Written by Megan Hilbert
Spoon Feed
The use of cardiac point-of-care ultrasound (POCUS) can help identify pediatric patients at risk for progressing to hemodynamic instability when presenting with concern for sepsis.
Using sound waves to tell who is sicker
This was a retrospective cohort study of pediatric patients (up to 21 years of age) with undifferentiated presentation consistent with systemic infection. Patients underwent cardiac POCUS for evaluation of global function prior to initiation of vasoactive medications. Primary outcome was use of vasoactive medications within 24 hours of ED arrival. This was used as a surrogate marker of septic shock.
Reduced cardiac function was strongly associated with the need for vasoactive medications (OR 7.9, 95%CI 2.7–23.0). Systolic hypotension and elevated lactate were also independently associated with the need for vasoactive medications. In addition, reduced cardiac function was associated with ICU admission (P<0.001) plus fewer ICU-free days (P<0.01) and hospital-free days (P<0.05) as a part of secondary outcome analysis.
Strengths of this study: it collected 9 years of data and had high interrater agreement for interpretation of POCUS images ( = 0.90). Also, the results make sense; sicker patients equals more need for resuscitation and higher level of care.
Limitations of this study: the retrospective nature introduces selection bias and limited generalizability due to completion at single academic center.
How will this change my practice?
We must keep a high index of suspicion for sepsis when a pediatric patient presents undifferentiated to the ER. I try to use every tool at my disposal when a patient is undifferentiated, and this study supports using cardiac POCUS to help guide resuscitation even before we note the more “traditional” clinical indicators of shock such as delayed capillary refill.
Source
Cardiac Dysfunction on Point-of-Care Ultrasound Is Associated With Subsequent Use of Vasoactive Medication in Children With Suspected Systemic Infection. Pediatr Emerg Care. 2026 Jul 14. doi: 10.1097/PEC.0000000000003659. Epub ahead of print. PMID: 42444168.
