[version 1; peer review: 1 approved with reservations]
No competing interests were disclosed.
Bedside echocardiography has emerged as a valuable diagnostic tool in intensive care units, aiding the prompt evaluation of cardiovascular function in critically ill patients. However, its application in the pediatric population, particularly within rural healthcare settings, still needs to be explored. This study aims to assess the influence of bedside echocardiography on the management and outcomes of critically ill pediatric patients admitted to a tertiary care center in rural Maharashtra, India.
A cross-sectional study will be conducted in the Pediatric Intensive Care Unit (PICU) of Acharya Vinoba Bhave Rural Hospital from July 2022 to July 2024 on 88 participants. The study will enroll critically ill pediatric patients aged one month to 18 years who meet the inclusion criteria. Data collection will involve comprehensive clinical assessments, echocardiography performed by pediatric cardiologists, and documentation of demographic information, clinical history, interventions, and outcomes. Statistical analyses will encompass descriptive statistics, correlation assessments, and significance testing.
This study aims to elucidate the indications and necessity of echocardiography in pediatric patients, correlate echocardiographic findings with clinical interventions, and assess their impact on patient outcomes. It seeks to contribute valuable insights into the utility of bedside echocardiography in rural PICUs and its potential to inform clinical decision making.
The care of critically ill pediatric patients demands continuous advancements in diagnostic and therapeutic strategies to optimize outcomes. Bedside echocardiography has emerged as a powerful diagnostic tool in intensive care settings, allowing for rapid and noninvasive assessment of cardiovascular function.
Timely and accurate assessment of cardiac function in pediatric critical care is paramount. Cardiac dysfunction can manifest in various forms, from structural anomalies to functional impairments, and often requires prompt intervention to mitigate adverse outcomes.
This study protocol outlines a comprehensive investigation of the impact of bedside echocardiography on the management and outcomes of critically ill pediatric patients in the Pediatric Intensive Care Unit (PICU) at Acharya Vinoba Bhave Rural Hospital, a tertiary care center located in the state of Maharashtra, India. This study aims to bridge the existing gap in knowledge by examining the utilization and effectiveness of echocardiography in this specific patient population.
By assessing the indications and necessity of echocardiography, correlating echocardiographic findings with clinical interventions, and evaluating the subsequent impact on patient outcomes, this study endeavors to provide valuable insights into the role of echocardiography in critically ill pediatric patients. These insights can inform clinical decision making, enhance diagnostic accuracy, and ultimately improve the quality of care for vulnerable patients in rural healthcare settings.
As demand for advanced critical care services continues to grow, particularly in regions with limited healthcare resources, understanding the value of bedside echocardiography in pediatric intensive care has become increasingly critical. This study represents a significant step towards unraveling the potential benefits of this diagnostic modality to enhance the care and outcomes of critically ill children.
This study aims to evaluate the impact of bedside echocardiography on the management and outcomes of critically ill pediatric patients in a Pediatric Intensive Care Unit (PICU).
To determine the indications and necessity of echocardiography assessment and therapeutic interventions in critically ill patients. To correlate the echocardiographic findings of patients admitted to the PICU with a systematic clinical examination. Correlation of cardiac dysfunction with the pediatric outcome.
This study will employ a cross-sectional design to assess the impact of bedside echocardiography on the management of critically ill pediatric patients in a Pediatric Intensive Care Unit (PICU).
The study population will consist of critically ill pediatric patients aged one month to 18 years admitted to the PICU at Acharya Vinoba Bhave Rural Hospital, associated with Jawaharlal Nehru Medical College, Maharashtra, India, between July 2022 and July 2024.
The study will be conducted at the Pediatric Intensive Care Unit (PICU) of Acharya Vinoba Bhave Rural Hospital, a tertiary care center in Maharashtra, India.
Aged between one month and 18 years. Critically ill status as determined by the treating healthcare team.
Post-operative patients requiring PICU admission. Patients who do not meet the age criteria (< one month or > 18 years).
To minimize bias, the study will adhere to rigorous methodologies. Patient selection will be based on explicit inclusion and exclusion criteria, and data collection will follow standardized procedures. Researchers involved in data collection will be trained to minimize observer bias and patient anonymity will be maintained to reduce reporting bias.
Enrollment will be initiated after obtaining informed consent from the parents or legal guardians of eligible pediatric patients admitted to the PICU. The enrollment process will involve obtaining consent, confirming the eligibility criteria, and documenting patient demographics.
Formula
Prevalence of patients who underwent echocardiographic evaluation = 35.4%.
P =35.4% (As per reference article
Minimum sample size required 88.
The data collection process for this study will be comprehensive and meticulously conducted to ensure the accuracy and reliability of the gathered information. This process will involve several steps and methods.
Upon admission to the PICU, critically ill pediatric patients meeting the inclusion criteria will be identified. Informed consent will be obtained from their parents or legal guardians before commencing the data collection procedures, ensuring full compliance with ethical standards.
Once consent is obtained, patient demographics including age, sex, and clinical history will be recorded by using data collection proforma. This will provide a baseline understanding of the patient population. Subsequently, a team of experienced pediatric cardiologists will conduct echocardiographic assessments of the enrolled patients. Echocardiographic evaluations will include parameters such as ejection fraction, fractional shortening, and systolic and diastolic cardiac function assessments. These assessments will be performed according to the clinical necessity, and the findings will be thoroughly documented.
In addition to echocardiographic data, relevant clinical information will be collected and recorded, including vital signs on admission, complaints, initial diagnosis, final diagnosis, type of ventilation, length of PICU stay, and the Pediatric Risk of Mortality (PRISM) score.
The necessity for echocardiography will be assessed based on clinical indications, which include a variety of factors, such as the presence of cardiac murmurs, suspected cardiac diseases, hypotension or shock, hypertension, arrhythmia, signs of congestive heart failure, and several other clinical situations. Therapeutic interventions following echocardiography, such as changes in fluid management, vasopressor therapy, antihypertensive therapy, and cardiac surgery, will also be meticulously recorded.
To maintain data accuracy and quality control, research personnel involved in data collection will receive training in standardized data collection procedures. Patient confidentiality will be strictly maintained throughout the process.
Descriptive statistical analysis will summarize the data, including the mean, standard deviation, median, interquartile range, and percentages. Parametric or non-parametric statistical tests, such as chi-square, Fisher’s exact test, independent t-test, Spearman’s rank correlation coefficient, or Pearson’s correlation coefficient, will assess the relationships between variables. Statistical significance will be set at P < 0.05. Data analysis will be conducted using the appropriate statistical software, R Studio version 2023.03.0-daily+82. pro2.
The Institutional Ethics Committee of the Datta Meghe Institute of Higher Education and Research (DU) has granted its approval to the study protocol (Reference number: DMIMS (DU)/IEC/2022/1073) Date: 27/06/2022. Before commencing the study, we will obtain written informed consent from all participants, providing them with a comprehensive explanation of the study’s objectives.
After completion of the study, we will publish it in an indexed journal or conference.
The study has not yet started. After the publication of the protocol, we will begin recruitment for the study.
Using bedside echocardiography in pediatric intensive care is paramount. Critically ill pediatric patients often present with complex and rapidly evolving cardiac issues, and timely and accurate assessment is crucial for their management. This study addresses the pressing need to evaluate the role of echocardiography in pediatric intensive care, particularly in a rural healthcare setting.
Bedside echocardiography can potentially transform the diagnosis and management of cardiac conditions in critically ill children. Providing real-time information on cardiac anatomy, function, and hemodynamics enables clinicians to rapidly make informed decisions. This study aims to shed light on the diagnostic value of echocardiography, including its indications, necessity, and the extent to which it correlates with clinical interventions.
The primary aim of this study is to correlate the cardiac functional or structural abnormalities identified through echocardiography with pediatric outcomes. This aspect of the research is critical, as it can elucidate whether echocardiography significantly improves patient outcomes in the PICU. If it demonstrates a positive impact, it could lead to a more widespread adoption of this diagnostic tool.
A unique aspect of this study is its location in a rural healthcare setting. Rural areas often require more resources and access to advanced medical technology. Assessing the applicability and effectiveness of bedside echocardiography in such a setting is particularly relevant and could provide insights directly applicable to similar healthcare environments worldwide.
This study will also explore how echocardiography influences clinical decision-making. This includes assessing whether echocardiographic findings lead to changes in therapeutic interventions such as medication adjustments or surgical procedures. Understanding its impact on clinical decisions is essential for determining the practical value of echocardiography in the PICU.
The findings of this study are expected to have implications for clinical practice, healthcare policies, and further research. Positive results may encourage healthcare facilities in rural areas to invest in echocardiographic equipment and training, potentially leading to improved outcomes. Additionally, the study may stimulate further research into optimizing echocardiography protocols and expanding their use in pediatric critical care.
It is important to acknowledge the potential limitations of this study. Cross-sectional studies provide valuable insights into prevalence and associations but do not establish causality. Additionally, the findings of this study may be influenced by various factors, such as the experience of the healthcare team and availability of resources.
No data are associated with this article.
Zenodo: Proforma for the data collections ‘A cross-sectional study on the impact of bedside echocardiography in critically ill pediatric patient’s management in the pediatric intensive care unit ’.
Data are available under the terms of the
In this interesting paper, the Authors have described the potential usefulness of bedside echocardiography for rapid assessment of cardiovascular function in critically ill pediatric patients, particularly within rural healthcare settings.
The Authors have proposed a research protocol that aims at evaluating the impact of bedside echocardiography on the management of critically ill pediatric patients in a Pediatric Intensive Care Unit.
The Authors primarily focused on the assessment of conventional echocardiographic parameters, such as ejection fraction, fractional shortening and parameters of diastolic function.
The Authors aim at evaluating how bedside echocardiography influences clinical decision-making. The research protocol is very interesting.
I have only one suggestion for the Authors.
The Authors could mention also innovative echocardiographic techniques.
In the Discussion section, paragraph "Diagnostic value of bedside echocardiography", the Authors could also state that recent advances in cardiovascular imaging have led to the introduction of speckle tracking echocardiography. This imaging modality may allow the clinicians to detect subclinical impairment in myocardial strain parameters, which occur earlier than ejection fraction reduction. The implementation of conventional transthoracic echocardiography with strain echocardiographic imaging may provide incremental diagnostic and prognostic information not only in adults but also in pediatric patients (refer 1 and 2).
Is the study design appropriate for the research question?
Yes
Is the rationale for, and objectives of, the study clearly described?
Yes
Are sufficient details of the methods provided to allow replication by others?
Yes
Are the datasets clearly presented in a useable and accessible format?
Yes
Reviewer Expertise:
Cardiology
I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.