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

Abstract

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. 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. 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. 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.