SAINT LOUIS UNIVERSITY BONIFACIO STREET, BAGUIO CITY

Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis

Presented to the Faculty of the School of Nursing In Partial Fulfillment For the requirement of the subject RLE Hospital Duty (SLUHSH; PEDIATRIC WARD.)

Submitted to: Mrs. Arlene Milo;RN CLINICAL INSTRUCTOR

Submitted by: LIBAO, DERECK MARTIL LATINA BSN IV-C1

December 15, 2011

II. REACTION At first I was confused and puzzled with questions because how could ultrasound determine the degree of dehydration in children? But after reading the journal I found out that they used the ultrasound to determine the diameter of the inferior vena cava and aorta which is correlated with intravascular volume. This is very helpful in accurately determining dehydration in children because its not enough to ask the mother about historical information such as oral intake, stool and urine output and weight loss are often inaccurate or difficult to obtain. Laboratory values can also be used to judge the severity of dehydration in children but it is generally acknowledged that these also have limited sensitivity and specificity. III. SUMMARY AND COMPREHENSIVE DISCUSSION OF THE RELEVANCE OF THE FOLLOWING: Prospectively identifying children with significant dehydration from gastroenteritis is difficult in acute care settings. Previous work by their group has shown that bedside ultrasound (US) measurement of the inferior vena cava (IVC) and the aorta (Ao) diameter ratio is correlated with intravascular volume. This study was designed to validate the use of this method in the prospective identification of children with dehydration by investigating whether the IVC/Ao ratio correlated with dehydration in children with acute gastroenteritis. Another objective was to investigate the inter-rater reliability of the IVC/Ao measurements. A prospective observational study was carried out in a pediatric emergency department (PED) between November 2007 and June 2009. Children with acute gastroenteritis were enrolled as subjects. A pair of investigators obtained transverse images of the IVC and Ao using bedside ultrasound. The ratio of IVC and Ao diameters (IVC/Ao) was calculated. Subjects were asked to return after resolution of symptoms. The difference between the convalescent weight and ill-weight was used to calculate the degree of dehydration. Greater than or equal to 5% difference was judged to be significant. Linear regression was performed with dehydration as the dependent variable, and the IVC/Ao as the independent variable. Pearsons correlation coefficient was calculated to assess the degree of agreement between observers. One hundred and twelve subjects were enrolled. Seventy-one subjects (63%) completed follow-up. Twenty-eight subjects (39%) had significant dehydration. The linear regression model resulted in an R-squared of 0.21 (p < 0.001), and a slope (B) of 0.11 (95%) confidence interval [CI] = 0.08 to 0.14). An IVC/Ao cut-off of 0.8 produced a sensitivity of 86% and a specificity of 56% for the diagnosis of significant dehydration. Forty-eight paired measurements of IVC/Ao ratios were made. The Pearson correlation coefficient was 0.76. In this pilot study the ratio of IVC to Ao diameters, as measured by bedside ultrasound, was a marginally accurate measurement of acute weight loss in children with dehydration from gastroenteritis. The technique demonstrated good inter-rater reliability. As a nurse, we may apply whatever knowledge we gain in our profession. We may educate other people and share our knowledge to them, thus promoting the well-being of our clients. If we are able to promote the well being of people, then we will be able to render effective care. Under our educative treatment since there was a new idea gain from the study about the use of ultrasound in accurately determining acute dehydration in children with acute gastroenteritis.. We can share this information especially to families with children. As to nursing education, the study may allow health care providers to have more knowledge about the use of ultrasound in accurately determining dehydration in children aside from laboratory test and asking historical information. It will serve as an additional lecture and

resource material especially to the subject medical surgical nursing. Knowledge gained from the study can also be properly disseminated as awareness to other forms of institution and agencies. It will lead to the development of a common understanding between health care professions in about the use of ultrasound in determining dehydration in children. The study also provides evidenced based knowledge which serves as a basis for new or improved course content for subject since there is added data, information and knowledge. Additional to this is that the findings can also be used as a reference for future researches. Here in the Philippines, I observed that in the ER, the clerks and interns commonly determine dehydration in children by asking history of patient, physical assessment and laboratory test which is for me enough but after reading the study I recommend that similar study will be conducted here in our country to compare if the results will be the same so that if there will be similar results I also recommend that transverse ultrasound of the inferior vena cava and aorta will be used in determining dehydration in children. IV.REFERENCE > http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3058669/?tool=pmcentrez