Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
Department of emergency medicine, Sir Run-Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
J Clin Anesth. 2018 Aug;48:62-66. doi: 10.1016/j.jclinane.2018.05.010. Epub 2018 May 12.
Point-of-care ultrasound (POCUS) has been widely used in the intensive care unit (ICU). However, it is largely unknown whether the use of POCUS is associated with improved patient-important outcomes. The study aimed to investigate whether incorporation of POCUS during morning round on a routine basis was able to improve clinical outcomes in critically ill patients with sepsis.
It was a prospective observational study.
A tertiary care emergency intensive care unit.
All patients admitted to the emergency ICU from January 2016 to December 2017 were screened for potential eligibility. Sepsis was defined as infection plus signs of organ dysfunction.
The intervention group incorporated POCUS during morning round on a routine basis, and a checklist was developed to improve the compliance. The control group did not have the mandates to perform POCUS during morning round, but could use POCUS when necessary.
Clinical outcomes of mortality, length of stay in ICU, durations of vasopressors and mechanical ventilation were compared between the intervention and control groups. Multivariable regression model was employed to adjust for confounding factors.
A total of 129 subjects, including 88 in the control group and 41 in the intervention group, were included for analysis. Univariate analysis showed that the intervention group had shorter durations of mechanical ventilation (MV) (4.5 ± 1.2 vs. 5.7 ± 1.0 days; p = 0.034) and more negative fluid balance (-143 vs. 48 ml/24 h; p = 0.003) on day 3. In multivariable model, routine incorporation of POCUS was associated with lower risk of prolonged (>7 days) ICU stay (OR: 0.39, 95% CI: 0.29-0.88; p = 0.029).
The study showed that incorporation of POCUS during morning round on a routine basis was associated with shortened duration of MV and length of stay in ICU. The possible mechanism underlying the relationship may be via reduced fluid administration. Future randomized controlled trials are needed to validate current findings.
床边超声（POCUS）已广泛应用于重症监护病房（ICU）。然而，其是否能改善患者预后尚不清楚。本研究旨在探讨常规晨间查房时应用 POCUS 是否能改善脓毒症危重症患者的临床结局。
前瞻性观察研究。
三级急救重症监护病房。
纳入 2016 年 1 月至 2017 年 12 月期间入住急诊 ICU 的所有患者进行潜在入选资格筛查。脓毒症定义为感染合并器官功能障碍。
干预组在常规晨间查房时应用 POCUS，制定检查表以提高依从性。对照组在晨间查房时无执行 POCUS 的任务，但可按需使用 POCUS。
比较干预组和对照组的死亡率、住 ICU 时间、血管加压素和机械通气时间的临床结局。采用多变量回归模型调整混杂因素。
共纳入 129 例患者，对照组 88 例，干预组 41 例。单因素分析显示，干预组机械通气时间更短（4.5±1.2 比 5.7±1.0 天；p=0.034），第 3 天的液体负平衡更多（-143 比 48ml/24h；p=0.003）。多变量模型显示，常规应用 POCUS 与 ICU 住院时间延长（>7 天）风险降低相关（OR：0.39，95%CI：0.29-0.88；p=0.029）。
本研究表明，常规晨间查房时应用 POCUS 与机械通气时间和 ICU 住院时间缩短相关。其潜在机制可能是减少液体输入。需要进一步的随机对照试验来验证目前的发现。
