Abstract
With the recent introduction of a high-quality, reasonably priced, and completely portable pediatric/neonatal ultrasound (US) machines, a new philosophy of US imaging emerged which is the 'critical ultrasound'. This is a paradigm shift from being organ-based, systematic, comprehensive diagnostic exam done by radiologists to a new concept of problem-based, goal-directed, focused multi-organ, time-dependent, exam done by the treating intensivist. Based on this concept, the US exam is not done for an organ (e.g. US for abdomen or chest) but rather done to enhance the management of a problem (US for hypotension, US for hypoxia, US for sepsis, etc.). Certain problem-based US exams can involve scanning of multiple organs to enhance the management of certain patient's problem. The US within this concept is not considered just as diagnostic tool but rather as an integral part of pediatric cardiac intensive care (PCICU) management that involves diagnosis, tailored treatment, monitoring effects, goal-directed therapy, ruling out possible complications, and to guide most of PCICU procedures. This article describes some of the applications of this innovative program over a 6-year period in a PCICU and its impact on patient care.