Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis: A Pilot Study

Abstract

Background

It is challenging to identify emergency department (ED) patients with sepsis who will require resources such as positive-pressure ventilation, vasopressors, or intensive care unit (ICU) admission.

Objectives

Describe the correlation of cardiopulmonary ultrasound (CPUS) with need for care escalation.

Methods

Single center, prospective, observational study of adult patients with suspected sepsis. CPUS assessed left ventricular systolic function (LVF), right ventricular (RV) size and function, inferior vena cava (IVC) collapsibility, and thoracic B lines. The primary composite outcome was need for care escalation within 12 hours of ED presentation defined as: ICU admission or positive-pressure ventilation or vasopressor infusion.

Results

A total of 92 patients were enrolled; 18 (19.6%) required care escalation. A logistic regression model identified the presence of ≥4 thoracic B-lines as a statistically significant predictor of care escalation (OR 7.8, 95% CI [1.3–26.4], p = 0.002). Other features positively correlated with care escalation were: reduced LVF (OR 4.26, 95% CI [0.06–12.9], p = 0.14), and dilated RV size (OR 2.8, 95% CI [0.4–11.8], p = 0.16). A retrospective stepwise regression model incorporating these three variables to predict care escalation showed an AUROC = 0.75 (95% CI [0.63–0.88]). When 2 or more variables were abnormal the model showed excellent specificity of 95% (LR+ 6.2), but low sensitivity of 33% (LR- 0.7).

Conclusions

In patients with concern for sepsis early findings of ≥4 B-lines is associated with care escalation. Combining this finding with LVF and RV size assessment improves the positive predictive power and may be useful in rapid identification of patients likely to require care escalation.