title: Limited echocardiography-guided therapy in subacute shock is associated with change in management and improved outcomes.
abstract: OBJECTIVE
  The purpose of the study was to compare the effect of limited echocardiography (LE)-guided therapy to standard management on 28-day mortality, intravenous fluid prescription, and inotropic dosing following early resuscitation for shock.
  
  
  METHODS
  Two hundred twenty critically ill patients with undifferentiated shock from a quaternary intensive care unit were included in the study. The LE group consisted of 110 consecutive patients prospectively studied over a 12-month period receiving LE-guided management. The standard management group consisted of 110 consecutive patients retrospectively studied with shock immediately prior to the LE intervention.
  
  
  RESULTS
  In the LE group, fluid restriction was recommended in 71 (65%) patients and initiation of dobutamine in 27 (25%). Fluid prescription during the first 24 hours was significantly lower in LE patients (49 [33-74] vs 66 [42-100] mL/kg, P = .01), whereas 55% more LE patients received dobutamine (22% vs 12%, P = .01). The LE patients had improved 28-day survival (66% vs 56%, P = .04), a reduction in stage 3 acute kidney injury (20% vs 39%), and more days alive and free of renal support (28 [9.7-28] vs 25 [5-28], P = .04).
  
  
  CONCLUSIONS
  Limited echocardiography-guided management following early resuscitation is associated with improved survival, less fluid, and increased inotropic prescription. A prospective randomized control trial is required to verify these results.
authors.affiliation: Department of Critical Care Medicine, University of British Columbia; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Hussein D
authors.initials: HD
authors.lastname: Kanji
authors.affiliation: Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Jessica
authors.initials: J
authors.lastname: McCallum
authors.affiliation: Critical Care Research Laboratories, Centre for Heart Lung Innovation at St. Paul's Hospital University of British Columbia, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, University of British Columbia.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Sirounis
authors.affiliation: Critical Care Research Laboratories, Centre for Heart Lung Innovation at St. Paul's Hospital University of British Columbia, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, University of British Columbia.
authors.forename: Ruth
authors.initials: R
authors.lastname: MacRedmond
authors.affiliation: Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada.
authors.forename: Robert
authors.initials: R
authors.lastname: Moss
authors.affiliation: Critical Care Research Laboratories, Centre for Heart Lung Innovation at St. Paul's Hospital University of British Columbia, Vancouver, British Columbia, Canada; Department of Critical Care Medicine, University of British Columbia; Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: John.Boyd@hli.ubc.ca.
authors.forename: John H
authors.initials: JH
authors.lastname: Boyd
mesh_terms: D058186:Acute Kidney Injury / Q000401:mortality / Q000517:prevention & control; D000368:Aged; D000704:Analysis of Variance; D002316:Cardiotonic Agents / Q000008:administration & dosage*; D016638:Critical Illness / Q000628:therapy; D004280:Dobutamine / Q000008:administration & dosage*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D005260:Female; D005440:Fluid Therapy / Q000379:methods*; D006801:Humans; D007362:Intensive Care Units; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods; D012189:Retrospective Studies; D012769:Shock / Q000401:mortality / Q000628:therapy*; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D002316:Cardiotonic Agents; D004280:Dobutamine
keywords: Echocardiography; Point-of-care ultrasound; Resuscitation; Shock