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Published on: January 27, 2023
Image-Guided Resuscitation With Limited Transthoracic Echocardiogram in Pediatric Trauma Patients
Valerie Plant1, Poornima Vanguri, Rahul Anand
1From the Division of Acute Care Surgical Services, Department of Surgery, Virginia Commonwealth University, Richmond, VA.
Insights
Limited transthoracic echocardiogram (LTTE) use in pediatric trauma patients reduces unnecessary fluid resuscitation. This imaging technique helps identify patients who do not require large fluid volumes, improving care.
Area of Science:
- Emergency Medicine
- Pediatric Critical Care
- Point-of-Care Ultrasound
Background:
- Limited transthoracic echocardiogram (LTTE) is a valuable tool for guiding resuscitation in adult trauma patients.
- Its feasibility in pediatric trauma resuscitation remains to be established.
Purpose of the Study:
- To evaluate the feasibility and impact of image-guided resuscitation using LTTE in pediatric trauma patients.
- To determine if LTTE can help limit unnecessary intravenous fluid administration.
Main Methods:
- Retrospective chart review of pediatric trauma alerts (age ≤18 years) at a level I trauma center.
- Patients were divided into two groups: those who underwent LTTE and those who did not.
- Data collected included demographics, injury severity, fluid administration, and intensive care unit admission.
Main Results:
- Fourteen patients underwent LTTE, and 13 did not; groups were similar in injury severity and demographics.
- The LTTE group received significantly less intravenous fluid (1.2 L vs. 2.3 L).
- In the LTTE group, patients with a "full" inferior vena cava (IVC) received less fluid than those with an "empty" IVC (1.1 L vs. 2.4 L).
Conclusions:
- Limited transthoracic echocardiogram is feasible in pediatric trauma resuscitation.
- LTTE can effectively guide fluid resuscitation, reducing unnecessary crystalloid administration in non-hypovolemic pediatric trauma patients.
Introduction:
Limited transthoracic echocardiogram (LTTE) has been shown to be a useful tool in guiding resuscitation in adult trauma patients. Our hypothesis is that image-guided resuscitation in pediatric trauma patients with LTTE is feasible.
Methods:
A retrospective chart review was performed on highest level pediatric trauma alerts (age 18 years or younger) at our level I trauma center during a 6-month period. Patients were divided into 2 groups as follows: those who had LTTE performed (LTTE group) and those who did not have LTTE performed (non-LTTE group).
Results:
A total of 31 charts were reviewed; 4 patients were excluded because they died on arrival to the emergency department. Fourteen patients had LTTE performed (LTTE group); 13 patients did not have LTTE performed (non-LTTE group). There was no difference in mechanism of injury, age, injury severity score, weight, or intensive care unit admission between the groups. The LTTE group received significantly less intravenous fluid than the non-LTTE group (1.2 vs 2.3 L, P = 0.0013).Within the LTTE group, 8 patients had "full" inferior vena cava (IVC) and 6 patients had "empty" IVC. There was no difference in injury severity score between these subgroups (P = 0.1018). Less fluid was given in the group labeled with full IVC [1.1 L (0.8-1.2)] than the group with empty IVC [2.4 L (1.7-2.6)], P = 0.0005. Four of the 6 patients with "empty" IVC had a confirmed source of bleeding.
Conclusions:
Limited transthoracic echocardiogram can limit the amount of unnecessary crystalloid resuscitation given to pediatric trauma patients who are not hypovolemic.
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