POCUS in Pediatrics: Beyond the Basics

Point-of-care ultrasound (POCUS) has moved decisively beyond its early role as a rapid diagnostic adjunct. In many acute and critical care environments, it now informs real-time decision-making, longitudinal monitoring, and increasingly complex clinical questions. As uptake has expanded, so have the clinical, governance, ethical, and methodological challenges associated with its use. This themed issue, POCUS Beyond the Basics, aims to explore how POCUS is being applied at the edges of current practice, where evidence is emerging, workflows are evolving, and standards are still being defined.We invite submissions that address advanced, controversial, or underexplored applications of POCUS across pediatric acute care and critical care, emergency medicine, anesthesia, and perioperative settings. Contributions may include original research, pilot studies, methodological papers, narrative or focused reviews, debates, and expert opinion pieces. Submissions should go beyond introductory or competency-based POCUS and instead examine how ultrasound findings influence management, prognostication, escalation or de-escalation of care, and system-level decision-making.Topics of interest include, but are not limited to, the role of POCUS within clinical governance frameworks; the implications of image acquisition without formal archiving; and how ultrasound-derived physiological markers should be interpreted when traditional gold standards are absent or delayed. Neuro-ultrasound themes may include transcranial Doppler applications in cardiac arrest, ischemic or non-traumatic brain injury, intracranial pressure surrogates, ventricular measurements, and waveform analysis as predictors of neurological outcome. Airway, diaphragmatic, and neuromuscular ultrasound applications are welcomed, particularly where they informintubation, extubation readiness, or post-procedural complications such as vocal cord dysfunction.We also encourage submissions exploring gastrointestinal, renal, and soft tissue ultrasound in critically ill patients, including motility assessment, congestion and perfusion markers, and the use of POCUS to guide weaning from extracorporeal or organ support therapies. Procedural innovation, such as ultrasound-guided tube placement or bedside confirmation techniques, as well as focused applications in emergency and acute surgical presentations, are equally relevant.Authors are encouraged to critically appraise limitations, sources of bias, and areas of uncertainty, and to address how POCUS findings should be integrated with clinical assessment rather than replace it. Educational, ethical, and system-level implications are particularly welcome. This issue seeks to challenge assumptions, highlight gaps inevidence, and stimulate informed discussion about how POCUS should evolve as a mature clinical tool.GoalPoint-of-care ultrasound is increasingly used to guide diagnosis, monitoring, and treatment in acute and critical care, yet much of its advanced application sits outside clearly defined evidence bases, governance structures, and outcome-driven frameworks. The purpose of this Research Topic is to examine how POCUS is being used beyondfoundational indications, where findings directly influence management decisions, prognostication, and escalation or withdrawal of care. This collection aims to address the clinical, methodological, and governance challenges that arise when POCUS is applied to complex physiology, longitudinal assessment, and high-stakes decision-making. By bringing together advanced applications, pilot data, and critical debate, the goal is toclarify where POCUS adds meaningful value, where its limitations lie, and how it can be integrated responsibly into contemporary clinical practice.Scope and Information for AuthorsThis Research Topic focuses on advanced, non-foundational uses of point-of-care ultrasound where clinical impact, interpretation, and governance are central. Submissions should address one or more of the following themes:● POCUS and clinical governance, including documentation, image storage, auditability, and medicolegal implications● Decision-making based on non-archived or operator-dependent ultrasound findings● Neuro-ultrasound beyond screening: TCD-derived indices, waveform analysis, optic nerve sheath assessment, ventricular measurements, and outcome prediction● Ultrasound markers of physiological effectiveness during resuscitation, including cardiac arrest● Aortic velocity–time integral (VTI) measurement in sepsis and shock, including assessment of stroke volume, fluid responsiveness, and response to vasoactive therapy● Airway, laryngeal, diaphragmatic, and neuromuscular ultrasound to guide ventilation, intubation, extubation, and complication detection● Gastrointestinal ultrasound for motility, feeding tolerance, and ileus prevention in critical care● Renal ultrasound, venous congestion, and perfusion assessment, including VExUS-based frameworks and their role in fluid and organ support decisions● Procedural innovation and bedside confirmation techniques● Limitations, bias, training requirements, and integration of POCUS into complex clinical pathways Topic editors: Bogdana Zoica, Virginie Plante, Michael Griksaitis, Marina Mir, Rebecca Mitting Source: https://www.frontiersin.org/research-topics/77115/pocus-in-pediatrics-beyond-the-basics