770: POINT-OF-CARE ULTRASOUND IN THE PEDIATRIC CARDIAC ICU: SURVEY OF USE, NEEDS, AND FUTURE DIRECTIONS
Bibliographic record
Abstract
Introduction: Use of point-of-care ultrasound (POCUS) has expanded rapidly across Critical Care Medicine. It has made procedures safer, while informing and expediting the evaluation of patients with cardiorespiratory failure. Pediatric Cardiac Critical Care is unique in the complexity of its patients and multidisciplinary approach. Despite a large number of cardiologist-intensivists, the field lacks consensus on the appropriate use of POCUS. We endeavored to understand current usage patterns, perspective on appropriate scope, perceived needs, and barriers to POCUS within Pediatric Cardiac ICUs. Methods: A 33-question survey was developed, vetted by the Scientific Committees of the Pediatric Cardiac Intensive Care Society (PCICS) and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI). It was distributed by PCICS, and the results analyzed. Results: Ninety-one CICU providers (75 MDs, 16 NPs) completed the survey, representing 55 institutions and 63% of PC4 centers. Most were dedicated CICUs in the U.S.; 7 were international. 63% were in their first 10 years of practice, 36% in their first 5. Nearly all utilized POCUS for vascular access. US was also used for thoracentesis (76%), paracentesis (58%), and cardiac assessments (68%), including evaluation of cardiac arrest (47%). Chest tubes were most often placed by cardiac surgeons in 75% of CICUs represented, and by intensivists in 25%; intensivists were more likely to use US (85% vs 36%). Use of POCUS for all of the above applications was felt by most respondents to be both feasible and relevant. Ninety-five percent (95%) and 70% of respondents believed that CICU MDs and NPs should use POCUS for limited cardiac assessments, respectively. Barriers include lack of time (54%), education (49%), quality assurance (44%), credentialing (41%), and established workflows (40%). Interestingly, 45% of respondents also cited limitations imposed by peers. Conclusions: Procedural and diagnostic POCUS, including targeted cardiac assessments, are highly relevant to pediatric CICU practice, and felt by providers to be both feasible and in-scope for MDs and NPs alike. Effort should be focused on openly addressing both infrastructural and cultural barriers, in order to ensure that bedside ultrasound is utilized rigorously and safely in our vulnerable CICU patients.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.005 | 0.011 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".