The Use of Point‐of‐Care Ultrasound to Evaluate Pulsus Paradoxus in Children With Asthma

Abstract

Pulsus paradoxus (PP) is defined as a fall of systolic blood pressure of greater than 10 mm Hg during the inspiratory phase of respiration. Measurement of PP is recommended by national and international asthma guidelines as an objective measure of asthma severity but is rarely used in clinical practice. Cardiac point‐of‐care ultrasound with pulsed wave Doppler imaging measuring respiratory‐phasic changes of mitral valve inflow velocities is well described in cardiac tamponade as “sonographic” PP. We present 10 cases of acute asthma presenting to an emergency department showing the finding of sonographic determined PP in the apical 4‐chamber view of the heart on pulsed wave Doppler imaging.

Pleural line slope in point of care ultrasound assessment of paediatric wheeze may reflect respiratory effort

“…16 A case report describes pulsus paradoxus on cardiac POCUS as a measure of asthma severity. 17 Studies of bronchiolitis and of mechanical ventilation in children have investigated changes in diaphragmatic thickness. [18][19][20] However, measuring diaphragmatic thickness is technically difficult, and the utility of this approach has been questioned.…”

“…A case report describes pulsus paradoxus on cardiac POCUS as a measure of asthma severity 17 . Studies of bronchiolitis and of mechanical ventilation in children have investigated changes in diaphragmatic thickness 18–20 .…”