Determination of end point of fluid resuscitation using simplified lung ultrasound protocol in patients with septic shock

Ismail, Rana Mohamed; Dahroug, Amr Hassan; Zaytoun, Tayseer

doi:10.4103/ejcdt.ejcdt_134_18

Cited by 4 publications

(6 citation statements)

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“…(15) Additionally, Panuccio et al, [14] , conducted Apilot study in nephrology ward,including 40 patients.The average age was 68±16 y and patient admitted according to KDIGO classification to diagnose acute kidney injury, lung ultrasound b lines score correlate with lung crackles severity detected by auscultation to detect pulmonary congestion and found that b lines ≥15 are accompanied by moderate to severe lung congestion. (16) in contrast to our study, Enghard et al, [15] studied LUS protocol and showed excellent prediction of EVLW in ventilated ICU cases . (17) In this study mechanically ventilated patients admitted with different causes of admission, subjected to LUS and trans-pulmonary thermodilution measurement using the PiCCO equipment for determination of volume over load.…”

Section: Discussioncontrasting

confidence: 99%

“…We also studied correlation between CVP and po2 /fio2 on day 0 of diagnosis of acute kidney injury and after 48 hours and day4 there was negative correlation between CVP and po2/fio2 on day zero, 2 nd day and no correlation on the 4 th day and it was statistically significant. Similarly, Ismail et al, [16] studied role of LUS in determination end point of fluid resuscitation in septic shock cases.it was carried out on 80 cases classified in 2 groups one of them received early directed goal treatment with a target CVP of 8-12mmHg, while the 2 nd received fluids guided by simplified LUS protocol till achieving a scoreof16.exhibited a negative correlation between CVP and ~ 138 ~ hypoxia index (Spearman's r=-0.39, P=0.012). Additionally, Semler et al, [17] , conducted a study to detect effect of Initial CVP on the Outcome of Conservative Vs. Liberal Fluid therapy in ARDS,it was done on 609 patient admitted without shock and subdivided in two groups based on initial measurement of CVP first group when CVP <8cmh2o and second group when CVP >8 cmh 2 o and also compare between conservative and liberal fluid management between the two groups,it was found that patient with low CVP on initial measurement and treated with liberal fluid management had increased incidence of respiratory dysfunction and decrease in po2/fio2 ratio.…”

Section: Discussionmentioning

confidence: 81%

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Value of B lines score on lung ultrasound as a direct measure of respiratory dysfunction and volume overload in critical care patients with acute kidney injury

Shehataa

2023

Int. J. Med. Anesthesiology

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Background: Fluid overload is commonly detected in critically ill cases with AKI and is accompanied by serious outcome. Lung US (LUS) is an efficiently used tool to assess volume noninvasively. We assessed the importance of these measurements in combination, for estimation of the PaO2/FiO2 ratio in critical patients with AKI. The aim of the study: To evaluate the value of B-lines on chest ultrasound in predicting respiratory dysfunction in AKI and to assess the relation between the B lines on chest ultrasound and po2/fio2 ratio in acute kidney injury patients. Patients and methods: This was a prospective observational study in which 40 cases who were presented on admission or developed at any time during ICU stay acute kidney injury determined based on the KDIGO criteria and according to RIFLE classification. Cases were studied at baseline as well as following 48 hrs using lung US, in addition to measuring the arterial blood gases. Results: The PaO2/FiO2 ratio showed negative correlation with the B-lines score, and this correlation was kept even following adjustment. A cut of value of 15 for the B-lines score has a sensetivity of 94% and a specificity of 77.3% in detecting cases with PaO2/ FiO2 of less than 300. Conclusion:It can be concluded that B-lines on chest US can predict volume overload and respiratory dysfunction in cases with AKI.

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Section: Discussioncontrasting

confidence: 99%

Section: Discussionmentioning

confidence: 81%

Value of B lines score on lung ultrasound as a direct measure of respiratory dysfunction and volume overload in critical care patients with acute kidney injury

Shehataa

2023

Int. J. Med. Anesthesiology

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“…A total of 947 participants, of whom 473 were treated with ultrasound-guided fluid resuscitation, were included in the study (Table 1). [20,21,26–35]…”

Section: Resultsmentioning

confidence: 99%

“…A total of 947 participants, of whom 473 were treated with ultrasoundguided fluid resuscitation, were included in the study (Table 1). [20,21,[26][27][28][29][30][31][32][33][34][35] Nine studies reported fluid volume, of which 6 reported 24-hour fluid volume as mean ± SD [26,35] and median with interquartile range, [21,30,32,33] 1 reported 24-hour fluid balance, [29] 1 reported target titration of fluids, [27] and 1 reported 6-hour infusion volumes. [31] Three studies reported the dose of norepinephrine as "μg/kg/h" [26,27] and the maximum dose, [31] 1 reported the duration of norepinephrine, [33] and 1 reported the total dose of norepinephrine over 24 hours.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…[32] The length of stay was expressed as mean ± SD in 2 studies [20,27] and median with interquartile range in 3 studies. [21,26,32] The length of ICU stay was expressed as median with interquartile range in 3 studies, [26,31,33] as the median in 1 study, [29] and as the mean ± SD in 1 study. [27] The length of the free ICU stay was reported in 2 studies.…”

Section: Study Characteristicsmentioning

confidence: 99%

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Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Chen

Xiao

Liu

et al. 2023

Emerg Crit Care Med

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Background: Ultrasound is widely used in critical care for fluid resuscitation in critically ill patients. We conducted a systematic review to assess the relationship between ultrasound-guided fluid resuscitation strategies and usual care in septic shock.Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and registers for randomized controlled trials to evaluate the prognosis of ultrasound-guided fluid resuscitation in patients with septic shock.Results: Twelve randomized controlled studies with 947 participants were included. Ultrasound-guided fluid resuscitation in patients with septic shock was associated with reduced mortality (risk ratio: 0.78; 95% confidence interval [CI]: 0.65 to 0.94; P = 0.007) and 24-hour fluid volume (mean differences [MD]: −1.02; 95% CI: −1.28 to −0.75; P < 0.001), low heterogeneity (I 2 = 29%, I 2 = 0%), and increased dose of norepinephrine (MD: 0.07; 95% CI: 0.02-0.11; P = 0.002) and dobutamine dose (MD: 2.2; 95% CI: 0.35-4.04; P = 0.02), with low heterogeneity (I 2 = 45%, I 2 = 0%). There was no reduction in the risk of dobutamine use (risk ratio: 1.67; 95% CI: 0.52 to 5.36; P = 0.39; I 2 = 0%). Inferior vena cava-related measures reduced the length of hospital stay (MD: −2.91; 95% CI: −5.2 to −0.62; P = 0.01; low heterogeneity, I 2 = 8%) and length of intensive care unit stay (MD: −2.77; 95% CI: −4.51 to −1.02; P = 0.002; low heterogeneity, I 2 = 0%). The use of the passive leg-raising test combined with echocardiography to assess fluid reactivity was superior. Ultrasound-guided fluid resuscitation did not significantly change the length of the free intensive care unit stay (MD: 1.5; 95% CI: −3.81 to 6.81; P = 0.58; I 2 = 0%).Conclusion: Ultrasound-guided fluid resuscitation in patients with septic shock is beneficial, especially when using inferior vena cavarelated measures and the passive leg-raising test combined with echocardiography.

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Role of lung ultrasound in assessment of endpoint of fluid therapy in patients with hypovolemic shock

S.abd-alazeem

Elgazzar²,

Hammad

et al. 2021

Egyptian Journal of Anaesthesia

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Background: Different techniques are employed to assess the endpoint of fluid therapy in hypovolemic patients. Lung ultrasound (US) is increasingly becoming a diagnostic tool in the critical care setting, providing standardized data. The present study aimed to evaluate the role of lung US in comparison to central venous pressure (CVP) in assessment of endpoint of fluid therapy in patients with hypovolemic shock. Patients and methods: Observational cross-sectional study carried in 60 adult patients with hypovolemic shock admitted to the intensive care unit received lactated Ringer's solution. CVP, blood pressure (BP), urine output (UOP), and lung US score were recorded on admission and during the period of resuscitation. Lung US score was correlated with CVP, BP, and UOP and evaluated in assessment of endpoint fluid therapy in comparison to CVP as a gold standard. Results: There was a significant increase in CVP, BP, UOP,and lung US score during fluid resuscitation. Lung US showed a significant positive correlation with CVP, BP, and UOP at different stages of fluid resuscitation. Lung US score showed a sensitivity of 95.7%, specificity of 92.9% with a positive predictive value of 97.8% negative predictive value of 86.7%, and the total accuracy was 95%. Conclusion:Lung US provides a simple noninvasive approach in assessment of endpoint (score ≥16) of fluid therapy in patients with hypovolemic shock with high sensitivity and specificity.

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Determination of end point of fluid resuscitation using simplified lung ultrasound protocol in patients with septic shock

Cited by 4 publications

References 0 publications

Value of B lines score on lung ultrasound as a direct measure of respiratory dysfunction and volume overload in critical care patients with acute kidney injury

Value of B lines score on lung ultrasound as a direct measure of respiratory dysfunction and volume overload in critical care patients with acute kidney injury

Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Role of lung ultrasound in assessment of endpoint of fluid therapy in patients with hypovolemic shock

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