Focused cardiac ultrasound in the early resuscitation of severe sepsis and septic shock: a prospective pilot study

Sekiguchi, Hiroshi; Harada, Yoshiteru; Villarraga, Hector R.; Mankad, Sunil; Gajić, Ognjen

doi:10.1007/s00540-017-2312-8

Cited by 27 publications

(20 citation statements)

References 31 publications

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“… 24 Even at the Mayo Clinic, a study showed that the intensivists misjudged the ventricular function in about half of patients with septic shock before echocardiographic examination. 11 More importantly, the echocardiography findings changed the therapeutic plan in nearly one-third of the patients. 11 Because of the small sample size of this study, the differences in the initial fluid intake and fluid balance should be carefully estimated.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have focused on the prognostic value of specific echocardiographic measures in patients with sepsis or their influence on changes in the diagnostic and therapeutic plans; the incidences of such changes ranged from 17% to 67% in the intensive care unit (ICU) setting and even reached about 80% in anesthesia settings. 9 – 11 However, randomized controlled trials are required to confirm whether these changes benefit patient outcomes. In a recent study, focused ultrasonography had little effect on the final outcomes among patients with undifferentiated shock.…”

Section: Introductionmentioning

confidence: 99%

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Effect of focused cardiopulmonary ultrasonography on clinical outcome of septic shock: a randomized study

Wang

et al. 2021

J Int Med Res

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Objective To investigate the effect of focused ultrasonography on clinical outcomes of septic shock. Methods Patients with septic shock were randomized into an integrated cardiopulmonary ultrasonography (ICUS) group and conventional (CON) group. Within 1 hour of admission, the ICUS group underwent ICUS examination for hemodynamic decision-making, while the CON group received standard treatment. The primary endpoint was 28-day mortality after admission. The secondary endpoints were cumulative fluid administration in the first 6, 24, and 72 hours; use of vasoactive drugs; lactate clearance; duration of ventilation; and ICU stay. Results Ninety-four qualified patients were enrolled (ICUS group, 49; CON group, 45). ICUS showed no significant effect on 28-day mortality. Within the initial 6 hours, the ICUS group tended to have a higher fluid balance and fluid intake than the CON group. The duration of vasopressor support was shorter in the ICUS group. There were no differences in the cumulative fluid infusion within 24 or 72 hours, lactate clearance, ICU stay, or duration of ventilation. Conclusions The initially focused ICUS did not affect the clinical outcomes of septic shock, but it tended to be associated with a higher fluid balance within the initial 6 hours and shorter duration of vasopressor support.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Effect of focused cardiopulmonary ultrasonography on clinical outcome of septic shock: a randomized study

Wang

et al. 2021

J Int Med Res

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“…The echocardiographic plane of the IVC is easily obtained at the bedside and is less dependent on image quality than other echocardiographic imaging parameters. With an increasing number of ICU physicians being trained in focused cardiac ultrasound examination, IVC variation are used increasingly often in the management of critically ill patients [37–39]. Nonetheless, for ILVD patients, if fluid was administered according to the value of dIVC, the chance of a stroke volume increase would very slim.…”

Section: Discussionmentioning

confidence: 99%

Respiratory variations of inferior vena cava fail to predict fluid responsiveness in mechanically ventilated patients with isolated left ventricular dysfunction

Zhang

Chen

et al. 2019

Ann. Intensive Care

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Background: Respiratory variation of inferior vena cava is problematic in predicting fluid responsiveness in patients with right ventricular dysfunction. However, its effectiveness in patients with isolated left ventricular systolic dysfunction (ILVD) has not been reported. We aimed to explore whether inferior vena cava diameter distensibility index (dIVC) can predict fluid responsiveness in mechanically ventilated ILVD patients. Methods: Patients admitted to the intensive care unit who were on controlled mechanical ventilation and in need of a fluid responsiveness assessment were screened for enrolment. Several echocardiographic parameters, including dIVC, tricuspid annular plane systolic excursion (TAPSE), left ventricular ejection fraction (LVEF), and LV outflow tract velocity-time integral (VTI) before and after passive leg raising (PLR) were collected. Patients with LV systolic dysfunction only (TAPSE ≥ 16 mm, LVEF < 50%) were considered to have isolated left ventricular systolic dysfunction (ILVD). Results: One hundred and twenty-nine subjects were enrolled in this study, among them, 28 were labelled ILVD patients, and the remaining 101 were patients with normal LV function (NLVF). The value of dIVC in ILVD patients was as high as that in NLVF patients, (20% vs. 16%, p = 0.211). The ILVD group contained a much lower proportion of PLR responders than NLVF patients did (17.9% vs. 53.2%, p < 0.001). No correlation was detected between dIVC and ΔVTI in ILVD patients (r = 0.196, p = 0.309). dIVC was correlated with ΔVTI in NLVF patients (r = 0.722, p < 0.001), and the correlation was strengthened compared with that derived from all patients (p = 0.020). A receiver-operating characteristic (ROC) analysis showed that the area-under-the-curve (AUC) of dIVC for determining fluid responsiveness from ILVD patients was not statistically significant (p = 0.251). In NLVF patients, ROC analysis revealed an AUC of 0.918 (95% CI 0.858-0.978; p < 0.001), which was higher than the AUC derived from all patients (p = 0.033). Patients with LVEF below 40% had a lower ΔVTI and fewer PLR responders than those with LVEF 40-50% and LVEF above 50% (p < 0.001). Conclusion: dIVC should be used with caution when critically ill patients on controlled mechanical ventilation display normal right ventricular function in combination with abnormal left ventricular systolic function.

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“…Current research is exploring the potential benefits from lower fluid volumes and earlier institution of vasopressor support . Focussed ultrasound can assist in identification of a static dilated inferior vena cava or cardiac dysfunction, where early institution of inotropic support may be beneficial . Where ultrasound is not available, response of BP to bilateral passive leg raising may be assessed .…”

Section: Managementmentioning

confidence: 99%

“…44 Focussed ultrasound can assist in identification of a static dilated inferior vena cava or cardiac dysfunction, where early institution of inotropic support may be beneficial. 16,45 Where ultrasound is not available, response of BP to bilateral passive leg raising may be assessed. 43 In practice, we currently recommend judicious use of fluid boluses titrated to clinically appropriate end points.…”

Section: Fluid Resuscitation and Vasopressorsmentioning

confidence: 99%

Sepsis in the older person: The ravages of time and bacteria

Burkett

Macdonald

Carpenter

et al. 2018

Emerg Medicine Australasia

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Focused cardiac ultrasound in the early resuscitation of severe sepsis and septic shock: a prospective pilot study

Abstract: FCU is a valuable examination tool during early resuscitation of severe sepsis and septic shock.

Cited by 27 publications

References 31 publications

Effect of focused cardiopulmonary ultrasonography on clinical outcome of septic shock: a randomized study

Effect of focused cardiopulmonary ultrasonography on clinical outcome of septic shock: a randomized study

Respiratory variations of inferior vena cava fail to predict fluid responsiveness in mechanically ventilated patients with isolated left ventricular dysfunction

Sepsis in the older person: The ravages of time and bacteria

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