Ablordeppey Enyo A, Zhao Amy, Ruggeri Jeffery, Hassan Ahmad, Wallace Laura, Agarwal Mansi, Stickles Sean P, Holthaus Christopher, Theodoro Daniel
Department of Anaesthesiology, Washington University School of Medicine, St. Louis, MO, USA.
Department of Emergency Medicine, Washington University School of Medicine, St. Louis, MO, USA.
Emerg Med Int. 2024 May 6;2024:5675066. doi: 10.1155/2024/5675066. eCollection 2024.
Fixed, large volume resuscitation with intravenous fluids (IVFs) in septic shock can cause inadvertent hypervolemia, increased medical interventions, and death when unguided by point-of-care ultrasound (POCUS). The primary study objective was to evaluate whether total IVF volume differs for emergency department (ED) septic shock patients receiving POCUS versus no POCUS.
We conducted a retrospective observational cohort study from 7/1/2018 to 8/31/2021 of atraumatic adult ED patients with septic shock. We agreed upon variables and defined septic shock as lactate ≥4 and hypotension (SBP <90 or MAP <65). A sample size of 300 patients would provide 85% power to detect an IVF difference of 500 milliliters between POCUS and non-POCUS cohorts. Data are reported as frequencies, median (IQR), and associations from bivariate logistic models.
304 patients met criteria and 26% (78/304) underwent POCUS. Cardiac POCUS demonstrated reduced ejection fraction in 15.4% of patients. Lung ultrasound showed normal findings in 53% of patients. The POCUS vs. non-POCUS cohorts had statistically significant differences for the following variables: higher median lactate (6.7 [IQR 5.2-8.7] vs. 5.6], = 0.003), lower systolic blood pressure (77.5 [IQR 61-86] vs. 85.0, < 0.001), more vasopressor use (51% vs. 34%, = 0.006), and more positive pressure ventilation (38% vs. 24%, = 0.017). However, there were no statistically significant differences between POCUS and non-POCUS cohorts in total IVF volume ml/kg (33.02 vs. 32.1, = 0.47), new oxygen requirement (68% vs. 59%, = 0.16), ED death (3% vs. 4%, = 0.15), or hospital death (31% vs. 27%, = 0.48). There were similar distributions of lactate, total fluids, and vasopressors in patients with CHF and severe renal failure.
Among ED patients with septic shock, POCUS was more likely to be used in sicker patients. Patients who had POCUS were given similar volume of crystalloids although these patients were more critically ill. There were no differences in new oxygen requirement or mortality in the POCUS group compared to the non-POCUS group.
在脓毒性休克中，若未采用床旁超声（POCUS）引导，固定大容量静脉输液（IVF）进行复苏可能会导致意外的血容量过多、增加医疗干预并导致死亡。主要研究目的是评估接受POCUS与未接受POCUS的急诊科（ED）脓毒性休克患者的IVF总量是否存在差异。
我们对2018年7月1日至2021年8月31日期间患有脓毒性休克的非创伤性成年ED患者进行了一项回顾性观察队列研究。我们确定了变量，并将脓毒性休克定义为乳酸水平≥4且伴有低血压（收缩压<90或平均动脉压<65）。300名患者的样本量将提供85%的检验效能，以检测POCUS组与非POCUS组之间500毫升的IVF差异。数据以频率、中位数（四分位间距）以及二元逻辑模型的关联结果进行报告。
304名患者符合标准，其中26%（78/304）接受了POCUS检查。心脏POCUS显示15.4%的患者射血分数降低。肺部超声显示53%的患者结果正常。POCUS组与非POCUS组在以下变量方面存在统计学显著差异：较高的乳酸中位数（6.7[四分位间距5.2 - 8.7]对5.6，P = 0.003）、较低的收缩压（77.5[四分位间距61 - 86]对85.0，P < 0.001）、更多使用血管活性药物（51%对34%，P = 0.006）以及更多使用正压通气（38%对24%，P = 0.017）。然而，POCUS组与非POCUS组在IVF总量（毫升/千克）（33.02对32.1，P = 0.47）、新的吸氧需求（68%对59%，P = 0.16）、ED死亡（3%对4%，P = 0.15）或住院死亡（31%对27%，P = 0.48）方面无统计学显著差异。心力衰竭和严重肾衰竭患者的乳酸、总液体量和血管活性药物的分布相似。
在ED脓毒性休克患者中，POCUS更可能用于病情较重的患者。接受POCUS检查的患者接受了相似量的晶体液，尽管这些患者病情更危重。与非POCUS组相比，POCUS组在新的吸氧需求或死亡率方面无差异。
