Ultrasound-Guided Fluid Volume Management in Patients With Septic Shock: A Randomized Controlled Trial.

Abstract

Background: Ultrasound-guided fluid management is increasingly used in the intensive care unit, yet it's benefits in septic shock remains unknown.

Objective: To evaluate the use of critical care ultrasound for individualized volume management in septic shock patients.

Methods: A single-center, randomized controlled, prospective study was conducted on patients with septic shock admitted to the intensive care unit in Xi'an Daxing Hospital, Xi'an City, China, from September 2022 to December 2023. Upon intensive care unit admission, the patients were resuscitated according to the latest sepsis and septic shock guidelines and early goal-directed therapy. The study group additionally underwent critical care ultrasound examination to monitor and guide the adjustment of fluid resuscitation in real-time. The two groups' physiological and biochemical indexes and prognoses were compared before (T0) and 6 hours after (T6) fluid resuscitation.

Results: A total of 113 patients with septic shock were selected and randomly allocated into study (n = 57) and control (n = 56) groups. The central venous oxygen saturation, heart rate, mean arterial pressure, blood lactate, and lactate clearance rate of the two groups at T6 were significantly improved compared to T0 (P < .05). At T6, the study group's blood lactate was significantly lower and the lactate clearance was significantly higher than the control group (P < .05). At T6, the incidence of pulmonary edema, incidence of left heart failure, Sequential Organ Failure Assessment (SOFA) score and length of the intensive care unit hospitalization in the study group were significantly lower than the control group (P < .05).

Conclusion: The application of critical care ultrasound improved the outcome and helped guide individualized management of patients with septic shock.