Development of an Expert Consensus-Based Point-of-Care Ultrasound Protocol for Pediatric Septic Shock

Although point-of-care ultrasound (POCUS) is included in the Surviving Sepsis Campaign Pediatric Guidelines, evidence for its impact on pediatric sepsis outcomes is limited, and guidance on integrating POCUS into pediatric sepsis care is lacking. Our objective was to develop an expert consensus–based POCUS protocol, to be evaluated in a future clinical trial, for the initial evaluation and management of children presenting with suspected septic shock.

This was a modified Delphi consensus study with a multispeciality panel of pediatric POCUS experts recruited via an advertisement in two pediatric POCUS international listserves. Inclusion criteria were >1500 POCUS scans performed and completion of a POCUS fellowship or holding a POCUS leadership role. In Round 1, panelists rated 26 survey statements regarding components of and timing for a proposed pediatric septic shock POCUS protocol. Consensus was defined as ≥80% agreement or disagreement. Two moderated online discussions addressed items without consensus, followed by additional survey rounds until consensus was achieved.

Eighteen POCUS experts from 16 US and 2 Canadian sites completed Round 1: 12 pediatric emergency physicians, 2 pediatric intensivists, 2 pediatric hospitalists, and 2 general emergency physicians; 17 panelists attended the live discussions and 17 completed Rounds 2 and 3. Consensus was reached to include the following POCUS components in the protocol: focused cardiac assessment for gross ventricular function and pericardial effusion (100%) with a minimum of 2 cardiac views, qualitative assessment of inferior vena cava collapsibility (83%), and symptom-directed diagnostic POCUS to identify a sepsis source (83%). Consensus was also reached to first perform the POCUS protocol “on initial evaluation of septic shock without delaying other necessary interventions” (100%) and to repeat the protocol when there is clinical deterioration (89%), treatment non-response (94%), or at the clinician’s discretion (94%).

This Delphi study established expert consensus on key components and timing of a POCUS protocol for children presenting with suspected septic shock. Future studies are needed to assess feasibility of use and clinical impact.