Effectiveness of Bedside Sonography by Residents for Fluid Management by Inferior Vena Cava Assessment

Abstract

Objective: To study the utility of point of care ultrasound (POCUS) in the diagnosis and management of shock when performed by medicine residents. Methods: A retrospective, case-control study was carried out in the medical intensive care unit at a tertiary care hospital. Consecutive patients who had received bolus fluid for hypotension during the hospital stay were screened from the case sheets and recorded. Results: A total of 57 patients were recruited into the study. Baseline parameters were comparable in both groups. The median amount of fluid given by the physician was 1000 milliliters (500, 1500) in the inferior vena cava (IVC) group as compared with 1000 milliliters (500, 1000) in the clinical group which was similar between the groups ( P = .51). The median quantity of fluid received in the first hour in the IVC group (500 milliliters; 75, 750) was significantly higher than in the clinical group (100 milliliters; 100, 125) ( z = 2.98; P = .003). More improvement in heart rate ( P = .0004), mean arterial pressure (MAP; P = .04), and Acute Physiology and Chronic Health Evaluation (APACHE; P = .0004) score was seen in the IVC group which was statistically significant. Conclusion: In this cohort, there was a significant increase in MAP, reduction in the APACHE II score, and heart rate in the IVC group when compared with the clinical group.