In the PICU, POCUS is used continuously rather than as a single investigation. It changes management in real time across several critical decisions:
- Fluid resuscitation: inferior vena cava assessment guides whether a child in shock needs more intravenous fluid or has already received enough, avoiding both under-resuscitation and fluid overload.
- Cardiac function: direct assessment of contractility identifies cardiogenic shock and guides the choice between fluid, vasopressors, and inotropes.
- Respiratory support: lung POCUS identifies whether a child on ventilatory support has evolving pneumothorax, new effusion, or lung consolidation that needs management.
- Procedural safety: every invasive procedure in the PICU, from central line insertion to pleural drainage, is performed more safely under direct ultrasound visualisation.
- Response to treatment: POCUS can be repeated immediately to assess whether a clinical intervention has had the intended effect.
A critically ill child in the PICU cannot be repeatedly transported to a radiology suite. POCUS brings the imaging to the patient.
Written by Dr Chhaya Pathak, MBBS, MD (Pediatrics), Senior Consultant Paediatrician and Co-Founder, Vatsalya Children's Hospital, Mahavir Road, Orderly Bazar, Varanasi, Uttar Pradesh 221002. Pioneer of Paediatric Point-of-Care Ultrasonography (POCUS) in Eastern Uttar Pradesh.
