Early exposure to hemodynamic point-of-care ultrasound during pediatric septic shock resuscitation is associated with decreased fluid overload

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Abstract
Objective: Fluid overload (FO) after pediatric septic shock resuscitation increases the risk of secondary organ failure and long-term morbidity. We hypothesized that early hemodynamic point-of-care ultrasound (hPOCUS) use in pediatric septic shock would be associated with decreased FO. Methods: Retrospective, observational study between 2015 and 2018 in a large academic Pediatric Intensive Care Unit (PICU) of children < 18 years receiving ≥ 40 mL/kg of bolus fluids or vasoactive infusion for treatment of septic shock. %FO and severe FO (%FO ≥ 15%) at 72 h after shock onset were compared between children with hPOCUS exposure < 6 h after shock onset and those without. %FO was calculated: [(fluid in – out)/weight on PICU admission]*100. The association between hPOCUS < 6 h after septic shock onset and %FO and severe FO were evaluated. Results: Of 591 children included, 115 (19.4%) had hPOCUS within 6 h. Children with early hPOCUS vs. without had higher PIM-3; median 4.3, IQR 2.9–9.4 vs. 3.2, IQR 0.9–5.7, p = 0.0012. %FO was not significantly different in the early hPOCUS group, median difference -1.6%, 95% CI -3.2 to 0.03, p = 0.06. After controlling for confounders, %FO was significantly lower in the early hPOCUS group, ß-coefficient= -2.76, 95% CI -4.7 to -0.6, p = 0.012. Those with early hPOCUS had lower occurrence of severe FO 11.3% vs. 22.9%, p = 0.006; adjusted OR 0.41, 95% CI 0.22 to 0.76, p = 0.005. Conclusions: Early hPOCUS assessment during septic shock resuscitation was independently associated with decreased FO. Prospective research is needed to optimize hPOCUS use in pediatric septic shock management.
Funding Information
  • The Children's Hospital of Philadelphia Department of Anesthesiology and Critical Care Medicine (The Children's Hospital of Philadelphia Department of Anesthesiology and Critical Care Medicine)

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