Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review
Background. Fixed, large volume resuscitation with intravenous fluids (IVFs) in septic shock can cause inadvertent hypervolemia, increased medical interventions, and death when unguided by point-of-care ultrasound (POCUS). The primary study objective was to evaluate whether total IVF volume differs...
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Wiley
2024-01-01
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| Series: | Emergency Medicine International |
| Online Access: | http://dx.doi.org/10.1155/2024/5675066 |
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| author | Enyo A. Ablordeppey Amy Zhao Jeffery Ruggeri Ahmad Hassan Laura Wallace Mansi Agarwal Sean P. Stickles Christopher Holthaus Daniel Theodoro |
| author_facet | Enyo A. Ablordeppey Amy Zhao Jeffery Ruggeri Ahmad Hassan Laura Wallace Mansi Agarwal Sean P. Stickles Christopher Holthaus Daniel Theodoro |
| author_sort | Enyo A. Ablordeppey |
| collection | DOAJ |
| description | Background. Fixed, large volume resuscitation with intravenous fluids (IVFs) in septic shock can cause inadvertent hypervolemia, increased medical interventions, and death when unguided by point-of-care ultrasound (POCUS). The primary study objective was to evaluate whether total IVF volume differs for emergency department (ED) septic shock patients receiving POCUS versus no POCUS. Methods. We conducted a retrospective observational cohort study from 7/1/2018 to 8/31/2021 of atraumatic adult ED patients with septic shock. We agreed upon a priori variables and defined septic shock as lactate ≥4 and hypotension (SBP <90 or MAP <65). A sample size of 300 patients would provide 85% power to detect an IVF difference of 500 milliliters between POCUS and non-POCUS cohorts. Data are reported as frequencies, median (IQR), and associations from bivariate logistic models. Results. 304 patients met criteria and 26% (78/304) underwent POCUS. Cardiac POCUS demonstrated reduced ejection fraction in 15.4% of patients. Lung ultrasound showed normal findings in 53% of patients. The POCUS vs. non-POCUS cohorts had statistically significant differences for the following variables: higher median lactate (6.7 [IQR 5.2–8.7] vs. 5.6], p=0.003), lower systolic blood pressure (77.5 [IQR 61–86] vs. 85.0, p<0.001), more vasopressor use (51% vs. 34%, p=0.006), and more positive pressure ventilation (38% vs. 24%, p=0.017). However, there were no statistically significant differences between POCUS and non-POCUS cohorts in total IVF volume ml/kg (33.02 vs. 32.1, p=0.47), new oxygen requirement (68% vs. 59%, p=0.16), ED death (3% vs. 4%, p=0.15), or hospital death (31% vs. 27%, p=0.48). There were similar distributions of lactate, total fluids, and vasopressors in patients with CHF and severe renal failure. Conclusions. Among ED patients with septic shock, POCUS was more likely to be used in sicker patients. Patients who had POCUS were given similar volume of crystalloids although these patients were more critically ill. There were no differences in new oxygen requirement or mortality in the POCUS group compared to the non-POCUS group. |
| format | Article |
| id | doaj-art-52788fff2f734b488e96db4e86aad96f |
| institution | Kabale University |
| issn | 2090-2859 |
| language | English |
| publishDate | 2024-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Emergency Medicine International |
| spelling | doaj-art-52788fff2f734b488e96db4e86aad96f2025-08-20T03:36:31ZengWileyEmergency Medicine International2090-28592024-01-01202410.1155/2024/5675066Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective ReviewEnyo A. Ablordeppey0Amy Zhao1Jeffery Ruggeri2Ahmad Hassan3Laura Wallace4Mansi Agarwal5Sean P. Stickles6Christopher Holthaus7Daniel Theodoro8Department of AnaesthesiologyWashington University School of MedicineDepartment of Emergency MedicineWashington University School of MedicineDepartment of Emergency MedicineDivision of BiostatisticsDepartment of Emergency MedicineDepartment of Emergency MedicineDepartment of Emergency MedicineBackground. Fixed, large volume resuscitation with intravenous fluids (IVFs) in septic shock can cause inadvertent hypervolemia, increased medical interventions, and death when unguided by point-of-care ultrasound (POCUS). The primary study objective was to evaluate whether total IVF volume differs for emergency department (ED) septic shock patients receiving POCUS versus no POCUS. Methods. We conducted a retrospective observational cohort study from 7/1/2018 to 8/31/2021 of atraumatic adult ED patients with septic shock. We agreed upon a priori variables and defined septic shock as lactate ≥4 and hypotension (SBP <90 or MAP <65). A sample size of 300 patients would provide 85% power to detect an IVF difference of 500 milliliters between POCUS and non-POCUS cohorts. Data are reported as frequencies, median (IQR), and associations from bivariate logistic models. Results. 304 patients met criteria and 26% (78/304) underwent POCUS. Cardiac POCUS demonstrated reduced ejection fraction in 15.4% of patients. Lung ultrasound showed normal findings in 53% of patients. The POCUS vs. non-POCUS cohorts had statistically significant differences for the following variables: higher median lactate (6.7 [IQR 5.2–8.7] vs. 5.6], p=0.003), lower systolic blood pressure (77.5 [IQR 61–86] vs. 85.0, p<0.001), more vasopressor use (51% vs. 34%, p=0.006), and more positive pressure ventilation (38% vs. 24%, p=0.017). However, there were no statistically significant differences between POCUS and non-POCUS cohorts in total IVF volume ml/kg (33.02 vs. 32.1, p=0.47), new oxygen requirement (68% vs. 59%, p=0.16), ED death (3% vs. 4%, p=0.15), or hospital death (31% vs. 27%, p=0.48). There were similar distributions of lactate, total fluids, and vasopressors in patients with CHF and severe renal failure. Conclusions. Among ED patients with septic shock, POCUS was more likely to be used in sicker patients. Patients who had POCUS were given similar volume of crystalloids although these patients were more critically ill. There were no differences in new oxygen requirement or mortality in the POCUS group compared to the non-POCUS group.http://dx.doi.org/10.1155/2024/5675066 |
| spellingShingle | Enyo A. Ablordeppey Amy Zhao Jeffery Ruggeri Ahmad Hassan Laura Wallace Mansi Agarwal Sean P. Stickles Christopher Holthaus Daniel Theodoro Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review Emergency Medicine International |
| title | Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review |
| title_full | Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review |
| title_fullStr | Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review |
| title_full_unstemmed | Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review |
| title_short | Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in Patients with Septic Shock: A Retrospective Review |
| title_sort | does point of care ultrasound affect fluid resuscitation volume in patients with septic shock a retrospective review |
| url | http://dx.doi.org/10.1155/2024/5675066 |
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