Pediatric Critical Care Ultrasound: An Essential Skill in Pediatric Cardiac Intensive Care Unit

Ultrasound (US) is considered nowadays an essential intensive care tool; we always use US in the perioperative period and by pediatric cardiac intensive care (PCICU) specialists to address clinical problems and guide invasive procedures. This is a paradigm shift from being organ based, systematic, comprehensive diagnostic exam done by radiologists to a new concept of problem-based, goal-directed, focused multi-organ, time-dependent, exam done by the treating intensivist. Based on this concept, the US exam is not done for an organ (e.g., US for abdomen or chest) but rather done to enhance the management of a problem (US for hypotension, US for hypoxia, US for sepsis, etc.). Certain problem-based US exams can involve scanning of multiple organs to enhance the management of certain patient’s problem. The US within this concept is not considered just as diagnostic tool but rather as an integral part of pediatric cardiac intensive care (PCICU) management that involves diagnosis, tailored treatment, monitoring effects, goal-directed therapy, ruling out possible complications and to guide most of PCICU procedures. The authors have started a formal program of Pediatric and Neonatal Critical Care US at their institution in collaboration with and as part of the World Interactive Network Focused On Critical UltraSound (WINFOCUS; www.winfocus.org ) in 2008. This chapter describes some of the applications of this innovative program over a 10-year period in a PCICU and its impact on patient care (further details of this program can be found under ref. 1).