Bedside Ultrasound in the Pediatric Intensive Care Unit: Newer Uses

  • Yuki Shiomi
  • Hiroshi KurosawaEmail author
Critical Care (J Giuliano and M Bigham, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Critical Care


Purpose of Review

To explore recent advancements in the use of point-of-care ultrasound in the pediatric intensive care unit or during the perioperative period.

Recent Findings

Ultrasound is useful for selecting an appropriate endotracheal tube size, predicting postextubation stridor, assessing vocal cord paralysis, performing ultrasound-guided lung recruitment, assessing circulatory volume status, performing transcranial Doppler for assessment of cerebral perfusion, assessing intracranial hypertension, assessing central venous catheter tip position, and performing arterial line cannulation.


There has been rapid progress in the use of point-of-care ultrasound in pediatric critical care, which can revolutionize daily clinical practice. However, further studies are required to verify that some of these areas of clinical application are translatable and scalable to widespread adoption.


Pediatric intensive care unit Point-of-care ultrasound Endotracheal tube Postextubation stridor Transcranial Doppler Lung recruitment 


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Shibasaki M, Nakajima Y, Ishii S, Shimizu F, Shime N, Sessler DI. Prediction of pediatric endotracheal tube size by ultrasonography. Anesthesiology. 2010;113(4):819–24. Scholar
  2. 2.
    Bae JY, Byon HJ, Han SS, Kim HS, Kim JT. Usefulness of ultrasound for selecting a correctly sized uncuffed tracheal tube for paediatric patients. Anaesthesia. 2011;66(11):994–8. Scholar
  3. 3.
    Schramm C, Knop J, Jensen K, Plaschke K. Role of ultrasound compared to age-related formulas for uncuffed endotracheal intubation in a pediatric population. Paediatr Anaesth. 2012;22(8):781–6. Scholar
  4. 4.
    • Altun D, Orhan-Sungur M, Ali A, Ozkan-Seyhan T, Sivrikoz N, Camci E. The role of ultrasound in appropriate endotracheal tube size selection in pediatric patients. Paediatr Anaesth. 2017;27(10):1015–20. A prospective clinical study which showed practical approach in selecting ETT size. CrossRefGoogle Scholar
  5. 5.
    Pillai R, Kumaran S, Jeyaseelan L, George SP, Sahajanandan R. Usefulness of ultrasound-guided measurement of minimal transverse diameter of subglottic airway in determining the endotracheal tube size in children with congenital heart disease: a prospective observational study. Ann Card Anaesth. 2018;21(4):382–7. Scholar
  6. 6.
    Shi F, Xiao Y, Xiong W, Zhou Q, Huang X. Cuffed versus uncuffed endotracheal tubes in children: a meta-analysis. J Anesth. 2016;30(1):3–11. Scholar
  7. 7.
    Kleinman ME, Chameides L, Schexnayder SM, Samson RA, Hazinski MF, Atkins DL, et al. Part 14: pediatric advanced life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation. 2010;122(18 Suppl 3):S876–908. Scholar
  8. 8.
    Lee JH, Nuthall G, Ikeyama T, Saito O, Mok YH, Shepherd M, et al. Tracheal intubation practice and safety across international PICUs: a report from National Emergency Airway Registry for children. Pediatr Crit Care Med. 2019;20(1):1–8. Scholar
  9. 9.
    Ding LW, Wang HC, Wu HD, Chang CJ, Yang PC. Laryngeal ultrasound: a useful method in predicting post-extubation stridor. A pilot study. Eur Respir J. 2006;27(2):384–9. Scholar
  10. 10.
    • El Amrousy D, Elkashlan M, Elshmaa N, Ragab A. Ultrasound-guided laryngeal air column width difference as a new predictor for postextubation stridor in children. Crit Care Med. 2018;46(6):e496–501. A high sensitivity and specificity in predicting postextubation stridor.CrossRefGoogle Scholar
  11. 11.
    Wang LM, Zhu Q, Ma T, Li JP, Hu R, Rong XY, et al. Value of ultrasonography in diagnosis of pediatric vocal fold paralysis. Int J Pediatr Otorhinolaryngol. 2011;75(9):1186–90. Scholar
  12. 12.
    Ongkasuwan J, Ocampo E, Tran B. Laryngeal ultrasound and vocal fold movement in the pediatric cardiovascular intensive care unit. Laryngoscope. 2017;127(1):167–72. Scholar
  13. 13.
    Tomomi Hasegawa MM, Kurosawa H. Ultrasonographic assessment of vocal cord paralysis in an infant after cardiovascular surgery. J Pediatr Card Surgery. 2018;2(2):101–3. Scholar
  14. 14.
    Lee MGY, Millar J, Rose E, Jones A, Wood D, Luitingh TL, et al. Laryngeal ultrasound detects a high incidence of vocal cord paresis after aortic arch repair in neonates and young children. J Thorac Cardiovasc Surg. 2018;155(6):2579–87. Scholar
  15. 15.
    Ruan Z, Ren R, Dong W, Ma J, Xu Z, Mao Y, et al. Assessment of vocal cord movement by ultrasound in the ICU. Intensive Care Med. 2018;44(12):2145–52. Scholar
  16. 16.
    Song IK, Kim EH, Lee JH, Ro S, Kim HS, Kim JT. Effects of an alveolar recruitment manoeuvre guided by lung ultrasound on anaesthesia-induced atelectasis in infants: a randomised, controlled trial. Anaesthesia. 2017;72(2):214–22. Scholar
  17. 17.
    Wu L, Hou Q, Bai J, Zhang J, Sun L, Tan R, et al. Modified lung ultrasound examinations in assessment and monitoring of positive end-expiratory pressure-induced lung reaeration in young children with congenital heart disease under general anesthesia. Pediatr Crit Care Med. 2019;20(5):442–9. Scholar
  18. 18.
    Su E, Steffen KM. Ultrasound-targeted lung recruitment: process improvement for ventilating the critically ill child. Pediatr Crit Care Med. 2019;20(5):493–4. Scholar
  19. 19.
    Ambroggio L, Sucharew H, Rattan MS, O'Hara SM, Babcock DS, Clohessy C, et al. Lung ultrasonography: a viable alternative to chest radiography in children with suspected pneumonia? J Pediatr. 2016;176:93–8 e7. Scholar
  20. 20.
    Jones BP, Tay ET, Elikashvili I, Sanders JE, Paul AZ, Nelson BP, et al. Feasibility and safety of substituting lung ultrasonography for chest radiography when diagnosing pneumonia in children: a randomized controlled trial. Chest. 2016;150(1):131–8. Scholar
  21. 21.
    Tripathi S, Ganatra H, Martinez E, Mannaa M, Peters J. Accuracy and reliability of bedside thoracic ultrasound in detecting pulmonary pathology in a heterogeneous pediatric intensive care unit population. J Clin Ultrasound. 2019;47(2):63–70. Scholar
  22. 22.
    Kaskinen AK, Martelius L, Kirjavainen T, Rautiainen P, Andersson S, Pitkanen OM. Assessment of extravascular lung water by ultrasound after congenital cardiac surgery. Pediatr Pulmonol. 2017;52(3):345–52. Scholar
  23. 23.
    Freedman SB, Vandermeer B, Milne A, Hartling L. Pediatric emergency research Canada gastroenteritis study G. diagnosing clinically significant dehydration in children with acute gastroenteritis using noninvasive methods: a meta-analysis. J Pediatr. 2015;166(4):908–16 e1-6. Scholar
  24. 24.
    Kosiak W, Swieton D, Piskunowicz M. Sonographic inferior vena cava/aorta diameter index, a new approach to the body fluid status assessment in children and young adults in emergency ultrasound--preliminary study. Am J Emerg Med. 2008;26(3):320–5. Scholar
  25. 25.
    Chen L, Hsiao A, Langhan M, Riera A, Santucci KA. Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Acad Emerg Med. 2010;17(10):1042–7. Scholar
  26. 26.
    Kwon H, Jung JY, Lee JH, Kwak YH, Kim do K, Jung JH, et al. Sonographic aorta/IVC cross-sectional area index for evaluation of dehydration in children. Am J Emerg Med. 2016;34(9):1840–4. Scholar
  27. 27.
    Lin EE, Chen AE, Panebianco N, Conlon T, Ju NR, Carlson D, et al. Effect of inhalational anesthetics and positive-pressure ventilation on ultrasound assessment of the great vessels: a prospective study at a children’s hospital. Anesthesiology. 2016;124(4):870–7. Scholar
  28. 28.
    • O'Brien NF, Maa T, Reuter-Rice K. Noninvasive screening for intracranial hypertension in children with acute, severe traumatic brain injury. J Neurosurg Pediatr. 2015;16(4):420–5. Interesting study in predicting high intracranial pressure. PubMedGoogle Scholar
  29. 29.
    Lin JJ, Hsia SH, Wang HS, Chiang MC, Lin KL. Transcranial Doppler ultrasound in therapeutic hypothermia for children after resuscitation. Resuscitation. 2015;89:182–7. Scholar
  30. 30.
    Ducharme-Crevier L, Mills MG, Mehta PM, Smith CM, Wainwright MS. Use of transcranial Doppler for management of central nervous system infections in critically ill children. Pediatr Neurol. 2016;65:52–8 e2. Scholar
  31. 31.
    Robba C, Santori G, Czosnyka M, Corradi F, Bragazzi N, Padayachy L, et al. Optic nerve sheath diameter measured sonographically as non-invasive estimator of intracranial pressure: a systematic review and meta-analysis. Intensive Care Med. 2018;44(8):1284–94. Scholar
  32. 32.
    Ballantyne J, Hollman AS, Hamilton R, Bradnam MS, Carachi R, Young DG, et al. Transorbital optic nerve sheath ultrasonography in normal children. Clin Radiol. 1999;54(11):740–2.CrossRefGoogle Scholar
  33. 33.
    Agrawal S, Brierley J. Optic nerve sheath measurement and raised intracranial pressure in paediatric traumatic brain injury. Eur J Trauma Emerg Surg. 2012;38(1):75–7. Scholar
  34. 34.
    Choi SH, Min KT, Park EK, Kim MS, Jung JH, Kim H. Ultrasonography of the optic nerve sheath to assess intracranial pressure changes after ventriculo-peritoneal shunt surgery in children with hydrocephalus: a prospective observational study. Anaesthesia. 2015;70(11):1268–73. Scholar
  35. 35.
    • Alonso-Quintela P, Oulego-Erroz I, Rodriguez-Blanco S, Muniz-Fontan M, Lapena-Lopez-de Armentia S, Rodriguez-Nunez A. Location of the central venous catheter tip with bedside ultrasound in young children: can we eliminate the need for chest radiography? Pediatr Crit Care Med. 2015;16(9):e340–5. Useful skill for central venous catheter placement. CrossRefGoogle Scholar
  36. 36.
    Gu WJ, Tie HT, Liu JC, Zeng XT. Efficacy of ultrasound-guided radial artery catheterization: a systematic review and meta-analysis of randomized controlled trials. Crit Care. 2014;18(3):R93. Scholar
  37. 37.
    Kantor DB, Su E, Milliren CE, Conlon TW. Ultrasound guidance and other determinants of successful peripheral artery catheterization in critically ill children. Pediatr Crit Care Med. 2016;17(12):1124–30. Scholar
  38. 38.
    White L, Halpin A, Turner M, Wallace L. Ultrasound-guided radial artery cannulation in adult and paediatric populations: a systematic review and meta-analysis. Br J Anaesth. 2016;116(5):610–7. Scholar
  39. 39.
    Aouad-Maroun M, Raphael CK, Sayyid SK, Farah F, Akl EA. Ultrasound-guided arterial cannulation for paediatrics. Cochrane Database Syst Rev. 2016;(9):CD011364.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Pediatric Critical Care MedicineHyogo Prefectural Kobe Children’s HospitalKobeJapan

Personalised recommendations