RULE OF RUSH PROTOCOL IN MANAGEMENT OF SHOCKED PATIENTS

Abstract

SESSION TITLE: Wednesday Abstract Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/23/2019 09:45 AM - 10:45 AM PURPOSE: Background: Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients. Rapid Ultrasound in Shock (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. 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, positive predictive value PPV and negative predictive value NPV of RUSH for diagnosis of each case. RESULTS: We performed RUSH examination on 68 shocked patients. 39 were males (58%) and 29 were females (41%), with mean age 58 years. 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%, but it had low sensitivity. For shock with distributive or mixed etiology, RUSH showed a PPV of {97% & 100%} respectively, with high sensitivity. The agreement of protocol for final diagnosis was highest in distributive and obstructive shock followed by cardiogenic and hypovolemic shock [(94% & 93%), P < 0.001 & (84% & 73%), P < 0.001,] respectively. CONCLUSIONS: We highlight the role of integrating focused ultrasound techniques, such as the RUSH examination, in the physician resuscitation pathways to diagnose shock etiology, augment their clinical evaluation and guide resuscitation CLINICAL IMPLICATIONS: Early identification of causes of shock in critically ill patients allow good clinical evaluation and guide resuscitation and help physician to used correct treatment. DISCLOSURES: no disclosure on file for Esrra Abdei-All; no disclosure on file for Gamal Agamy; no disclosure on file for AzzA Ahmad; No relevant relationships by Hamdy Mohammadien, source=Web Response