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Anaesthesia for critically ill children during magnetic resonance imaging
J R Tobin1, E A Spurrier, R C Wetzel
1Department of Anesthesiology/Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21205.
Insights
Critically ill children can now safely undergo magnetic resonance imaging (MRI) and transport from the paediatric intensive care unit (ICU). This study demonstrates the feasibility of MRI for critically ill pediatric patients, overcoming previous exclusion criteria.
Area of Science:
- Pediatric critical care medicine
- Diagnostic imaging
- Neuroscience
Background:
- Magnetic resonance imaging (MRI) offers valuable diagnostic insights but has historically excluded critically ill children due to safety and technical challenges.
- Previous studies have limited the use of MRI in pediatric intensive care unit (ICU) populations.
- The safe transport and imaging of critically ill children remain a significant concern in pediatric healthcare.
Purpose of the Study:
- To assess the safety and feasibility of performing MRI in critically ill children.
- To evaluate the successful transport of pediatric ICU patients to an MRI facility.
- To demonstrate that advanced imaging can be achieved without compromising patient stability.
Main Methods:
- Conducted MRI scans on 21 critically ill pediatric patients transferred from the ICU.
- Utilized assisted ventilation with a modified Mapleson D system for all intubated patients.
- Maintained continuous monitoring of oxygenation, ventilation, and hemodynamic status, including invasive pressures.
Main Results:
- Successfully completed transport and MRI for 21 out of 24 eligible pediatric ICU patients.
- Achieved satisfactory image quality in all completed MRI studies.
- All patients were returned to the ICU in stable condition post-procedure.
Conclusions:
- MRI can be safely and effectively performed on critically ill children.
- The study overcomes previous limitations excluding critically ill pediatric patients from MRI.
- This demonstrates a viable approach for obtaining advanced neuroimaging in vulnerable pediatric populations.
Abstract:
Magnetic resonance imaging (MRI) is becoming increasingly useful in children. Because of technical considerations and safety concerns, critically ill children have frequently been excluded from MRI. We have accomplished safely both transport and MRI in 21 patients from paediatric intensive care units (ICU). Three children were not considered appropriate for transport from the ICU to the MRI facility. All patients underwent assisted ventilation using a modified Mapleson D system. Monitoring of oxygenation, ventilation and haemodynamic state, including invasive arterial (n = 4) and intracranial pressures (n = 3) was continued successfully using routinely available equipment. All MRI studies were completed successfully with satisfactory image quality and all patients returned to the ICU in satisfactory condition. In contrast with previous reports which have excluded critically ill children, we have demonstrated that MRI may be undertaken safely and efficiently in critically ill children.