Clinical application of bedside ultrasound measurement of inferior vena cava diameter combined with lung ultrasound in fluid resuscitation of children with septic shock
Objective To investigate the clinical value of bedside ultrasound in fluid resusciation of children with septic shock.Methods Fifty children diagnosed with septic shock in the First Department of Critical Medicine,Hebei Children's Hospital Affiliated to Hebei Medical University from December 2021 to January 2023 were recruited.They were assigned into the routine group and the ultrasound group by random number table method,with 25 cases in each group.After admission,all children were given symptomatic treatment like anti-infection and respiratory support.Children in both groups were given an initial fluid resuscitation(20mL/kg sodium acetate Ringer's injection).After initial fluid resusciation,children in the routine group were continuously managed by fluid resuscitation according to the guideline,with the early goal-directed therapy for 6h,and those in the ultrasound group were managed by fluid resuscitation guided by the ultrasound examination of inferior vena cava diameter and lung ultrasound examination.Heart rate at 6h and 12h after fluid resuscitation,mean arterial pressure(MAP)and systemic central venous oxygen saturation(ScvO2)were compared between the two groups.Total fluid intake at 24h and vascular drug scores,oxygenation index at 12h,24h and 48h after fluid resuscitation,case number of pulmonary edema and 28-day mortality were also compared between the two groups.Results There were no significant differences in the heart rate,MAP and ScvO2 at 6h and 12h of fluid resuscitation between the two groups(P>0.05).Total fluid intake at 24h in the ultrasound group was significantly lower than that of the routine group(P<0.05).The score of vasoactive drugs at 24h was lower in the ultrasound group than that of the routine group,although a significant difference was not detectable(P>0.05).At 12h of liquid resuscitation,the oxygenation index in the ultrasound group was higher than that of the routine group,although a significant difference was not detectable(P>0.05).The oxygenation indexes at 24h and 48h of liquid resuscitation in the ultrasound group were significantly higher than those of the routine group(P<0.05).The case number of pulmonary edema during liquid resuscitation in the ultrasound group was significantly less than that of the routine group(P<0.05).There was no significant difference in the 28-day mortality between groups(P>0.05).Conclusion Bedside ultrasound measurement of inferior vena cava diameter combined with lung ultrasound can guide fluid management of septic shock in children,reduce fluid intake and risk of pulmonary edema,optimize volume status,and improve hemodynamic indicators.The non-invasive ultrasonography is more suitable for children and widely applied in pediatric clinic.
bedside ultrasoundinferior vena cava diameterlung ultrasoundseptic shock in childrenfluid resuscitation
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