Neonatal & Paediatric Point Of Care Ultrasound (Pocus): A Novel Standard Practice

2021 ◽  
Vol 8 (3) ◽  
pp. 124-131
Author(s):  
Dr. Abhijit Shinde ◽  
Dr. Sushrut Kumar ◽  
Dr. Sneha Mhaske

An ever expanding branch of applications have been developed for ultrasound, including its goal directed use at the bedside, often called point-of-care ultrasound (POCUS). ).  Although neonatologist-performed functional echocardiography has been at the frontline of the worldwide growth of POCUS, a rapidly growing body of evidence has also demonstrated the importance of non-cardiac applications, including guidance of placement of central catheterisation and lumbar puncture, endotracheal tube localisation as well as rapid estimation of the brain, lungs, bladder and bowel.  Ultrasonography has become a pivotal adjunct to the care of neonates in the neonatal intensive care unit (NICU); but a full appreciation for its diagnostic capabilities in the NICU is lacking.(2) Ultrasonography (USG) is no longer the exclusive domain of radiologists and cardiologists. With appropriate training, clinician performed ultrasound (CPU) is now practised widely in obstetrics, emergency medicine and adult intensive care .In many developed countries,it is standard practice in neonatology. (3) In this review, we will discuss neonatal & pediatric point of care ultrasound (POCUS) as a novel standard practice & its clinical application for assessment of the head, heart, lung, gut, bladder, for vascular line localization & for endotracheal tube placement. As new applications and adoption of point-of-care ultrasound continues to gain acceptance in paediatric and neonatal medicine throughout the world, a rapidly growing body of evidence suggests that the result will be faster, safer and more successful diagnosis and treatment of our  patients.

2020 ◽  
Vol 39 (6) ◽  
pp. 448-453
Author(s):  
Taichi Itoh ◽  
Stephen Gorga ◽  
Andrew Hashikawa ◽  
James Cranford ◽  
Jeffrey Thomas ◽  
...  

PEDIATRICS ◽  
1986 ◽  
Vol 77 (1) ◽  
pp. 132-132
Author(s):  
RICHARD M. HELLER ◽  
ROBERT B. COTTON

In Reply.— We agree with Dr Bloch that auscultation is a primary tool for determinig appropriate position of an endotracheal tube. However, experience in a busy neonatal intensive care unit has shown that, even with careful auscultation, endotracheal tubes still become inappropriately positioned, often with serious consequences. Our experience has been that the illuminated endotracheal tube provides a clear indication of depth of penetration when asymmetric lung disease may cause auscultatory findings to be equivocal. Dr Goldenring raises the important point that the cost of the illuminated endotracheal tube is under evaluation at the present time, and as soon as information concerning pricing is available, I will make this information available to the readership of Pediatrics.


2020 ◽  
Vol 35 (6) ◽  
pp. 629-631
Author(s):  
Michael Joyce ◽  
Jordan Tozer ◽  
Michael Vitto ◽  
David Evans

AbstractIntroduction:The Advanced Cardiac Life Support (ACLS) guidelines were recently updated to include ultrasound confirmation of endotracheal tube (ETT) location as an adjunctive tool to verify placement. While this method is employed in the emergency department under the guidance of the most recent American College of Emergency Physicians (ACEP; Irving, Texas USA) guidelines, it has yet to gain wide acceptance in the prehospital setting where it has the potential for greater impact. The objective of this study to is determine if training critical care medics using simulation was a feasible and reliable method to learn this skill.Methods:Twenty critical care paramedics with no previous experience with point-of-care ultrasound volunteered for advanced training in prehospital ultrasound. Four ultrasound fellowship trained emergency physicians proctored two three-hour training sessions. Each session included a brief introduction to ultrasound “knobology,” normal sonographic neck and lung anatomy, and how to identify ETT placement within the trachea or esophagus. Immediately following this, the paramedics were tested with five simulated case scenarios using pre-obtained images that demonstrated a correctly placed ETT, an esophageal intubation, a bronchial intubation, and an improperly functioning ETT. Their accuracy, length of time to respond, and comfort with using ultrasound were all assessed.Results:All 20 critical care medics completed the training and testing session. During the five scenarios, 37/40 (92.5%) identified the correct endotracheal placements, 18/20 (90.0%) identified the esophageal intubations, 18/20 (90.0%) identified the bronchial intubation, and 20/20 (100.0%) identified the ETT malfunctions correctly. The average time to diagnosis was 10.6 seconds for proper placement, 15.5 seconds for esophageal, 15.6 seconds for bronchial intubation, and 11.8 seconds for ETT malfunction.Conclusions:The use of ultrasound to confirm ETT placement can be effectively taught to critical care medics using a short, simulation-based training session. Further studies on implementation into patient care scenarios are needed.


2011 ◽  
Vol 16 (1) ◽  
pp. 61-68 ◽  
Author(s):  
Nick Evans ◽  
Veronique Gournay ◽  
Fernando Cabanas ◽  
Martin Kluckow ◽  
Tina Leone ◽  
...  

2021 ◽  
Vol 8 (8) ◽  
pp. 284-288
Author(s):  
Sidhant Swarup ◽  
Rakesh Panigrahi ◽  
Suryakanta Swain ◽  
Hemant Agrawal

Introduction: Up to 29% of late preterm babies suffer from respiratory distress due to which they need to be admitted to neonatal intensive care unit (NICU). Point-of-care ultrasound is a useful tool in critical neonate care, providing valuable information without any risk of ionizing radiation to the newborn. Materials and Method: This mono-centric, descriptive, and prospective study was conducted in NICU. Preterm newborns of less than 36 weeks with respiratory distress at birth on non-invasive ventilation were recruited. A lung ultrasound was performed at first 12 h of life and followed till their discharge. Main outcomes need for surfactant treatment. Results: Sixty preterm infants (median gestational age: 29 weeks) were recruited. Newborn in the surfactant group requiring ultrasound and intervention was significantly higher than in no surfactant group (p<0.0001). In 15 newborns who received surfactant, the first dose was administered at a median age of 4.5 h. In 13 of these 15 newborns, the lung ultrasound scan was subsequently repeated an average of 2 h (Standard deviation or SD: 2) On average, the second dose of surfactant was administered at 24 h of life (SD: 9). Conclusion: Early lung ultrasound in preterm infants with respiratory distress appears to be a useful tool with no adverse effects for the patient. It allows a better assessment of respiratory distress by detecting patients with a greater risk of requiring surfactant or mechanical ventilation, even before oxygenation criteria.


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