Clinical Value Of Bedside Ultrasound In Early Fluid Resuscitation

Objective:To compare the effects of bedside ultrasound and pulse wave indicator continuous cardiac output（PICCO）on early fluid resuscitation in septic shock patients.Methods:From December 2018 to May 2020,a total of 30 patients with septic shock who were diagnosed and treated in the emergency ICU of the Second Affiliated Hospital of the Nanchang University were randomly divided into ultrasound group and PICCO Group with 15 patients in each group,the Central venous pressure,mean arterial pressure（MAP）,Oxygenation Index,lactate,acute physiological and chronic health score（Aphache II）,and sequential organ failure score（Sofa）were recorded at admission.In the ultrasound group,the presence of pulmonary interstitial syndrome was used as a marker for stopping fluid replacement,in PICCO Group,extravascular lung water index（EVLWI）was more than 7 ml/kg,otherwise,fluid resuscitation was performed.In PICCO Group,the stroke volume was measured by transthoracic echocardiography after passive leg-lifting test and calculated by aortic velocity time integral method.In PICCO Group,the stroke volume was measured by PICCO monitoring module after passive leg-lifting test and calculated by PICCO.The volume response was judged by the variability rate of stroke volume（SV）over 10%,and the patients were treated with rehydration therapy.Three times of passive leg-raising test were performed daily within 3 days after admission.The changes of SV were recorded.The 28-day mortality,ICU stay time and the time of mechanical ventilation caused by pulmonary edema were used as the main indexes.The CVP,MAP,Oxygenation Index,lactate value,rehydration volume and urine volume were the secondary indexes after 6 and 12 hours of treatment.Results:There was no significant difference between the Stroke volume measured by bedside ultrasound and the Stroke volume measured by PICCO（p>0.05）,and there was significant positive correlation（r2=0.983）.The mortality of PICCO Group and ultrasound group was 26.7%and 13%,respectively,and there was no significant difference between the two groups（χ²=0.833,p=0.651）.The duration of stay in ICU of PICCO Group and ultrasound group was 12.43±2.57 days,respectively,13.39±2.85 days,there was no significant difference between the two groups（t=1.193,p=0.253）,and the total duration of mechanical ventilation in PICCO group（157.78±50.65hours）was significantly longer than that in ultrasound group（105±29.09hours）.There was significant difference between the two groups（t=5.154,p<0.001）Secondary Indexes:CVP,MAP,Oxygenation Index and lactic acid value had no significant difference between the two groups within 6 hours of fluid infusion（p>0.05）,the volume of fluid infusion in ultrasound group（1119.74±125.7ml）was less than that in PICCO group（1502.04±126.34ml）,and the volume of urine（244±32.36ml）was more than that in PICCO group（121.65±32.77ml）,CVP（9.22±2.39cm H2O）was significantly lower than PICCO group（10.83±1.87cm H₂O）at 12h（p<0.05）,and the Oxygenation Index was significantly higher at 12h than at 6h（p=0.417）.Conclusion:There is a good agreement between bedside ultrasound and PICCO in the measurement of stroke volume.Comparison with the rehydration group under the guidance of PICCO,bedside ultrasound cannot change the mortality and the length of ICU stay in patients with septic shock during early fluid resuscitation,but it can reduce the time of mechanical ventilation caused by pulmonary edema.