Critical Care: Critical Care |

Using Point-of-Care Bedside Ultrasound for Volume Assessment in Early Shock: An Outcome Study FREE TO VIEW

Daniel Mitchell, DO; Aaron Leng; Stuart Gardiner, PhD; Laura Vanderwerff, MD; Steven Jones, MD; Dennis Thompson, RPh; Poh Leng, MD
Author and Funding Information

Legacy Medical Center, Portland, OR

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A148. doi:10.1016/j.chest.2016.02.154
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SESSION TITLE: Critical Care

SESSION TYPE: Original Investigation Slide

PRESENTED ON: Sunday, April 17, 2016 at 02:15 PM - 03:45 PM

PURPOSE: Utilizing point-of-care bedside ultrasound (POCUS) to evaluate intravascular volume status in early shock in a controlled retrospective cohort study. Outcomes measured: 1) Time to vasopressor wean (50 % reduction in dose of vasopressors), 2) Time to discontinuation of vasopressors, 3) Days on ventilator, 4) Length of stay in ICU.

METHODS: POCUS and control patients were matched utilizing SOFA scores on admission to the ICU. 45 patients (22 in the POCUS arm, 23 in the control arm) were studied over an 8 month period. Using Sonosite, the respiratory variations in inferior vena cava (IVC) diameter and change in LVOT velocity-time integrals (VTI) were calculated before and after straight leg raising. Cutoff values of 18% for IVC variation for patients on mechanical ventilation and 12% for VTI change after staight-leg raise were used to predict if a patient would be responsive to volume resuscitation. If the pateint was predicted to be volume responsive, fluids were administered. If the patient was not predicted to be fluid responsive, pressors were preferred.

RESULTS: Total hours on vasopressors: Treatment = 36.43 Control = 58.57 P=0.0308. Hazard ratio = 2.109, 95% confidence interval (1.072, 4.150) Hours to 50% wean of vasopressors: Treatment = 22.24 Control = 40.66 P=0.0952. Hazard ratio = 1.8040, 95% confidence interval (0.902, 3.608) Total hours on ventilator: Treatment = 68.3 Control = 133.67 P=0.283. Hazard ratio = 1.4157, 95% confidence interval (0.7508, 2.669) Days in ICU: Treatment = 4.41 Control = 6.74 P=0.200. Hazard ratio = 1.513, 95% confidence interval (0.8037, 2.848)

CONCLUSIONS: The POCUS treatment group had significantly less total time on vasoactive agents, and a trend towards improved outcomes in all other measured end-points when compared with the control group. These trends persisted despite the POCUS group having higher SOFA scores.

CLINICAL IMPLICATIONS: Patients in early shock evaluated with POCUS spent less time on pressors, and showed trends towards fewer days on mechanical ventilation and time in the ICU. The decreased morbidity and calculated cost savings from these results, about $20,000 per patient, could be very significant.

DISCLOSURE: The following authors have nothing to disclose: Daniel Mitchell, Aaron Leng, Stuart Gardiner, Laura Vanderwerff, Steven Jones, Dennis Thompson, Poh Leng

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