Cardiac and lung point‐of‐care ultrasound in pediatric anesthesia and critical care medicine: Uses, pitfalls, and future directions to optimize pediatric care

Abstract

Point-of-care ultrasound (POCUS) has found many relevant applications in pediatric anesthesia and critical care medicine. Specifically, the cardiac and pulmonary POCUS examinations provide a wealth of information from physical examination assistance to diagnostic evaluation and assessment of treatment response. However, as with any adjunct, potentially dangerous pitfalls exist when POCUS is performed, interpreted, and applied by the novice sonographer. Using case illustrations, we highlight the clinical application of POCUS in addition to potential dangers. Additionally, suggestions for learning POCUS, assessing competency and credentialing are reviewed. K E Y W O R D S anesthesiology, cardiac, critical care, perioperative, point-of-care ultrasound, pulmonary, ultrasound | 791 ADLER Et AL. S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Adler AC, Brown KA, Conlin FT, Thammasitboon S, Chandrakantan A. Cardiac and lung point-of-care ultrasound in pediatric anesthesia and critical care medicine: Uses, pitfalls, and future directions to optimize pediatric care. Pediatr Anesth. 2019;29:790-798.

Point of care ultrasound for all by all: A multidisciplinary survey across a large quaternary care medical system

“…Emergency medicine physicians, early adopters of POCUS, declared it “integral to the practice of emergency medicine” as early as 2001 6 . In contrast, other specialties later to adopt POCUS, such as pediatric critical care, are still exploring the best applications for their practices 1,7,8 . Thanks to advances in technology, POCUS devices are smaller, less expensive, and increasingly accessible, 9 substantially broadening their use.…”

American Society of Regional Anesthesia and Pain Medicine expert panel recommendations on point-of-care ultrasound education and training for regional anesthesiologists and pain physicians—part I: clinical indications

“…POCUS is becoming an essential tool for diagnostic and procedural purposes in pediatric acute care medicine, similar to its use in adult populations. [145][146][147][148][149] Evidence documents the benefits of gastric, 106 150 151 cardiac, 147 148 airway and lung [152][153][154][155][156] ultrasound use in children. While there are many similarities between POCUS imaging for adults and children, the differing size, physiology, common injury patterns and distribution of comorbidities in children create aspects of POCUS that are unique to pediatric patients.…”

Perioperative Point-of-Care Ultrasound Use by Anesthesiologists

“…It has even been postulated to be equal or superior to either chest radiography or chest computed tomography (CT) in some instances such as in acute respiratory distress syndrome (ARDS) [19]. Its uses include but are not limited to evaluating causes of hypoxia via pleural effusions, pulmonary edema, pneumothoraces, atelectasis, and bilateral ventilation [20,21]. It is also able to elucidate the degree of severity in pulmonary effusions and edema.…”

“…It is also able to elucidate the degree of severity in pulmonary effusions and edema. Intraoperatively, the apical segments of the lung and posterior axillary line are usually accessible, which makes it a powerful tool to utilize in real-time during an operation [20]. The use of pulmonary ultrasound can be highly advantageous in the perioperative setting as compared to lung auscultation and chest radiography.…”