Atkinson Paul, Taylor Luke, Milne James, Diegelmann Laura, Lamprecht Hein, Stander Melanie, Lussier David, Pham Chau, Henneberry Ryan J, Fraser Jacqueline, Howlett Michael, Mekwan Jay, Ramrattan Brian, Middleton Joanna, Van Hoving Daniel J, Peach Mandy, Dahn Tara, Hurley Sean, MacSween Kayla, Richardson Lucas, Stoica George, Hunter Sam, Atkinson Jack P, Olszynski Paul, Banerjee Ankona, Lewis David
Emergency Medicine, Saint John Regional Hospital, Saint John, CAN.
Emergency Medicine, Dalhousie University, Saint John, CAN.
Cureus. 2020 Aug 20;12(8):e9899. doi: 10.7759/cureus.9899.
Introduction Point of Care Ultrasound (PoCUS) protocols are commonly used to guide resuscitation for patients with undifferentiated hypotension, yet there is a paucity of evidence for any outcome benefit. We undertook an international multicenter randomized controlled trial (RCT) to assess the impact of a PoCUS protocol on key clinical outcomes. Here we report on resuscitation markers. Methods Adult patients presenting to six emergency departments (ED) in Canada and South Africa with undifferentiated hypotension (systolic blood pressure (SBP) <100mmHg or a Shock Index >1.0) were randomized to receive a PoCUS protocol or standard care (control). Reported physiological markers include shock index (SI), and modified early warning score (MEWS), with biochemical markers including venous bicarbonate and lactate, at baseline and four hours. Results A total of 273 patients were enrolled, with data collected for 270. Baseline characteristics were similar for each group. Improvements in mean values for each marker during initial treatment were similar between groups: Shock Index; mean reduction in Control 0.39, 95% CI 0.34 to 0.44 vs. PoCUS 0.33, 0.29 to 0.38; MEWS, mean reduction in Control 2.56, 2.22 to 2.89 vs. PoCUS 2.91, 2.49 to 3.32; Bicarbonate, mean reduction in Control 2.71 mmol/L, 2.12 to 3.30 mmol/L vs. PoCUS 2.30 mmol/L, 1.75 to 2.84 mmol/L, and venous lactate, mean reduction in Control 1.39 mmol/L, 0.93 to 1.85 mmol/L vs. PoCUS 1.31 mmol/L, 0.88 to 1.74 mmol/L. Conclusion We found no meaningful difference in physiological and biochemical resuscitation markers with or without the use of a PoCUS protocol in the resuscitation of undifferentiated hypotensive ED patients. We are unable to exclude improvements in individual patients or in specific shock types.
引言 床旁超声（PoCUS）方案常用于指导未分化型低血压患者的复苏，但几乎没有证据表明其能带来任何结局益处。我们开展了一项国际多中心随机对照试验（RCT），以评估PoCUS方案对关键临床结局的影响。在此，我们报告复苏指标。
方法 加拿大和南非6家急诊科收治的成年未分化型低血压患者（收缩压（SBP）<100mmHg或休克指数>1.0）被随机分为接受PoCUS方案组或标准治疗（对照组）。报告的生理指标包括休克指数（SI）和改良早期预警评分（MEWS），生化指标包括静脉血碳酸氢盐和乳酸，分别在基线和4小时时测定。
结果 共纳入273例患者，收集到270例患者的数据。两组的基线特征相似。初始治疗期间，两组各指标平均值的改善情况相似：休克指数；对照组平均降低0.39，95%置信区间0.34至0.44，PoCUS组为0.33，0.29至0.38；MEWS，对照组平均降低2.56，2.22至2.89，PoCUS组为2.91，2.49至3.32；碳酸氢盐，对照组平均降低2.71mmol/L，2.12至3.30mmol/L，PoCUS组为2.30mmol/L，1.75至2.84mmol/L；静脉血乳酸，对照组平均降低1.39mmol/L，0.93至1.85mmol/L，PoCUS组为1.31mmol/L，0.88至1.74mmol/L。
结论 我们发现，在未分化型低血压急诊科患者的复苏中，使用或不使用PoCUS方案，生理和生化复苏指标均无显著差异。我们无法排除个体患者或特定休克类型存在改善的情况。
