in practice? What is the role of technology in distributing training and maintenance of competence?…”

“…Les compétences en échographie au chevet sont-elles transférables des populations adultes aux populations pédiatriques? 12 Si les compétences en échographie au chevet sont des actes professionnels non supervisés fondamentaux pour les spécialistes terminant leur formation, comment formons-nous les milliers de professionnels pratiquant déjà l'anesthésie? Quel rôle joue la technologie dans la diffusion de la formation et le maintien des compétences?…”