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Abstract

Introduction: Focused bedside ultrasonography (BUS) has been shown to improve acute management of critically ill patients. Limited data are available supporting use of BUS in a tertiary pediatric intensive care unit (PICU) setting. Hypothesis: Implementation of a BUS education program in an academic PICU is feasible. Non-procedural BUS for intravascular fluid status and cardiac function (FC) evaluation would affect clinical management more frequently compared to other core applications. Methods: BUS education for PICU fellows and attending physicians was developed and implemented. The curriculum consisted of a 2 days hands-on course followed by BUS image review by peer practitioners and BUS experts (bi-weekly in PICU and weekly at adult Emergency Medicine BUS rounds). Participants are required to perform BUS studies in the following core applications: procedural (P), FC, thoracic (T), and abdominal (A). BUS clips with clinical scenarios were assessed by two reviewers to determine whether the BUS affected management (critical). Descriptive statistics of categorical variables are compared using Fisher’s exact test with p-value<0.05 as significant. Results: 13 critical care faculty and 3 fellows received BUS training. From January to June 2012, 201 BUS studies were performed: 57(28%) P, 76(38%) FC, 33(16%) A, and 35(17%) T. 24 studies (17% of all non-P) were identified as critical to lead patient care at the bedside. 46%(11/24) of those studies were FC, followed by other core indications (25% A and 29% T). The proportion of critical BUS studies were not significantly different across the indications (FC 11/76[15%] vs A+T 13/68[19%], p=0.51). Examples of critical studies include: diagnosis of cardiac tamponade, identification of pulmonary hypertension, hemodynamic assessment before tracheal intubation, determination of pneumothorax, location of the chest tube and urinary catheter, differentiation of pleural fluid from pulmonary consolidation and assessment of undifferentiated hypotension and hypoxia. Conclusions: Implementation of a BUS education program in an academic PICU is feasible. The utilization of all non-procedural core applications resulted in critical changes in diagnosis and management of PICU patients.