1034: DOES POCUS AFFECT FLUID RESUSCITATION IN SEPTIC SHOCK? A RETROSPECTIVE OBSERVATIONAL STUDY

Abstract

Introduction: Point of care ultrasound (POCUS) may guide intravenous fluids (IVF) resuscitation in septic shock to prevent inadvertent hypovolemia and death. The primary study objective is to determine if total IVF volume differs for Emergency Department (ED) septic shock patients receiving POCUS vs. no POCUS. Secondary objectives included new oxygen requirement and overall mortality. Methods: We conducted a retrospective observational cohort study from 7/1/2018 – 8/31/2021 of atraumatic adult patients who presented to the ED septic shock. We agreed upon a priori outcome variables and defined septic shock as lactate ≥4 and hypotension (SBP < 90 or MAP < 65). A sample size of 300 patients would provide 85% power to detect an IVF difference of 500 mls between POCUS and non-POCUS cohorts. Data is reported as frequencies, median(IQR) and associations from bivariate logistic models. Results: A total of 304 patients met criteria and 26% (78/304) used cardiopulmonary POCUS. There were no statistical differences between POCUS vs. non-POCUS cohorts for: age, race, gender or co-morbidities. History of CHF and severe renal disease was present in 42% of POCUS group and 29% of non-POCUS group. The POCUS vs. non-POCUS cohorts had statistically significant differences for the following variables: higher median lactate (6.7 [IQR 5.2-8.7] vs. 5.6 [IQR 4.7-7.4], p=0.003), lower systolic blood pressure (77.5 (IQR 61-86] vs. 85.0 (IQR 73-95), p< 0.001), more vasopressor use (51% vs. 34%, p=0.006), and more positive pressure ventilation (38% vs. 24%, p=0.017). However, there were no statistical significance in patient outcomes between POCUS and non-POCUS cohorts including total IVF volume ml/kg (33.02 vs. 32.1, p= 0.47), new oxygen requirement (68% [53/78) vs. 59% [133/226], p=.16), ED death (3% vs. 4%, p=0.15), or hospital death (31% vs. 27%, p=0.48). Similar distributions of lactate, total fluids, and vasopressors were found in CHF and severe renal disease subsets. Conclusions: POCUS was more likely to be used in ED septic patients with higher lactate, lower blood pressure, vasopressor use, and in those requiring mechanical ventilation. There were no differences in total IVF received, new oxygen requirement, and mortality in the POCUS group compared to non-POCUS group.