Published online November 15, 2004
PEDIATRICS Vol. 114 No. 6 December 2004, pp. e667-e671 (doi:10.1542/10.1542/peds.2004-0881)
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow E-mail this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My File Cabinet
Right arrow Download to citation manager
Right arrowRequest Permissions
Citing Articles
Right arrow Citing Articles via CrossRef
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Pershad, J.
Right arrow Articles by Chin, T.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Pershad, J.
Right arrow Articles by Chin, T.
Related Collections
Right arrow Heart & Blood Vessels
Social Bookmarking
Add to CiteULike   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Facebook   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

ELECTRONIC ARTICLE

Bedside Limited Echocardiography by the Emergency Physician Is Accurate During Evaluation of the Critically Ill Patient

Jay Pershad, MD*,{ddagger}, Sharon Myers{ddagger}, Cindy Plouman{ddagger}, Cindy Rosson{ddagger}, Krista Elam{ddagger}, Jim Wan, PhD§ and Thomas Chin, MD, FACC, FACS||

* Division of Emergency Medicine, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee
{ddagger} Le Bonheur Children's Medical Center, Memphis, Tennessee
§ Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, Tennessee
|| Division of Cardiology, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee

Objective. Echocardiography can be a rapid, noninvasive, objective tool in the assessment of ventricular function and preload during resuscitation of a critically ill or injured child. We sought to determine the accuracy of bedside limited echocardiography by the emergency physician (BLEEP) in estimation of (1) left ventricular function (LVF) and (2) inferior vena cava (IVC) volume, as an indirect measure of preload.

Methods. We conducted a prospective observational study of a convenience sample of patients who were admitted to our intensive care unit. All patients underwent BLEEP followed by an independent formal echocardiogram by an experienced pediatric echocardiography provider (PEP). IVC volume was assessed by measurement of the maximal diameter of the IVC. LVF was determined by calculating shortening fraction (SF) using M-mode measurements on the parasternal short-axis view at the level of the papillary muscle. An independent blinded pediatric cardiologist reviewed all images for accuracy and quality. Estimates of SF obtained on the BLEEP examination were compared with those obtained by the PEP.

Results. Thirty-one patients were enrolled. The mean age was 5.1 years (range: 23 days–16 years); 48.4% (15 of 31) were girls; 58.1% (18 of 31) were on mechanical ventilatory support at the time of their study. There was good agreement between the emergency physician (EP) and the PEP for estimation of SF (r = 0.78). The mean difference in the estimate of SF between the providers was 4.4% (95% confidence interval: 1.6%–7.2%). This difference in estimate of SF was statistically significant. Similarly, there was good agreement between the EP and the PEP for estimation of IVC volume (r = 0.8). The mean difference in the estimate of IVC diameter by the PEP and the EP was 0.068 mm (95% confidence interval: –0.16 to 0.025 mm). This difference was not statistically significant.

Conclusions. Our study suggests that PEP sonographers are capable of obtaining images that permit accurate assessment of LVF and IVC volume. BLEEP can be performed with focused training and oversight by a pediatric cardiologist.

Key Words: cardiovascular • emergency medicine

Abbreviations: ED, emergency department • BLEEP, bedside limited echocardiography by the emergency physician • CVP, central venous pressure • EP, emergency physician • FAST, focused abdominal sonography in trauma • US, ultrasound • IVC, inferior vena cava • RA, right atrium • LVF, left ventricular function • PEP, pediatric echocardiography provider • SF, shortening fraction • PE, pericardial effusion

Accepted Aug 11, 2004.


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Facebook Facebook   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?