The Pediatric Tri-POCUS Approach: Conceptual Review and Case Series

Effective fluid management presents a significant challenge for pediatric intensivists. Enhanced ultrasound data that predict adverse outcomes, such as edema and venous congestion, can provide important information about optimal fluid management. The integration of bedside multiorgan ultrasound protocols (Multi-POCUS) mitigates the limitations of individual scoring systems, enabling more accurate fluid monitoring and management. The Tri-POCUS approach, described initially in adult patients, combines lung ultrasound, focused cardiac ultrasound, and venous excess ultrasound, and its application in the pediatric population is proposed. This study examines the Tri-POCUS approach from a pediatric perspective: we applied it to a cohort of critically ill pediatric patients with venous congestion admitted to a pediatric intensive care unit. Four cases are presented to demonstrate the bedside utility of the Tri-POCUS approach in critically ill children with the goal of monitoring venous congestion.