Maine Medical Center, Department of Emergency Medicine, Portland, USA.
Ann Emerg Med. 2012 Sep;60(3):346-58.e4. doi: 10.1016/j.annemergmed.2012.01.006. Epub 2012 May 24.
Sepsis protocols promote aggressive patient management, including invasive procedures. After the provision of point-of-care ultrasonographic markers of volume status and cardiac function, we seek to evaluate changes in emergency physician clinical decisionmaking and physician assessments about the clinical utility of the point-of-care ultrasonographic data when caring for adult sepsis patients.
For this prospective before-and-after study, patients with suspected sepsis received point-of-care ultrasonography to determine cardiac contractility, inferior vena cava diameter, and inferior vena cava collapsibility. Physician reports of treatment plans, presumed causes of observed vital sign abnormalities, and degree of certainty were compared before and after knowledge of point-of-care ultrasonographic findings. The clinical utility of point-of-care ultrasonographic data was also evaluated.
Seventy-four adult sepsis patients were enrolled: 27 (37%) sepsis, 30 (40%) severe sepsis, 16 (22%) septic shock, and 1 (1%) systemic inflammatory response syndrome. After receipt of point-of-care ultrasonographic data, physicians altered the presumed primary cause of vital sign abnormalities in 12 cases (17% [95% confidence interval {CI} 8% to 25%]) and procedural intervention plans in 20 cases (27% [95% CI 17% to 37%]). Overall treatment plans were changed in 39 cases (53% [95% CI 41% to 64%]). Certainty increased in 47 (71%) cases and decreased in 19 (29%). Measured on a 100-mm visual analog scale, the mean clinical utility score was 65 mm (SD 29; 95% CI 58 to 72), with usefulness reported in all cases.
Emergency physicians found point-of-care ultrasonographic data about cardiac contractility, inferior vena cava diameter, and inferior vena cava collapsibility to be clinically useful in treating adult patients with sepsis. Increased certainty followed acquisition of point-of-care ultrasonographic data in most instances. Point-of-care ultrasonography appears to be a useful modality in evaluating and treating adult sepsis patients.
脓毒症方案促进了积极的患者管理，包括有创性操作。在提供了即时超声心动图检测容量状态和心功能的指标后，我们评估了即时超声心动图数据对成年脓毒症患者护理的临床实用性对急诊医师临床决策和医师评估的影响。
这项前瞻性的前后对照研究中，疑似脓毒症患者接受了即时超声心动图检查，以确定心肌收缩力、下腔静脉直径和下腔静脉塌陷度。比较了在获得即时超声心动图检查结果前后，医师对治疗计划的报告、观察到的生命体征异常的假定原因以及确定性的程度。还评估了即时超声心动图数据的临床实用性。
共纳入 74 例成年脓毒症患者：27 例（37%）脓毒症，30 例（40%）严重脓毒症，16 例（22%）脓毒性休克，1 例（1%）全身炎症反应综合征。在获得即时超声心动图数据后，医师改变了 12 例（17% [95%置信区间 {CI} 8%至 25%]）生命体征异常假定主要原因和 20 例（27% [95% CI 17%至 37%]）操作干预计划的假设。共有 39 例（53% [95% CI 41%至 64%]）改变了整体治疗计划。47 例（71%）的确定性增加，19 例（29%）的确定性降低。在 100 毫米视觉模拟量表上测量，平均临床实用性评分为 65 毫米（SD 29；95% CI 58 至 72），所有病例均报告了有用性。
急诊医师发现心肌收缩力、下腔静脉直径和下腔静脉塌陷度的即时超声心动图数据在治疗成年脓毒症患者方面具有临床实用性。在大多数情况下，获得即时超声心动图数据后确定性增加。即时超声心动图似乎是评估和治疗成年脓毒症患者的有用方法。
