Pediatr Crit Care Me
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Pediatr Crit Care Me · Nov 2015
Editorial CommentFamily Involvement in PICU Rounds: Reality or Rhetoric?
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Pediatr Crit Care Me · Oct 2015
Review Meta AnalysisUltrasound Imaging Reduces Failure Rates of Percutaneous Central Venous Catheterization in Children.
Ultrasound imaging has been shown to be beneficial for percutaneous central venous cannulation in systematic reviews of randomized controlled trials in adult patients, but not in pediatrics. The aim of this updated review was to determine whether percutaneous central venous catheterization with the aid of ultrasound reduces cannulation failure in children. ⋯ The meta-analysis of five nonrandomized studies showed that the rate of cannulation failure was significantly lower with real-time ultrasound guidance than anatomic landmark technique (odds ratio, 0.44 [95% CI, 0.27-0.72]; p = 0.001). The combination of nine randomized controlled trials also showed lower failure rates with either the real-time ultrasound guidance or the prelocation technique over the landmark technique (odds ratio, 0.22 [95% CI, 0.07-0.69]; p = 0.0003) and fewer arterial punctures in the ultrasound group (odds ratio, 0.31 [95% CI, 0.09-1.08]; p = 0.07). However, seven out of nine studies were assessed as having high risk of bias. Since the lower cannulation failure and less frequent chance of arterial puncture with ultrasound were predominantly shown in studies at high risk of bias, further definitive and adequately powered studies with clear outcomes are needed.