title: Focused cardiac ultrasound in the early resuscitation of severe sepsis and septic shock: a prospective pilot study.
abstract: OBJECTIVE
  Point-of-care ultrasonography has been increasingly used in the care of critically ill patients; however, reports on its use during active resuscitation are limited. The aim of this study was to investigate the true impact of focused cardiac ultrasound (FCU) during the management of sepsis with early (6-h) resuscitation.
  
  
  METHODS
  A prospective pilot observational study was conducted at an academic medical center from March 2011 through July 2012. Patients undergoing resuscitation for severe sepsis or septic shock were prospectively enrolled at medical and combined medical-surgical intensive care units. Patients underwent a 10-min FCU examination when echocardiography was not part of their care plan. FCU was performed by sonographers and interpreted by cardiologists to minimize risks of inadequate image acquisition and misinterpretation. Intensivists completed surveys on their diagnostic and therapeutic plans before and after receiving FCU information.
  
  
  RESULTS
  Of the 30 patients enrolled, 18 (60%) were male and the median age was 61 years [interquartile range (IQR) 50-71 years]. Median central venous oxygen saturation and lactate levels were 59.6% (IQR 53.1-66.2%) and 2.7 mmol/L (IQR 1.2-4.1 mmol/L), respectively. Clinical assessment by intensivists before FCU commonly failed to correctly estimate ventricular function; specifically, left ventricular in 12 patients [40%, 95% confidence interval (CI) 25-58%] and right ventricular function in 15 patients (50%, 95% CI 33-67%). Intensivists' therapeutic plans changed in eight cases (27%, 95% CI 14-44%) after FCU information became available. The most common changes were fluid management and imaging tests. Intensivists' confidence in their therapeutic plans improved for 11 patients (37%, 95% CI 22-55%).
  
  
  CONCLUSIONS
  FCU is a valuable examination tool during early resuscitation of severe sepsis and septic shock.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA. sekiguchi.hiroshi@mayo.edu.
authors.forename: Hiroshi
authors.identifier: http://orcid.org/0000-0001-9409-1617
authors.initials: H
authors.lastname: Sekiguchi
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Yohei
authors.initials: Y
authors.lastname: Harada
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Hector R
authors.initials: HR
authors.lastname: Villarraga
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
authors.forename: Sunil V
authors.initials: SV
authors.lastname: Mankad
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
authors.forename: Ognjen
authors.initials: O
authors.lastname: Gajic
mesh_terms: D000368:Aged; D016638:Critical Illness; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D012151:Resuscitation / Q000379:methods*; D018805:Sepsis / Q000175:diagnosis / Q000000981:diagnostic imaging*; D012772:Shock, Septic / Q000000981:diagnostic imaging*
keywords: Critical care; Critical illness; Echocardiography; Point-of-care testing; Sepsis; Shock; Ultrasonography