Echocardiography in PICU: when the heart sees what is invisible to the eye / Ecocardiografia na UTIP: quando o coração vê o que é invisível aos olhos

ABSTRACT OBJECTIVE: Echocardiography has become an indispensable bedside diagnostic tool in the realm of pediatric intensive care units (PICU). It has proven to be an influential factor in the formula of clinical decision-making. This study aimed to delineate the impact of echocardiography on the management of critically ill pediatric patients in the PICU at Sultan Qaboos University Hospital, Oman. METHOD: This was a retrospective cohort study conducted in a five-bed PICU. Patients admitted to the PICU from January of 2011 to December of 2012 were reviewed. Those who have undergone bedside echocardiography during their ICU stay were recruited. Electronic patient record was used as data source. RESULTS: Over a-24-month period, 424 patients were admitted in this PICU. One hundred and one clinically indicated transthoracic echocardiograms were performed. 81.8% of these presented new findings (n = 82) that significantly impacted the clinical decision of patient management, namely, alteration in drug therapy and procedure, whereas no difference in the management was yielded in the remaining 17.8% of the studied cases. CONCLUSIONS: Echocardiography had a significant impact on the management of PICU patients. Such salutary effect was consequently reflected on the outcome. Pediatric intensivists are encouraged to acquire such bedside skill.

RESUMO OBJETIVO: A ecocardiografia se tornou uma ferramenta de diagnóstico relevante, indispensável no âmbito das unidades de terapia intensiva pediátrica (UTIP). Ela se tornou um fator influente na tomada de decisões clínicas. O objetivo deste estudo foi delinear o impacto da ecocardiografia sobre o manejo de pacientes pediátricos gravemente doentes na UTIP do Hospital Universitário Sultan Qaboos, em Omã. MÉTODO: Este é um estudo de coorte retrospectivo feito em uma UTIP de cinco leitos. Foram analisados pacientes internados na UTIP entre janeiro de 2011 e dezembro de 2012. Foram recrutados os pacientes que passaram por ecocardiografia durante sua internação na UTI. O registro eletrônico dos pacientes foi usado como fonte de dados. RESULTADOS: Em 24 meses, 424 pacientes foram internados em nossa UTIP, 101 pacientes foram encaminhados para ecocardiografias transtorácicas, 81,8% deles tiveram novos achados (n = 82) que afetaram significativamente a decisão clínica, como a terapia medicamentosa e os procedimentos, ao passo que não houve diferença no manejo nos outros 17,8% dos casos estudados. CONCLUSÕES: A ecocardiografia teve um impacto significativo sobre o manejo de pacientes da UTIP. Esse efeito refletiu-se nos resultados. Os intensivistas pediátricos devem ser incentivados a adquirir essa habilidade relevante.

Non-Invasive Ventilation in a Pediatric Intensive Care Unit: An Experience of Tertiary Care Hospital Over 4 Years in Oman.

Background: Noninvasive ventilation (NIV) has now become an integral tool in the treatment of both acute and chronic respiratory failure, and at the same time reducing the need for invasive ventilation. Aim: To determinate the efficacy of NIV in pediatrics whom admitted to Pediatric intensive care unit (PICU) with respiratory failure (Short term evaluation). Subjects and Methods: Based on a retrospective review of electronic medical records (EPR) of patients who underwent NIV in the period between January 2007 and December 2010, demographic and clinical data were collected before and after applying the NIV. The data included heart rate (HR), respiratory rate (RR), oxygen concentration (PO2) and CO2 concentration (PCO2). Results: NIV was used for a total of 61 pediatric patients admitted to PICU during the period of the study. Pneumonia was the commonest indication for the NIV (n=25, 40.9%), and continuous positive airway pressure (CPAP) was used in 52(85.2%) patients. The mean duration of NIV was 8±7.2 days, there was a significant clinical improvement after one hour from application of NIV. The mean improvement in RR was from 48.4±2.2 to 35.0±1.5 (P=0.000), SPO2 was improved from 88.1±1.8 to 96.5±0.7 (P= 0.000), and the PCO2 was improved from 61.4±6.1 to 48.7±3.7 (P=0.002). Five patients were failing to respond to the NIV and shifted to mechanical ventilation. Conclusion: The NIV is a useful tool for treatment of respiratory failure in pediatrics, especially under the age of one year. Pneumonia was the commonest indication for the use of the NIV.