Effect of focused cardiopulmonary ultrasonography on clinical outcome of septic shock: a randomized study

Abstract

Objective To investigate the effect of focused ultrasonography on clinical outcomes of septic shock. Methods Patients with septic shock were randomized into an integrated cardiopulmonary ultrasonography (ICUS) group and conventional (CON) group. Within 1 hour of admission, the ICUS group underwent ICUS examination for hemodynamic decision-making, while the CON group received standard treatment. The primary endpoint was 28-day mortality after admission. The secondary endpoints were cumulative fluid administration in the first 6, 24, and 72 hours; use of vasoactive drugs; lactate clearance; duration of ventilation; and ICU stay. Results Ninety-four qualified patients were enrolled (ICUS group, 49; CON group, 45). ICUS showed no significant effect on 28-day mortality. Within the initial 6 hours, the ICUS group tended to have a higher fluid balance and fluid intake than the CON group. The duration of vasopressor support was shorter in the ICUS group. There were no differences in the cumulative fluid infusion within 24 or 72 hours, lactate clearance, ICU stay, or duration of ventilation. Conclusions The initially focused ICUS did not affect the clinical outcomes of septic shock, but it tended to be associated with a higher fluid balance within the initial 6 hours and shorter duration of vasopressor support.

A Study to Compare Ultrasound-guided and Clinically-guided Fluid Management in Children with Septic Shock

“…The adult RCT from China, much like our study, assessed lung ultrasound, ejection fraction, IVC variations, and additionally RV dilatation but only at a single time point. 22 Cumulative fluid balance at 72 hours, vasoactive drug usage, lactate clearance, duration of ventilation, and ICU stay were similar in both groups. The author stated that lesser number of patients (22.4%) than expected had abnormal ultrasound findings, which weakened its clinical effect.…”

“…Comparable to our observation, lengths of ICU and hospital stay were similar in both groups of the adult studies. 20 , 22 , 23 …”

“…Similar observation was noted by both pediatric and adult studies from different corners of the globe. 12 , 22 , 23 A larger study might find a mortality benefit of ultrasound guidance. However, on subgroup analysis, the Egyptian study has albeit found significant benefit in mortality due to unresolved shock in study group [38% (5/13) vs 88% (15/17)].…”

Use of Cardio-Pulmonary Ultrasound in the Neonatal Intensive Care Unit

“…In adult and pediatric intensive care units, integrated CPUS has shown a significantly better performance than LUS alone in the diagnosis of acute respiratory failure, being particularly useful to distinguish cases of hemodynamic pulmonary edema and pneumonia, often changing the clinical approach and management [ 87 ]. The CPUS approach leads to a shorter duration of vasopressor support [ 88 ]. Recently, it has been shown that in neonates, the expertise in CPUS interpretation to guide neonatal shock can be achieved in a relatively short time [ 89 ].…”

POCUS in dyspnea, nontraumatic hypotension, and shock; a systematic review of existing evidence

“…Scanning physicians were POCUS experts, not involved in patient management but not blinded to obvious clinical signs. Li et al [89] conducted an outcome study in 94 patients of whom 49 received POCUS and found no difference in 28-day mortality. The clinical effect might have been subtle because of a small number of patients with abnormal ultrasound findings.…”