Transthoracic Echocardiography in Pediatric Intensive Care

Kutty, Shelby; Attebery, Jonah; Yeager, Emily M.; Natarajan, Swetha; Li, Ling; Peng, Qinghai; Truemper, Edward J.; Hammel, James M.; Danford, David A.

doi:10.1097/pcc.0000000000000099

Cited by 28 publications

(15 citation statements)

References 26 publications

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“…In our study, a decisive or supplemental information was obtained in 64.6% patients. To our knowledge, studies available in literature are very few in this regard ( 11 , 23 , 24 ) and our study is first to be conducted prospectively comparing the two groups. Stanko and coauthors reported that TTE resulted in a change in the diagnosis and management frequently ( 25 ).…”

Section: Discussionmentioning

confidence: 99%

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study

Şahin¹,

Yazıcı

Ayar³

et al. 2017

Anatol J Cardiol

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Objective:To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children.Methods:A total of 140 children, including 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) children, who were admitted consecutively from March to August 2013 were evaluated prospectively. Data regarding the indication for echocardiography and therapeutic approaches used were documented. For evaluating disease severity, the Pediatric Risk of Mortality Score III (PRISM) was ascertained. The correlation between PRISM score and the requirement of echocardiographic evaluations were analyzed.Results:Patients ages were between 45 days to 18 years. The male-to-female ratio was 1.33. In 35.4% patients who underwent echocardiographic evaluation, no definitive alteration occurred in treatment approach, whereas in the remaining 64.6% patients, decisive or supplemental information was gathered. Echocardiography was indicated in 88% MV children and 46.2% SB children. Echocardiographic evaluation was necessary in MV children and there was a positive correlation between the PRISM score and the requirement of echocardiographic assessment (p<0.001).Conclusion:Echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. Basic training for intensivists in this procedure is crucial and needs to be improved and supported in critically ill.

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Section: Discussionmentioning

confidence: 99%

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study

Şahin¹,

Yazıcı

Ayar³

et al. 2017

Anatol J Cardiol

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“…Our findings contribute to preexisting literature on critical care echocardiography. In a study of pediatric ICU patients, echocardiography introduced a new diagnosis unrelated to the echo indication in 13%; an echo ordered as stat was more likely to change management and diagnosis than a routinely ordered echo [33]. In another study of critically ill patients, TTE changed diagnosis in 19% of cases and management in 34% of cases with "adequate clinical data".…”

Section: Discussionmentioning

confidence: 99%

Unanticipated critical findings on echocardiography in septic patients

et al. 2020

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Background: Echocardiography is increasingly performed among septic patients as a routine part of evaluation and management in the intensive care unit (ICU). The rate of unanticipated critical findings (e.g., severe left or right ventricular dysfunction or pericardial tamponade) on such echocardiograms is unknown. We evaluated a retrospective cohort of septic ICU patients in whom transthoracic echocardiography was performed as a routine part of sepsis management. In addition to identifying critical findings, we defined whether each critical finding was anticipated, and whether the clinical team responded to the critical finding. The primary outcome was rate of unanticipated critical findings, which we hypothesized would occur in fewer than 5% of patients. We also performed an exploratory analysis of the association between unanticipated critical finding and mortality, controlling for severity of illness. Results: We studied 393 patients. Unanticipated critical findings were identified in 5% (95% CI 3-7%) of patients (n = 20). Among the 20 patients with unanticipated critical findings, a response to the unanticipated critical finding was identified in 12 (60%) patients. An unanticipated critical finding was not significantly associated with 28-day mortality when controlling for admission APACHE II (p = 0.27). Conclusions: Unanticipated critical findings on echocardiograms in septic ICU patients are uncommon. The potential therapeutic relevance of echocardiography to sepsis is more likely related to hemodynamic management than to traditional cardiac diagnoses. Research studies that employ blinded echocardiograms in septic patients may anticipate unblinding for critical findings approximately 1 in every 20 echocardiograms.

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“…This finding was in line with recent study suggesting a reduction of CXRs by using point-of-care ultrasonography techniques. [ 8 9 10 ] A literature review shows different performance such as clarification of perioperative hemodynamics,[ 11 ] adding diagnostic values,[ 12 ] demonstration of cardiac dysfunctions and abnormalities[ 13 ] for echocardiography which makes a powerful tool for diagnosis.…”

Section: Discussionmentioning

confidence: 99%

Assessment of limited chest x-ray technique in postcardiac surgery management

et al. 2017

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Objectives:The objective of this study is to investigate the safety of elimination of chest radiography in the postcardiac surgery Intensive Care Unit (ICU).Methods and Design:We compared patients in two different groups of routine CXR (RCXR) and limited CXR (LCXR) and their diagnostic and therapeutic outcome in a University hospital-based single center from 2014 to 2016. 3 CXR in the RCXR group and 1 CXR in the limited group was performed, in addition to on-demand criteria.Measurement and Main Results:A total of 978 samples were acceptable for analysis which 55.21% of RCXR and 59.50% of LCXR were male patients. In total, 523 abnormalities in RCXR group and 154 occasions in LCXR group resulted in 26.73% diagnostic efficacy for RCXRs and 28.57% for LCXR. From 1956 CXR that was taken in RCXR group, 72 occasions required intervention (3.68%) and 84 cases out of 539 (15.58%) LCXR needed an action to therapy. This means a 14.40% in RCXRs’ abnormalities and 56.00% of LCXRs’ abnormalities were accompanied with some interventions.Conclusions:Abolishing routine CXR in the ICUs would not be harmful for the patients, and it can be managed based on their clinical status and other safer imaging techniques.

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Transthoracic Echocardiography in Pediatric Intensive Care

Cited by 28 publications

References 26 publications

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study

Clinical impact and efficacy of bedside echocardiography on patient management in pediatric intensive care units (PICUs): A prospective study

Unanticipated critical findings on echocardiography in septic patients

Assessment of limited chest x-ray technique in postcardiac surgery management

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