Salloum Shafee, Lautz Andrew J, Statile Christopher
Division of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
J Pediatr Clin Pract. 2025 Mar 7;16:200143. doi: 10.1016/j.jpedcp.2025.200143. eCollection 2025 Jun.
To evaluate the frequency and diagnostic yield of transthoracic echocardiography (TTE) in a noncardiac pediatric intensive care unit (PICU).
This was a single-center retrospective observational study of a 48-bed quaternary-care PICU. Patients younger than 18 years who had a TTE performed during their PICU stay from February 3, 2015, to December 8, 2022, were included, and patients on extracorporeal membrane oxygenation support were excluded.
We analyzed 2633 TTEs from 1445 patients, with only the first study included for patients with multiple TTEs. The median age of all patients was 4.4 years (IQR 1-12.4 years). Low ventricular function, defined as moderate or severe systolic dysfunction, was found in 6% of all TTEs, whereas 94% showed hyperdynamic, normal, or mildly diminished ventricular function. TTEs were classified into 25 categories on the basis of indications. Low ventricular function was present in 10% of shock cases, 17% of cardiac arrests, and 2% of respiratory failures. Among cases of respiratory failure, 88% showed no pulmonary hypertension. A low yield group, comprising 16% of total first TTEs, included acute respiratory failure, persistent tachycardia, abnormal electrocardiograms, and systemic hypertension. Among those evaluated for pulmonary hypertension, 62% showed no evidence of it, whereas 4% exhibited severe pulmonary hypertension, all with a pre-existing history. For pericardial effusion evaluation, 82% had no or trivial-small effusion.
TTE frequently is used in the noncardiac PICU, but its diagnostic yield varies widely on the basis of clinical indications. This study emphasizes the need for careful use of TTE in the PICU, with consideration of pretest probability and clinical context to enhance diagnostic effectiveness in critically ill pediatric patients.
评估经胸超声心动图（TTE）在非心脏儿科重症监护病房（PICU）中的使用频率和诊断价值。
这是一项针对拥有48张床位的四级医疗PICU的单中心回顾性观察研究。纳入了2015年2月3日至2022年12月8日期间在PICU住院期间接受TTE检查的18岁以下患者，体外膜肺氧合支持的患者被排除。
我们分析了1445例患者的2633次TTE检查结果，多次接受TTE检查的患者仅纳入首次检查结果。所有患者的中位年龄为4.4岁（四分位间距1 - 12.4岁）。在所有TTE检查中，6%发现心室功能低下，定义为中度或重度收缩功能障碍，而94%显示心室功能亢进、正常或轻度降低。根据检查指征，TTE检查分为25类。休克病例中10%存在心室功能低下，心脏骤停病例中17%存在，呼吸衰竭病例中2%存在。在呼吸衰竭病例中，88%未显示肺动脉高压。一个低诊断价值组，占首次TTE检查总数的16%，包括急性呼吸衰竭、持续性心动过速、心电图异常和系统性高血压。在接受肺动脉高压评估的患者中，62%未显示有肺动脉高压迹象，而4%表现为严重肺动脉高压，均有既往病史。对于心包积液评估，82%没有或仅有少量 - 微量积液。
TTE在非心脏PICU中经常使用，但其诊断价值因临床指征而异。本研究强调在PICU中谨慎使用TTE的必要性，需考虑检查前概率和临床背景，以提高危重症儿科患者的诊断效果。
