International evidence-based guidelines on Point of Care Ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC)

Peter Kenderessy,Pierre Tissieres,Yogen Singh,Joe Brierley,Martin C. Kneyber,Eduardo Da Cruz,Akira Nishisaki,María V. Fraga,Cecile Tissot,Philippe Durand,Dusan Raffaj,Daniele De Luca,Juan Mayordomo Colunga,Jorge Lopez,Joan Sanchez-de-Toledo,Nadya Yousef,Rafael Gonzalez Cortes,Thomas W. Conlon,Hans-Joerg Lang

doi:10.1186/s13054-020-2787-9

Abstract

BackgroundPoint-of-care ultrasound (POCUS) is nowadays an essential tool in critical care. Its role seems more important in neonates and children where other monitoring techniques may be unavailable. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children.MethodsCreation of an international Euro-American panel of paediatric and neonatal intensivists expert in POCUS and systematic review of relevant literature. A literature search was performed, and the level of evidence was assessed according to a GRADE method. Recommendations were developed through discussions managed following a Quaker-based consensus technique and evaluating appropriateness using a modified blind RAND/UCLA voting method. AGREE statement was followed to prepare this document.ResultsPanellists agreed on 39 out of 41 recommendations for the use of cardiac, lung, vascular, cerebral and abdominal POCUS in critically ill neonates and children. Recommendations were mostly (28 out of 39) based on moderate quality of evidence (B and C).ConclusionsEvidence-based guidelines for the use of POCUS in critically ill neonates and children are now available. They will be useful to optimise the use of POCUS, training programs and further research, which are urgently needed given the weak quality of evidence available.

Highlights

The incorporation of Point of Care Ultrasound (POCUS) has represented a transformative change in clinical practice, challenging the traditional diagnostic and procedural “art” of medicine, especially in acute care environments
Point-of-care ultrasound (POCUS) should not be used as a screening tool for diagnosing congenital heart defects in neonates and children, unless neonatologists/ paediatric intensivists have received an advanced echocardiography training for this purpose—strong agreement
The goal of cardiac POCUS is to obtain physiological and haemodynamic information to aid in clinical decision making

Summary

Introduction

The incorporation of Point of Care Ultrasound (POCUS) has represented a transformative change in clinical practice, challenging the traditional diagnostic and procedural “art” of medicine, especially in acute care environments It has emerged as “the new” clinical tool and it has displaced, in some way, the classical stethoscope. The use of POCUS by critical care providers has increased significantly in recent years and adult emergency medicine had pioneered this field with the publication of guidelines for implementation of structured POCUS training [1,2,3,4,5,6,7]. POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC) aimed to provide evidence-based clinical guidelines for the use of POCUS in critically ill neonates and children

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Discussion

Conclusion