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The pediatric intensive care unit (PICU), like other intensive care units (ICUs), is a dynamic place that provides multidisciplinary care with the integration of numerous medical and surgical subspecialists who come together with a common goal, the care of a critically ill child. Predictably, the diseases span the spectrum of adult ICU care and range from acute illnesses like septic shock and sepsis-related cardiomyopathy to hemorrhagic shock with traumatic visceral rupture. While the problems are similar to those encountered in adult ICUs, three additional layers of complexity are important to understand when caring for a critically ill child, namely age, size, and developmental status, and all of these have relevance for critical care ultrasonography. First, many differential diagnoses encountered in the PICU are age dependent, which is important for the ultrasonographer to remember when performing ultrasound for diagnostic purposes on a child. Second, a child's size may range from <2 to >200 kg, which has important implications for the technical aspects of ultrasound procedures. Finally, children may not be able to cooperate with an examination or procedure as adults are, making the use of ultrasonography, a pain-free and noninvasive tool, an ideal method for extending one's physical examination. Bedside ultrasound is an important and evolving tool for pediatric intensivists and can be used to evaluate many disease processes, assist in procedural interventions, and assess for complications related to those procedures. This chapter aims to provide a practical discussion on the use of bedside ultrasonography in the PICU.

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Ultrasound use in the PICU ranges from being an aid for vascular access to being a versatile instrument that is able to perform an acute, comprehensive assessment of the critically ill child at the bedside and monitor response to critical treatment. Common indications for bedside ultrasound in the PICU are listed in Table 5.1.

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Table 5.1. Indications for the Use of Ultrasound in the Pediatric Intensive Care Unit
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Similarly, equipment also ranges from simple ultrasound with the use of a linear probe for vascular access to an instrument with multiple probes that can be manipulated and enhanced to provide the best visualization of cardiac, abdominal, vascular, and thoracic structures (see Chapter 3). Pediatric-sized probes are also available. Small, hockey stick–style linear probes have a small footprint and are able to provide excellent images in less accessible areas of the body such as the neck or axillae. Small phased-array probes are also available for focused echocardiography but are infrequently necessary.

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In some PICUs, a portable notebook-type ultrasound system is placed on a mobile cart with a curvilinear abdominal probe, a linear high-frequency probe, and a low-frequency cardiac probe. The probes can be ...

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