Department of Anesthesiology, Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York, USA
Department of Anesthesiology Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Massachusetts, USA.
Reg Anesth Pain Med. 2020 Dec;45(12):985-992. doi: 10.1136/rapm-2020-101341. Epub 2020 Sep 14.
Point-of-care ultrasound (PoCUS) has been well described for adult perioperative patients; however, the literature on children remains limited. Regional anesthesiologists have gained interest in expanding their clinical repertoire of PoCUS from regional anesthesia to increasing numbers of applications. This manuscript reviews and highlights emerging PoCUS applications that may improve the quality and safety of pediatric care.In infants and children, lung and airway PoCUS can be used to identify esophageal intubation, size airway devices such as endotracheal tubes, and rule in or out a pulmonary etiology for clinical decompensation. Gastric ultrasound can be used to stratify aspiration risk when nil-per-os compliance and gastric emptying are uncertain. Cardiac PoCUS imaging is useful to triage causes of undifferentiated hypotension or tachycardia and to determine reversible causes of cardiac arrest. Cardiac PoCUS can assess for pericardial effusion, gross ventricular systolic function, cardiac volume and filling, and gross valvular pathology. When PoCUS is used, a more rapid institution of problem-specific therapy with improved patient outcomes is demonstrated in the pediatric emergency medicine and critical care literature.Overall, PoCUS saves time, expedites the differential diagnosis, and helps direct therapy when used in infants and children. PoCUS is low risk and should be readily accessible to pediatric anesthesiologists in the operating room.
床边超声（PoCUS）在成年围手术期患者中已有详细描述；然而，儿童相关文献仍然有限。区域麻醉医师对将其 PoCUS 临床应用从区域麻醉扩展到更多应用领域的兴趣日益浓厚。本文回顾并强调了新兴的 PoCUS 应用，这些应用可能会提高儿科护理的质量和安全性。在婴儿和儿童中，肺部和气道 PoCUS 可用于识别食管插管、确定气道设备（如气管内导管）的大小，并确定临床失代偿的肺部病因。当无法确定禁食和胃排空情况时，胃超声可用于分层评估误吸风险。心脏 PoCUS 成像可用于分诊不明原因低血压或心动过速的原因，并确定心脏骤停的可逆原因。心脏 PoCUS 可评估心包积液、心室收缩功能、心脏容量和充盈以及瓣膜大体病理。在儿科急诊医学和危重病学文献中，当使用 PoCUS 时，可更快速地实施针对特定问题的治疗，并改善患者结局。总体而言，PoCUS 可节省时间、加快鉴别诊断，并有助于指导婴儿和儿童的治疗。PoCUS 风险低，应在手术室中方便儿科麻醉医师使用。
