BEDSIDE ECHOCARDIOGRAPHY IN A HEMODYNAMICALLY UNSTABLE CHILD
Journal
Macedonian Journal of Anaesthesia
Date Issued
2019-12
Author(s)
Toleska M.
Trposka A.
Abstract
Introduction:Echocardiography may be considered as an important tool due to hemodynamic
assessment of a hemodynamically unstable child in a Pediatric Intensive Care Units (PICU),
which could provide identification of the etiology and pathophysiology of hemodynamic instability
but also to help due to guiding therapy.
Objectives: The aim of our cohort study is to determine the impact of usage of fast focused
echocardiography examination in the Surgical PICU done by Anesthesiologist/Intensivist.
Material and Methods: We’ve made a fast focused bedside transthoracic echocardiographic
examination of 11 hemodynamically unstable children using the regular parasternal long and
short axis view and four chamber subcostal view of the heart, LVOT, aorta, truncus pulmonalis
and Inferior vena cava (IVC) for qualitative assessment. Dimensions and collapsibility of IVC
were measured. The youngest patient was premature neonate born in 28th gestation week and
the oldest was 12 years old child.
Results: In 9 out of 11 children we’ve identified abnormality by the qualitative assessment of
the heart due to performing focused echocardiography. In 4 children we found global myocardial
hypokinesia, one child with insignificant pericardial effusion (2 mm) and 4 children with Inferior
vena cava collapsibility greater than 50%. In the children with hypokinesia inotropic support was
established while the children with IVC collapsibility greater than 50% were treated with fluid
boluses. Persistence of foramen ovale as a random finding was seen in 5 neonates, insignificant
for the hemodynamic instability.
Conclusion: Several studies have shown the positive effect of the echocardiography usage
in the management of critically ill children, changing their treatment in 30%–60% of cases after
the test is performed (2). From our study we can conclude that performing focused echocardiography
is feasible and provides valuable data which could lead to improved care of severely
ill children and thus should be encouraged in daily ICU practice.
assessment of a hemodynamically unstable child in a Pediatric Intensive Care Units (PICU),
which could provide identification of the etiology and pathophysiology of hemodynamic instability
but also to help due to guiding therapy.
Objectives: The aim of our cohort study is to determine the impact of usage of fast focused
echocardiography examination in the Surgical PICU done by Anesthesiologist/Intensivist.
Material and Methods: We’ve made a fast focused bedside transthoracic echocardiographic
examination of 11 hemodynamically unstable children using the regular parasternal long and
short axis view and four chamber subcostal view of the heart, LVOT, aorta, truncus pulmonalis
and Inferior vena cava (IVC) for qualitative assessment. Dimensions and collapsibility of IVC
were measured. The youngest patient was premature neonate born in 28th gestation week and
the oldest was 12 years old child.
Results: In 9 out of 11 children we’ve identified abnormality by the qualitative assessment of
the heart due to performing focused echocardiography. In 4 children we found global myocardial
hypokinesia, one child with insignificant pericardial effusion (2 mm) and 4 children with Inferior
vena cava collapsibility greater than 50%. In the children with hypokinesia inotropic support was
established while the children with IVC collapsibility greater than 50% were treated with fluid
boluses. Persistence of foramen ovale as a random finding was seen in 5 neonates, insignificant
for the hemodynamic instability.
Conclusion: Several studies have shown the positive effect of the echocardiography usage
in the management of critically ill children, changing their treatment in 30%–60% of cases after
the test is performed (2). From our study we can conclude that performing focused echocardiography
is feasible and provides valuable data which could lead to improved care of severely
ill children and thus should be encouraged in daily ICU practice.
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