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

Abstract

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.

Keywords: Focused ultrasonography; clinical outcome; early goal-directed therapy; hemodynamic monitoring; septic shock; severe sepsis.

Figure 1.

Flow diagram of study.

Figure 2.

Comparison of 28-day mortality with Kaplan–Meier estimate (p = 0.58).

Figure 3.

Comparison of cumulative volume intake and balance over time. *p < 0.05. At 24 and 72 hours, the data for patients who were dead or had been discharged from the hospital before that were analyzed as missing.