Integrated Multiorgan Bedside Ultrasound for the Diagnosis and Management of Sepsis and Septic Shock

2021 ◽  
Vol 42 (05) ◽  
pp. 641-649
Author(s):  
Daniel A. Sweeney ◽  
Brandon M. Wiley
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Bedside Ultrasound ◽  
Multiple Point ◽  
Point Of Care Ultrasound ◽  
Suspected Sepsis ◽  
Source Of Infection ◽  
Organ Systems ◽  
Sepsis And Septic Shock ◽  
Delays In Diagnosis

AbstractDespite decades of research, the mortality rate of sepsis and septic shock remains unacceptably high. Delays in diagnosis, identification of an infectious source, and the challenge of providing patient-tailored resuscitation measures routinely result in suboptimal patient outcomes. Bedside ultrasound improves a clinician's ability to both diagnose and manage the patient with sepsis. Indeed, multiple point-of-care ultrasound (POCUS) protocols have been developed to evaluate and treat various subsets of critically ill patients. These protocols mostly target patients with undifferentiated shock and have been shown to improve clinical outcomes. Other studies have shown that POCUS can improve a clinician's ability to identify a source of infection. Once a diagnosis of septic shock has been made, serial POCUS exams can be used to continuously guide resuscitative efforts. In this review, we advocate that the patient with suspected sepsis or septic shock undergo a comprehensive POCUS exam in which sonographic information across organ systems is synthesized and used in conjunction with traditional data gleaned from the patient's history, physical exam, and laboratory studies. This harmonization of information will hasten an accurate diagnosis and assist with hemodynamic management.

scholarly journals Shedding light on a hidden source of septic shock with POCUS

POCUS Journal ◽  
2019 ◽  
Vol 4 (2) ◽  
pp. 15-16
Author(s):  
Miguel Lourenço Varela, MD ◽  
Rita Martins Fernandes, MD ◽  
Maria Luísa Melão, MD ◽  
Javier Moreno, MD ◽  
Cristina Granja, MD, PhD
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Unstable Condition ◽  
X Ray ◽  
Source Of Infection ◽  
Time To Diagnosis ◽  
Portable Chest ◽  
Chest X Ray ◽  
Tentative Diagnosis

A 77-year old male was admitted in the emergency department for septic shock, yet no clear source of infection was noted upon physical examination and a portable chest x-ray. Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted, hence a tentative diagnosis of liver abscess was made. This was latter confirmed by abdominal computed tomography. This case highlights that point-of-care ultrasound, when performed by expert physicians, can significantly decrease time to diagnosis for septic patients. 

512 Bedside Transthoracic echography volume Assessment in the BICU

2021 ◽  
Vol 42 (Supplement_1) ◽  
pp. S103-S103
Author(s):  
Michael G Chambers ◽  
Britton Garrett ◽  
Leopoldo C Cancio
Keyword(s):  
Point Of Care ◽  
Injured Patient ◽  
Bedside Ultrasound ◽  
Point Of Care Ultrasound ◽  
Ultrasound Images ◽  
Advanced Practice ◽  
Multidisciplinary Rounds ◽  
Volume Assessment ◽  
Us Findings ◽  
Image Repository

Abstract Introduction Point-of-Care Ultrasound (POCUS) has been shown to be a useful adjunct in assessment of various shock states and utilized to guide resuscitative and post-resuscitation de-escalation efforts. POCUS use for guiding resuscitation in burn injured patient has not be described. Objectives characterize the use of bedside ultrasound examinations performed by advance practice providers and treating physicians in a regional burn intensive care unit Methods Daily beside ultrasound examinations were performed utilizing a bedside ultrasound device by an advanced practice provider prior to rounds POCUS examinations consist of: Ultrasound images were archived to a centralized image repository and reviewed daily during multi-disciplinary rounds. Ultrasonographic volume assessment compared to clinical volume assessment made during daily multidisciplinary rounds. Results 100 examinations were performed of those 32 were within the initial 72 hour window: Conclusions Our results demonstrate that bedside ultrasound aides in guidance of both resuscitative and post-resuscitative efforts. We identified a cohort of patients who appeared hypervolemic clinically but US findings supported hypovolemia, we refer to as pseudohypervolemia US volume assessment provides information that changes management. We believe point of care ultrasound is a viable tool in preventing over-resuscitation as well as to guide post-resuscitative diuresis.

scholarly journals The importance of early detection of endotoxemia

2016 ◽  
Vol 22 (7) ◽  
pp. 503-509 ◽  
Author(s):  
Barbara Adamik ◽  
Jakub Smiechowicz ◽  
Andrzej Kübler
Keyword(s):  
Septic Shock ◽  
Point Of Care ◽  
Point Of Care Testing ◽  
Clinical Challenge ◽  
Endotoxin Activity ◽  
Sepsis And Septic Shock ◽  
Clinical Conditions ◽  
Endotoxin Elimination ◽  
Selection Of Patients ◽  
Selection Of

Endotoxin is considered a key signaling molecule in the pathogenesis of sepsis and septic shock. Anti-endotoxin therapies may result in the improvement of a patient’s clinical condition and lower mortality. The pressing clinical challenge is to identify patients for whom endotoxin elimination would be the most beneficial. An endotoxin activity assay (EAA) has been available for detection of endotoxins, allowing selection of patients at high risk of endotoxemia in intensive care units (ICUs). We studied a cohort of 172 consecutive patients who had septic shock on admission to the ICU. Endotoxin activity (EA) was measured with a rapid chemiluminescent EAA, regarded as point-of-care testing. Endotoxemia with a mean EA of 0.59 ± 0.14 EAU was present in 104 patients (60%) and absent in 68 patients (EA = 0.25 ± 0.11 EAU). The risk of endotoxemia increased with the presence of a Gram-negative infection [odds ratio (OR) 3.1, 95% confidence interval (CI) 1.6–5.9; P = 0.001] and bacteremia (OR 3.8, 95% CI 1.6–8.9; P = 0.02) but did not change with a diagnosis of peritonitis (OR 1.03, 95% CI 0.54–1.97; P = 0.90). These findings indicate that anti-endotoxin interventions should be tailored to individual patients based on both clinical conditions and measured endotoxin levels.

scholarly journals Pemeriksaan Laboratorium sebagai Indikator Sepsis dan Syok Septik

2019 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Diana S. Purwanto ◽  
Dalima A.W. Astrawinata
Keyword(s):  
Septic Shock ◽  
Acute Phase ◽  
Laboratory Tests ◽  
Acute Phase Proteins ◽  
Cell Surfaces ◽  
Tissue Hypoperfusion ◽  
Organ Systems ◽  
Almost All ◽  
Sepsis And Septic Shock ◽  
Bacterial Products

Abstract: The complexity of the pathogenesis and pathophysiology of sepsis involves almost all types of cells, tissues, and organ systems. Therefore, there are numbers of laboratory tests that can be used as biomarkers of sepsis and septic shock. Some widely used biomarkers are divided into groups of bacterial products, acute phase proteins, tissue hypoperfusion, coagulation mediators, cell surfaces, and cytokines.Keywords: sepsis, septic shock, biomarkersAbstrak: Kompleksnya patogenesis dan patofisiologi sepsis melibatkan hampir semua jenis sel, jaringan, dan sistem organ. Oleh karena itu, terdapat banyak parameter laboratorik yang dapat dijadikan biomarker sepsis dan syok septik. Berbagai biomarker yang banyak digunakan terbagi dalam kelompokan produk bakteri, protein fase akut, hipoperfusi jaringan, mediator koagulasi, permukaan sel, dan sitokin.Kata kunci: sepsis, syok septik, biomarker

scholarly journals Antimicrobial utilization pattern in Systemic Inflammatory Response Syndrome positive septicemia: a prospective study in an apex hospital in South Delhi

2019 ◽  
Vol 8 (3) ◽  
pp. 557
Author(s):  
Anwer Habib ◽  
Razi Ahmad
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Systemic Inflammatory Response Syndrome ◽  
Inflammatory Response ◽  
High Risk Patient ◽  
Systemic Inflammatory Response ◽  
Early Initiation ◽  
Source Of Infection ◽  
Sepsis And Septic Shock ◽  
Sirs Criteria

Background: Despite significant advances in critical care, mortality and morbidity in severe sepsis and septic shock remain high, this may be explained by the fact that in sepsis bacterial infection triggers the innate immune response, setting in motion a cascade of pro-inflammatory and anti-inflammatory cytokines leading to what we recognize as the systemic inflammatory response syndrome (SIRS). It has been thought that this self-propagating cascade drives the progression to severe sepsis and septic shock with increasing degrees of cellular injury and end-organ dysfunction, therefor early initiation of empirical antimicrobial agent is crucial and life-saving atleast in high risk patient. This study aimed to see the outcome (recover or mortality) of patients diagnosed by using SIRS criteria.Methods: Total of 105 patients of suspected sepsis fulfilling SIRS criteria (SIRS ≥2), were included in study. Study population were administered appropriate empirical antimicrobial depending on the source of infection and followed till the final outcome (complete recovery or death).Results: Out of 105 patients included in study based on SIRS criteria, 87 (82.85%) were confirmed to be having septicemia on further evaluation. In majority of patient primary source of infection were respiratory tract (44.76%) and most commonly employed and effective empirical antimicrobial were a combination piperacillin with tazobactum and amikacin (40%). 92.39% patients recovered with empirical antimicrobial, with total in-hospital mortality rate of 7.61%.Conclusions: Early initiation of appropriate antimicrobial by using SIRS as an indicator for the early diagnosis of septicemia is crucial in the management of septicemia and prevention of development of severe sepsis, septic shock.

scholarly journals Usefulness of the heparin-binding protein level to diagnose sepsis and septic shock according to Sepsis-3 compared with procalcitonin and C reactive protein: a prospective cohort study in China

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e026527 ◽  
Author(s):  
Yixuan Zhou ◽  
Zhen Liu ◽  
Jun Huang ◽  
Guiling Li ◽  
Fengying Li ◽  
...  
Keyword(s):  
Septic Shock ◽  
Cohort Study ◽  
Roc Curve ◽  
Prospective Cohort ◽  
Heparin Binding ◽  
C Reactive Protein ◽  
Suspected Sepsis ◽  
Reactive Protein ◽  
Heparin Binding Protein ◽  
Sepsis And Septic Shock

ObjectivesOur aim was to assess the release level of heparin-binding protein (HBP) in sepsis and septic shock under theThird International Consensus Definitions for Sepsis and Septic Shock(Sepsis-3).DesignProspective cohort study.SettingA general teaching hospital in China.ParticipantsAdult infected patients with suspected sepsis and people who underwent physical examination were included. According to the health status and severity of illness, the research subjects were divided into healthy, local infection, sepsis non-shock and septic shock under Sepsis-3 definitions.Main outcome measuresPlasma levels of HBP, procalcitonin (PCT), C reactive protein (CRP) and complete blood count were detected in all subjects. Single-factor analysis of variance was used to compare the biomarker levels of multiple groups. A receiver operating characteristic (ROC) curve was used to assess the diagnostic capacity of each marker.ResultsHBP levels were significantly higher in patients with sepsis non-shock than in those with local infections (median 49.7ng/mL vs 11.8 ng/mL, p<0.01) at enrolment. Moreover, HBP levels in patients with septic shock were significantly higher than in patients with sepsis without shock (median 153.8ng/mL vs 49.7 ng/mL, p<0.01). The area under the ROC curve (AUC) of HBP (cut-off ≥28.1 ng/mL) was 0.893 for sepsis which was higher than those of PCT (0.856) for a cut-off ≥2.05 ng/mL and of CRP (0.699) for a cut-off ≥151.9 mg/L. Moreover, AUC of HBP (cut-off ≥103.5 ng/mL) was 0.760 for septic shock which was higher than the ROC curve of sequential [sepsis-related] organ failure assessment (SOFA) Score (0.656) for a cut-off ≥5.5. However, there was no significant difference between 28-d survivors (n=56) and 28-d non-survivors (n=37) with sepsis in terms of HBP value (p=0.182).ConclusionsA high level of HBP in plasma is associated with sepsis, which might be a useful diagnostic marker in patients with suspected sepsis.

Accuracy of point of care ultrasound to identify the source of infection in septic patients: a prospective study

2016 ◽  
Vol 12 (3) ◽  
pp. 371-378 ◽  
Author(s):  
Francesca Cortellaro ◽  
Laura Ferrari ◽  
Francesco Molteni ◽  
Paolo Aseni ◽  
Marta Velati ◽  
...  
Keyword(s):  
Prospective Study ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Source Of Infection ◽  
A Prospective Study

scholarly journals It Is Always Early with Point-of-Care Ultrasound

2020 ◽  
Vol 2020 ◽  
pp. 1-3
Author(s):  
Zouheir Ibrahim Bitar ◽  
Tamer Mohamed Zaalouk ◽  
Ossama Sajeh Maadarani ◽  
Ragab Desouky Elshabasy
Keyword(s):  
Point Of Care ◽  
Care Physician ◽  
Point Of Care Ultrasound ◽  
Resonance Imaging ◽  
Critical Care Physician ◽  
Unstable Condition ◽  
Abdominal Magnetic Resonance Imaging ◽  
Source Of Infection ◽  
Time To Diagnosis ◽  
Tentative Diagnosis

A 56-year-old male was admitted to the emergency department for acute pulmonary edema and septic shock, yet no clear source of infection was noted upon physical examination. Due to his unstable condition, bedside ultrasound was performed. A heterogeneous mass in the liver was noted; hence, a tentative diagnosis of liver abscess was made. The abscess was confirmed by abdominal magnetic resonance imaging. Drainage of the abscess was attempted and guided by early ultrasound. This case highlights that point-of-care ultrasound, when performed by an ultrasound-capable critical care physician, can significantly decrease the time to diagnosis for septic patients.

scholarly journals Tricuspid Annular Plane of Systolic Excursion (TAPSE) for the Evaluation of Patients with Severe Sepsis and Septic Shock

2020 ◽  
Vol 21 (2) ◽  
pp. 348-352
Author(s):  
Shadi Lahham ◽  
Clifton Lee ◽  
Qumber Ali ◽  
John Moeller ◽  
Chanel Fischetti ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Length Of Stay ◽  
Large Scale ◽  
Admission Rate ◽  
Hospital Length Of Stay ◽  
Point Of Care Ultrasound ◽  
Septic Cardiomyopathy ◽  
Icu Admission ◽  
Sepsis And Septic Shock

Introduction: Sepsis is a systemic infection that can rapidly progress into multi organ failure and shock if left untreated. Previous studies have demonstrated the utility of point of care ultrasound (POCUS) in the evaluation of patients with sepsis. However, limited data exists on the evaluation of the tricuspid annular plane of systolic excursion (TAPSE) in patients with sepsis. Methods: We prospectively enrolled patients who presented to the emergency department (ED) with concern for severe sepsis or septic shock in a pilot study. In patients that screened positive, the treating physician then performed POCUS to measure the TAPSE value. We compared the intensive care unit (ICU) admission rate, hospital length of stay, and morbidity with their respective TAPSE values. Results: We enrolled 24 patients in the study. Eight patients had TAPSE values less than 16 millimeters (mm), two patients had TAPSE values between 16mm-20mm, and fourteen patients had TAPSE values greater than 20mm. There was no statistically significant association between TAPSE levels and ICU admission (p=0.16), or death (p=0.14). The difference of length of stay (LOS) was not statistically significant in case of hospital LOS (p= 0.72) or ICU LOS. Conclusion: Our pilot data did not demonstrate a correlation between severe sepsis or septic shock and TAPSE values. This may be due to several factors including patient comorbidities, strict definitions of sepsis and septic shock, as well as the absence of septic cardiomyopathy (SCM) in patients with sepsis and septic shock. Future large-scale studies are needed to determine if TAPSE can be beneficial in the ED evaluation of patients with concern for SCM.

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