Lung and Cardiac Ultrasound for Assessment of Intravascular Volume Status in Children

Abstract

Accurate assessment of fluid volume status is one of the vital tasks in the care of critically ill children. “To fill or not to fill,” in other words “whether to administer intravenous fluids or not” is the dilemma frequently faced by physicians caring for hemodynamically unstable patients. However, in routine clinical practice, most decisions regarding fluid therapy are made empirically with limited objective data. Over the past several years, point of care ultrasonography (POCUS) has emerged as a valuable adjunct to bedside clinical examination to answer focused questions, particularly in the field of emergency medicine. As it is performed by the same clinician making therapeutic decisions at the bedside as opposed to a formal ultrasound study performed and interpreted by the radiology department, it saves time and expedites care. Moreover, it is safe and does not expose patients to radiation. This is particularly important in the intensive care unit, where cumulative radiation dose can be higher during prolonged stays. The advent of cheaper and highly portable ultrasound devices has made this technique suitable for underserved areas and resource-limited settings. In this chapter, we will briefly review the technique and interpretation of the lung and limited cardiac ultrasound in the context of volume status assessment.