Also Pershad et al. They suggested that BLEEP examination may provide unbiased, rapid, noninvasive information about ventricular function and right ventricular filling in critically ill pediatric patients in emergency department The WINFOCUS experience has suggested the ideal conditions and recommendations for intensivists education in adults, getting accreditation for the use of echocardiography in the intensive care setting 9. At the same time, the Portuguese Working Group on Echocardiography has improved the skill-based program FADE to teach clinicians the use of bedside ultrasound to level-1 competency in echocardiography and chest ultrasound, enabling intensivists to determine major causes of hypotension, respiratory failure, and the need for a second opinion.
Consistent with the literature, in our study the most common indications were hypotension 23 and assessment of left ventricular function. Education and accreditation programs aiming to provide level-1 proficiency adapted to national needs and sensitivities are appearing in many countries and there are obvious national differences in education and accreditation programs, even for cardiologists 8.
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As far as we know, there is few training programs which implemented a training curriculum for pediatric intensivists to perform fast and primary echocardiography 12 , which one of them allows the treatment to be arranged rapidly at the bedside in a tertiary, non-cardiac PICU as well as training intensivists established within their fellowship curriculum In addition, in this study a pediatric cardiology specialist—who was blinded to performer—scored and judged the image quality and interpretation with a global assessment which was striking.
The credentialed providers had more precise image interpretation than the unsupervised noncredentialed group Nevertheless, all intensive care echocardiography studies to date lacks a systematic training program at the institutional level 31 because the groups of patients admitted to PICU requires particular expertise relating to the specific needs, such as trauma, medical, and surgical conditions.
Therefore, although many sources support the principle of training clinicians to perform echocardiography, the approach and the dataset still remains undefined. In addition, we considered the methodology, parameter selection, and investigator experience while performing echocardiography during mechanical ventilation.
In a previous study, authors stated that chest movement during mechanical ventilation does not decrease the quality of the obtained data Restrictions of echocardiographic views are ventral pneumothorax or left-sided alveolar hyperinflation, which decreases image quality Any inaccuracies were balanced when the same investigator assess all the measurements in each patient as in our study. Nevertheless all the above limitations do not decrease the importance of echocardiography because it is noninvasive, readily accessible, and repeatable for the assessment of cardiac performance Khilnani et al.
Formal training in courses of limited echocardiography obtained by intensivists has following limitations: learning curve is steep for the technique, there is interobserver variability, and interpretation is difficult in the presence of confounding factors—i. There are few studies in adults regarding the feasibility and potential clinical utility of TTE performed by intensivists in critically ill patients with handheld devices 19 , 34 , Also handheld ultrasound devices represent an alternative to standard echocardiographic systems in pediatric cardiology, so systems, including all echocardiographic modalities, offer unlimited versatility in intensive care Baron et al.
Bedside echocardiography in critically ill children can sometimes be a dilemma because it depends on only pediatric cardiologists to come and evaluate on off hours and unfortunately we cannot consult a pediatric cardiologist for 24 hours. Even though PICU setting lacks the evidence supporting the introduction of echocardiography, we believe that training for intensivists in this technique, at least for basic echocardiography, is an emerging issue.
As authors we are aware of limitations related to its design single-centered and the scarcity of existing opportunities in a developing country environment. In the light of our results; echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. This noninvasive monitoring tool helps intensivists in the adjustment of therapy in the PICU setting. We believe that the use of echocardiography by intensivists and pediatric cardiologists goes together.
However, in the future, it can be used at the bedside in the hands of pediatric intensivists with adequate training and quality control for primary echocardiographic assessment. Training of intensivists in this regard is crucial and needs to be improved and encouraged in critically ill patients.
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Guiding future studies and formative programs regarding basic training are required to accomplish this expectation. Conflict of interest: None declared. Peer-review: Externally peer-reviewed. Authorship contributions: Concept — S. National Center for Biotechnology Information , U. Journal List Anatol J Cardiol v.
Anatol J Cardiol. Published online Jun Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. Accepted Apr Abstract Objective: To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children. Methods: A total of children, including 75 mechanically ventilated MV and 65 spontaneously breathing SB children, who were admitted consecutively from March to August were evaluated prospectively.
Results: Patients ages were between 45 days to 18 years. Conclusion: Echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. Keywords: critically ill children, echocardiography, intensivist, mechanical ventilation, pediatric intensive care unit, training. Introduction To date, echocardiography has been used as an adjunct in predicting patient outcomes. Table 1 Demographic characteristics of the patients.
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Table 2 Indications of echocardiography. Results Demographic characteristics of the patients are listed on Table 1. Table 3 Therapeutic interventions performed after echocardiography. Discussion In this study we aimed to determine the indication and need for echocardiographic assessment in critically ill children and according to our results, the need for echocardiographic evaluation was higher in MV children, and the severity of the patients significantly increased the requirement.
Study limitations As authors we are aware of limitations related to its design single-centered and the scarcity of existing opportunities in a developing country environment. Conclusion In the light of our results; echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity.
Footnotes Conflict of interest: None declared. References 1. Myocardial performance index in children with ventricular septal defect. Ces-slov Pediatr Free Preview. Show next edition.
Echocardiography for Intensivists
Few books are written specifically for the intensivist Section D is highly original since it offers goal-directed and focus-oriented ICU echocardiography Numerous step-by-step algorithms help the reader with hands-on ICU applications see more benefits. Buy eBook. Rent the eBook. FAQ Policy. About this book This book contains all the information that readers will require in order to perform echocardiography and to interpret the findings correctly. Show all.
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Luca et al. The Aorta Pages Tritapepe, Luigi et al. Mitral Valve Pages Nicoletti, Ilaria et al. Skip to main content Skip to table of contents. Advertisement Hide. Echocardiography for Intensivists. Front Matter Pages i-xxiii. Front Matter Pages Dionisio F. Colella, Paolo Prati, Armando Sarti.
Pages Ultrasound Morphology of the Heart: Transthoracic Examination. Ultrasound Morphology of the Heart: Transesophageal Examination. Three-Dimensional Echocardiography. The Left Ventricle. The Right Ventricle and Pulmonary Artery. Left and Right Atria. Pericardium and Pericardial Diseases.