Hemodynamics in Shock Patients Assessed by Critical Care Ultrasound and Its Relationship to Outcome: A Prospective Study

Tongjuan Zou, Wanhong Yin, Yi Li, Lijing Deng, Ran Zhou, Xiaoting Wang, Yangong Chao, Lina Zhang, Yan Kang, Chinese Critical Ultrasound Study Group (CCUSG), Tongjuan Zou, Wanhong Yin, Yi Li, Lijing Deng, Ran Zhou, Xiaoting Wang, Yangong Chao, Lina Zhang, Yan Kang, Chinese Critical Ultrasound Study Group (CCUSG)

Abstract

Background: Shock is one of the causes of mortality in the intensive care unit (ICU). Traditionally, hemodynamics related to shock have been monitored by broad-spectrum devices with treatment guided by many inaccurate variables to describe the pathophysiological changes. Critical care ultrasound (CCUS) has been widely advocated as a preferred tool to monitor shock patients. The purpose of this study was to analyze and broaden current knowledge of the characteristics of ultrasonic hemodynamic pattern and investigate their relationship to outcome.

Methods: This prospective study of shock patients in CCUS was conducted in 181 adult patients between April 2016 and June 2017 in the Department of Intensive Care Unit of West China Hospital. CCUS was performed within the initial 6 hours after shock patients were enrolled. The demographic and clinical characteristics, ultrasonic pattern of hemodynamics, and outcome were recorded. A stepwise bivariate logistic regression model was established to identify the correlation between ultrasonic variables and the 28-day mortality.

Results: A total of 181 patients with shock were included in our study (male/female: 113/68). The mean age was 58.2 ± 18.0 years; the mean Acute Physiology and Chronic Health Evaluation II (APACHE II score) was 23.7 ± 8.7, and the 28-day mortality was 44.8% (81/181). The details of ultrasonic pattern were well represented, and the multivariate analysis revealed that mitral annular plane systolic excursion (MAPSE), mitral annular peak systolic velocity (S'-MV), tricuspid annular plane systolic excursion (TAPSE), and lung ultrasound score (LUSS) were the independent risk factors for 28-day mortality in our study, as well as APACHE II score, PaO2/FiO2, and lactate (p = 0.047, 0.041, 0.022, 0.002, 0.027, 0.028, and 0.01, respectively).

Conclusions: CCUS exam on admission provided valuable information to describe the pathophysiological changes of shock patients and the mechanism of shock. Several critical variables obtained by CCUS were related to outcome, hence deserving more attention in clinical decision-making. Trial Registration. The study was approved by the Ethics Committee of West China Hospital Review Board for human research with the following reference number 201736 and was registered on ClinicalTrials. This trial is registered with NCT03082326 on 3 March 2017 (retrospectively registered).

Conflict of interest statement

The authors declare that they have no competing interests.

Copyright © 2020 Tongjuan Zou et al.

Figures

Figure 1
Figure 1
Five standard views used in critical care ultrasonography (CCUS). Subxiphoid long-axis (SLAX) view (a), subxiphoid inferior vena cava (SIVC) view (b), parasternal long-axis (PLAX) view (c), parasternal short-axis (PSAX) view (d), and apical four-chamber (A4CH) view (e).
Figure 2
Figure 2
Eight-zone lung ultrasound examination protocol and lung ultrasound pattern. (a) Each hemithorax is separated into four quadrants: anterior, lateral zones (separated by the anterior axillary lines) each divided into upper and lower portions. AAL indicates anterior axillary line. (b) Lung ultrasound pattern: (A) A pattern; (B) B1 pattern; (C) B2 pattern; (D) C pattern (lung consolidation) [52].
Figure 3
Figure 3
Completion rate and findings of cardiac structure and pericardial effusion in shock patients. Abbreviations: LV: left ventricle; RV: right ventricle; IVS: interventricular septum.
Figure 4
Figure 4
Completion rate and findings of cardiac function, volume status, and lung ultrasound on shock patients. Abbreviations: LV: left ventricle; RV: right ventricle; LA: left atrium.
Figure 5
Figure 5
Completion rate and findings of lung ultrasound examination on shock patients.

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