Rule of RUSH protocol in management of shocked patients

Abstract

Background: RUSH is an easily learned and quickly performed shock ultrasound protocol, it allows for rapid evaluation of reversible causes of shock and improves accurate diagnosis in undifferentiated hypotension. Objectives: To evaluated the accuracy of early RUSH protocol performed by chest physicians to predict type of shock and its guide of resuscitation in critically ill patients . Patients and Methods: Study was conducted on 68 patients with shock state in RICU and evaluated for the cause of shock by performing early RUSH protocol for patients. Patients received all needed standard therapeutic and diagnostic interventions without delay and were followed to document their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index Sensitivity, specificity, PPV and NPV of RUSH for diagnosis of each case. Results: We performed RUSH on 68 patients. Kappa index was 0.85 (P= 0.0001), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97% yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 97% & 100% but it had low sensitivity. The agreement of protocol for cardiogenic and hypovolemic shock was (84%), (73%) respectively. The agreement of protocol for cardiogenic and hypovolemic shock was (84%), (73%) respectively. Conclusion: We highlight the role of integrating focused ultrasound techniques, such as the RUSH exam, in the physician resuscitation pathways to diagnose shock etiology, augment their clinical evaluation and guide resuscitation.