Validity of Clinical Indications of Pediatric Bedside Echocardiography in Critically Ill Children: A Single Center Study

Abstract

Background: Management of critically ill pediatric patients is a demanding task that relies on a combination of clinical skills and measurement of hemodynamic variables. Echocardiography is currently considered a key tool for the hemodynamic assessment in intensive care units, able to identify causes of hemodynamic instability and to correctly guide therapy. Aim of the work:To determine the type of indications for requesting bedside echocardiography in neonatal and pediatric intensive care units in our center, and to find which of these indications have the highest sensitivity to confirm the presence of echocardiographic abnormalities. Methods: We conducted a prospective study at Cairo University Children's Hospital on 271 critically ill patients admitted to neonatal and pediatric intensive care units and who underwent bedside echocardiography examination. Detailed clinical examination, chest X-ray and echocardiography were done for all patients and comparative results were evaluated. Results:The commonest encountered condition detected with bedside echocardiography in the neonatal intensive care units was pulmonary hypertension representing 35.8% of the examined neonates, while in the pediatric intensive care units it was impaired cardiac contractility representing 33.1% of the totally examined children. The commonest indication for requesting bedside echocardiography was screening for hemodynamically significant patent ductus arteriosus in preterm infants (n= 73, 42%) in neonatal intensive care units' group, while the most common indication for requesting bedside echocardiography was in pediatric intensive care units' group assessment of the cardiac function (n= 60, 61.9%). Of the total requested bedside echocardiography examinations, we found that 51.7% of those performed in neonatal intensive care units' and 19.6% in the pediatric intensive care units' had no significant cardiac abnormality. Conclusion:The use of bed side echocardiography by intensivists and pediatric cardiologists is necessary. Adequate training to attain skills for bedside echocardiography examination by neonatal and pediatric intensivists is an essential requisite for sound primary echocardiographic assessment.