Atkinson Paul, Hunter Sam, Banerjee Ankona, Lewis David, Fraser Jacqueline, Milne James, Diegelmann Laura, Lamprecht Hein, Stander Melanie, Lussier David, Pham Chau, Peach Mandy, Taylor Luke, Henneberry Ryan, Howlett Michael, Mekwan Jay, Ramrattan Brian, Middleton Joanna, Van Hoving Daniel J, Stoica George, French James, Olszynski Paul
Emergency Medicine, Saint John Regional Hospital, Saint John, CAN.
Science, University of Ottawa, Ottawa, CAN.
Cureus. 2019 Nov 3;11(11):e6058. doi: 10.7759/cureus.6058.
Introduction Our previously reported randomized-controlled-trial of point-of-care ultrasound (PoCUS) for patients with undifferentiated hypotension in the emergency department (ED) showed no survival benefit with PoCUS. Here, we examine the data to see if PoCUS led to changes in the care delivered to patients with cardiogenic and non-cardiogenic shock. Methods A post-hoc analysis was completed on a database of 273 hypotensive ED patients randomized to standard care or PoCUS in six centres in Canada and South Africa. Shock categories recorded one hour after the ED presentation were used to define subcategories of shock. We analyzed initial intravenous fluid volumes, as well as rates of inotrope use and procedures. Results 261 patients could be classified as cardiogenic or non-cardiogenic shock types. Although there were expected differences in the mean fluid volume administered between patients with non-cardiogenic and cardiogenic shock (p-value<0.001), there was no difference between the control and PoCUS groups (mean non-cardiogenic control 1881mL (95% CI 1567-2195mL) vs non-cardiogenic PoCUS 1763mL (1525-2001mL); and cardiogenic control 680mL (28.4-1332mL) vs. cardiogenic PoCUS 744mL (370-1117mL; p= 0.67). Likewise, there were no differences in rates of inotrope administration nor procedures for any of the subcategories of shock between the control group and PoCUS group patients. Conclusion Despite differences in care delivered by subcategory of shock, we did not find any difference in key elements of emergency department care delivered between patients receiving PoCUS and those who did not. This may help explain the previously reported lack of outcome differences between groups.
引言 我们之前报道的一项针对急诊科（ED）未分化低血压患者的即时超声检查（PoCUS）随机对照试验表明，PoCUS对生存率并无益处。在此，我们分析数据，以查看PoCUS是否导致了对心源性和非心源性休克患者的治疗发生变化。方法 对加拿大和南非六个中心的273名随机分配接受标准治疗或PoCUS的低血压ED患者的数据库进行了事后分析。ED就诊一小时后记录的休克类别用于定义休克亚类。我们分析了初始静脉输液量、血管活性药物使用速率和操作情况。结果 261名患者可被分类为心源性或非心源性休克类型。尽管非心源性和心源性休克患者之间平均输液量存在预期差异（p值<0.001），但对照组和PoCUS组之间无差异（非心源性休克对照组平均1881mL（95%CI 1567 - 2195mL），非心源性休克PoCUS组平均1763mL（1525 - 2001mL）；心源性休克对照组平均680mL（28.4 - 1332mL），心源性休克PoCUS组平均744mL（370 - 1117mL；p = 0.67）。同样，对照组和PoCUS组患者在任何休克亚类的血管活性药物给药速率和操作方面均无差异。结论 尽管不同休克亚类的治疗存在差异，但我们未发现接受PoCUS的患者与未接受PoCUS的患者在急诊科治疗的关键要素上存在任何差异。这可能有助于解释之前报道的两组之间缺乏结局差异的原因。
