Repeated bedside echocardiography in children with respiratory failure

Area of Science:

• Pediatric Cardiology
• Critical Care Medicine
• Diagnostic Imaging

Background:

• Assessing cardiac function in mechanically ventilated children is crucial.
• Bedside echocardiography offers a non-invasive method for real-time cardiac monitoring.
• Understanding the benefits and limitations of repeated echocardiographic exams in this population is essential.

Purpose of the Study:

• To evaluate the utility of serial bedside echocardiographic examinations in pediatric patients undergoing mechanical ventilation.
• To identify the advantages and disadvantages of this monitoring technique in high-risk pediatric groups.
• To assess the impact of mechanical ventilation on echocardiographic data quality.

Main Methods:

• A cohort of 235 children (average age 3.21 years) were included, categorized into high-risk groups (ALI/ARDS, ROSC, BPD, CMP, CPD).
• Transthoracic echocardiography was performed at two time points: shortly after invasive line insertion (time-1) and after 72 hours of treatment (time-2).
• Key parameters analyzed included right and left ventricular myocardial performance indices (RV MPI, LV MPI), left ventricular shortening fraction (SF), cardiac output (CO), and E/A ratio.

Main Results:

• At time-1, all high-risk groups showed elevated RV MPI and LV MPI, with reduced E/A ratio, SF, and CO compared to reference values.
• By time-2, RV MPI decreased but remained elevated, while other parameters showed improvement but were not significantly different from reference values.
• Despite chest excursion during mechanical ventilation, the quality of acquired echocardiographic data was not compromised.

Conclusions:

• Bedside echocardiography provides valuable real-time information on cardiac load in pediatric patients on mechanical ventilation.
• Serial echocardiographic assessments can track changes in cardiac function during critical illness and treatment.
• The technique is reliable, as chest movement during ventilation does not impede data acquisition quality.