Focused echocardiography as a tool for differential diagnosis of cardiovascular dysfunction in children with infections: Case reports

Abstract

Focused echocardiography is a screening method for evaluating the cardiovascular system in critically ill patients. It is widely utilized worldwide for the differential diagnosis and management of cardiovascular dysfunction in children with infectious diseases requiring treatment in intensive care units. This report presents three clinical cases of cardiovascular dysfunction of unknown origin in pediatric patients admitted to an infectious disease hospital with nonspecific symptoms. Focused echocardiography was performed in all cases, allowing for the identification of the underlying cause of hemodynamic disturbances. The bedside real-time application of focused echocardiography allowed for targeted therapy in all three cases, preventing life-threatening complications — sepsis, cardiac tamponade, and cardiogenic shock — along with continuing standard treatment and facilitating timely decision-making for specialized care. All cases involved cardiac manifestations within the infectious disease process. Each patient achieved full recovery. Focused echocardiography can be used as a simple, reliable, and highly effective tool for the differential diagnosis of cardiovascular dysfunction in children with infectious diseases requiring intensive care. This method deserves broader implementation in routine clinical practice.

Keywords

echocardiography / cardiovascular dysfunction / children / infections / intensive care / FOCUS protocol / case report

References

[1] Lekmanov AU, Mironov PI. Pediatric sepsis — time to reach agreement. Russian Bulletin of Perinatology and Pediatrics. 2020;65(3):131–137. doi: 10.21508/1027-4065-2020-65-3-131-137 EDN: XVXJFX

[2] Aleksandrovich JuS, Ivanov DO, Pshenisnov KV. Sepsis of newborns. Saint Petersburg: Saint-Petersburg State Pediatric Medical University; 2019. 176 p. (In Russ.)

[3] Bykov MV, Lazarev VV, Bykova LV, et al. New possibilities of diagnosing volume status disorders in children in acute infectious diseases. Infectious Diseases. 2017;15(2):64–69. doi: 10.20953/1729-9225-20172-64-69 EDN: ZBBBWT

[4] Flakskampf FA. Practical echocardiography: Guide to echocardiographic diagnostics: training manual. Moscow: MEDpress-inform; 2013. 872 p. (In Russ.)

[5] Shiller N, Osipov MA. Clinical echocardiography: 2nd ed. Moscow: MEDpress-inform; 2018. 344 p.

[6] Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification: a report from the American society of echocardiography’s guidelines and standards committee and the chamber quantification writing group, developed in conjunction with the European as-sociation of echocardiography, a branch of the European society of cardiology. J Am Soc Echocardiogr. 2005;18(12):1440–1463. doi: 10.1016/j.echo.2005.10.005

[7] Singh Y, Villaescusa JU, da Cruz EM, et al. Recommendations for hemo-dynamic monitoring for critically ill children-expert consensus statement issued by the cardiovascu-lar dynamics section of the European society of paediatric and neonatal intensive care (ESPNIC). Crit Care. 2020;24(1):620. doi: 10.1186/s13054-020-03326-2 EDN: KVPAKJ

[8] Boronina IV, Kovalev SA, Gribova NG, et al. Noninvasive hemodynamic monitoring in the pediatric intensive care unit. Creative Cardiology. 2024;18(1):83–91. doi: 10.24022/1997-3187-2024-18-1-83-91 EDN: HUJUAL

[9] Ermolenko KYu, Pshenisnov KV, Aleksandrovich YuS, et al. Role of ultrasound diagnostics in pediatric septic shock intensive care: a review and a clinical case. Pediatrician (St. Petersburg). 2022;13(2):5–15. doi: 10.17816/PED1325-15 EDN: VWUIXH

[10] Rudakova AA, Ionov OV, Filippova EA, et al. Possibilities and limitations of the use of echocardiography by an intensive care physician in the neonatal intensive care. Neonatology: News, Views, Education. 2022;10(4):54–62. doi: 10.33029/2308-2402-2022-10-4-54-62 EDN: DITQSU

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