Role of Point of Care Ultra Sound (POCUS) in Assessment of Fluid Resuscitation in Septic Patients
Sohier Fouad
Emergency Medicine and Traumatology Department, Faculty of Medicine, Tanta University, Egypt.
Nagat Elshamaa
Anesthesia, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Egypt.
Ghada El-Baradey
Anesthesia, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Egypt.
Hala Elgendy
Anesthesia, Surgical Intensive Care and Pain Management Department, Faculty of Medicine, Tanta University, Egypt.
*Author to whom correspondence should be addressed.
Abstract
Background: Initial fluid resuscitation in sepsis must be guided by clinical judgment based on ongoing reevaluation of the hemodynamic status (heart rate, blood pressure, arterial oxygen saturation, respiratory rate, temperature, urine output) and ultrasound measurements (stroke volume, cardiac output, lung ultrasound and inferior vena cava diameter) as positive fluid balance is harmful.
Methods: Adults Patients (≥ 18 years old) with symptoms or signs of tissue hypoperfusion (Sequential organ failure assessment score SOFA≥ 2) are included. Patients with elevated intra-abdominal pressure (as, ascites, pregnancy), Recent abdominal operation, cannot lie flat, Patient on mechanical ventilation and patients with valvular heart disease were excluded. IVC CI, SV, COP and B mean score were measured on patient arrival and after every 10 ml/kg isotonic saline over the first hour of patient arrival. Thereafter, patients were divided into two groups high caval index and low caval index according to inferior vena cava collapsibility index.
Results: Among our 50 patients,38% of patients were with high caval index and 62% have low caval index.
Conclusion: POCUS has additive value in guiding of fluid resuscitation in sepsis in order to avoid fluid overload and to identify proper timing of vasopressor use.
Keywords: Point of care ultra sound, fluid resuscitation, sepsis, vasopressor