BEDSIDE ECHOCARDIOGRAPHY IN A HEMODYNAMICALLY UNSTABLE CHILD

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.