Objective To determine the indication and need for echocardiographic assessment according to clinical severity of patients and therapeutic interventions performed after echocardiographic evaluation in critically ill children.

Design Prospective observational study.

Setting 14-bed, tertiary care Paediatric Intensive Care Unit (PICU).

Methods The PICU is a multidisciplinary referral centre. A total of 140 children; 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) who were admitted to our unit consecutively from March to August 2013 were included into the study. The indication for echocardiography and therapeutic interventions performed after cardiology consultation were recorded. For the estimation of severity of disease the paediatric risk of mortality score (PRISM) III was determined. The correlation between Prism III score and the need for echocardiographic evaluations were analysed.

Results Ages of all patients were between 45 days to 18 years. The male-female ratio was 1.33. Echocardiography was indicated in 88% (n = 66) of MV and%46.2 (n = 30) of SB patients. In 35.4% (n = 34) of patients who underwent echocardiographic evaluation no definitive change occured in treatment strategy while in 64.6% (n = 62) of patients decisive/supplemental information was obtained. Echocardiographic evaluation was necessary in MV children (p < 0.001) when compared with SB group and there was a positive correlation between Prism III score and the need for echocardiographic evaluation.

Conclusion Echocardiographic evaluation is essential in mechanically ventilated children and the need for echocardiographic assesment increases according to clinical severity of patients. Basic training for intensivists in this technique is challenging and needs to be developed and supported in critically ill children.