title: Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient.
abstract: OBJECTIVE
  Echocardiography can be a rapid, noninvasive, objective tool in the assessment of ventricular function and preload during resuscitation of a critically ill or injured child. We sought to determine the accuracy of bedside limited echocardiography by the emergency physician (BLEEP) in estimation of (1) left ventricular function (LVF) and (2) inferior vena cava (IVC) volume, as an indirect measure of preload.
  
  
  METHODS
  We conducted a prospective observational study of a convenience sample of patients who were admitted to our intensive care unit. All patients underwent BLEEP followed by an independent formal echocardiogram by an experienced pediatric echocardiography provider (PEP). IVC volume was assessed by measurement of the maximal diameter of the IVC. LVF was determined by calculating shortening fraction (SF) using M-mode measurements on the parasternal short-axis view at the level of the papillary muscle. An independent blinded pediatric cardiologist reviewed all images for accuracy and quality. Estimates of SF obtained on the BLEEP examination were compared with those obtained by the PEP.
  
  
  RESULTS
  Thirty-one patients were enrolled. The mean age was 5.1 years (range: 23 days-16 years); 48.4% (15 of 31) were girls; 58.1% (18 of 31) were on mechanical ventilatory support at the time of their study. There was good agreement between the emergency physician (EP) and the PEP for estimation of SF (r = 0.78). The mean difference in the estimate of SF between the providers was 4.4% (95% confidence interval: 1.6%-7.2%). This difference in estimate of SF was statistically significant. Similarly, there was good agreement between the EP and the PEP for estimation of IVC volume (r = 0.8). The mean difference in the estimate of IVC diameter by the PEP and the EP was 0.068 mm (95% confidence interval: -0.16 to 0.025 mm). This difference was not statistically significant.
  
  
  CONCLUSIONS
  Our study suggests that PEP sonographers are capable of obtaining images that permit accurate assessment of LVF and IVC volume. BLEEP can be performed with focused training and oversight by a pediatric cardiologist.
authors.affiliation: Division of Emergency Medicine, Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA. jpershad@pediatricemergencyspecialists.com
authors.forename: Jay
authors.initials: J
authors.lastname: Pershad
authors.forename: Sharon
authors.initials: S
authors.lastname: Myers
authors.forename: Cindy
authors.initials: C
authors.lastname: Plouman
authors.forename: Cindy
authors.initials: C
authors.lastname: Rosson
authors.forename: Krista
authors.initials: K
authors.lastname: Elam
authors.forename: Jim
authors.initials: J
authors.lastname: Wan
authors.forename: Thomas
authors.initials: T
authors.lastname: Chin
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004452:Echocardiography; D004635:Emergency Medicine; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010372:Pediatrics / Q000379:methods; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014682:Vena Cava, Inferior / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left