Role of chest ultrasonography in the management of shocked patients in the respiratory intensive care unit

Abstract

Abstract Background Shock is a serious state that arises from a failure in circulation. If not swiftly treated, it may result in tissue hypoxia and the risk of multi-organ failure. It is generally divided into four classifications: hypovolemic, distributive, cardiogenic, and obstructive. Objectives This study evaluates the role of chest ultrasonography in managing patients in shock in a respiratory intensive care unit (RICU). Methods This clinical prospective observational study study included 50 patients who were shocked and admitted to the RICU at Kafrelsheikh University Hospital. Bedside ultrasonography was done on admission and during the period of resuscitation using the BLUE (Bedside Lung Ultrasound in Emergency) and FALLS (Fluid Administration Limited by Lung Sonography) protocols to identify shock types and assess inferior vena cava (IVC) diameters. Results The mean age of patients was 65.3 years, with an equal gender distribution. Smoking prevalence was 38%. Bedside ultrasonography showed lung sliding in 90% of cases, pleural effusion in 32%, and consolidation in 48%. Shock patient types were identified as 13 hypovolemic, 17 septic, 15 cardiogenic, and five obstructive shock. Creatinine, TLC (total leukocytic count), CRP (C-reactive protein), procalcitonin, and dimer were predictive factors for improvement in either septic or hypovolemic patients. IVC min was lowest in hypovolemic shock ( p -value = 0.001), IVC ci was highest in septic shock ( p -value = 0.002), and there was no significant difference regarding IVC max. In the hypovolemic and septic shock patients, there was a substantial increase in MAP (mean arterial pressure), central venous pressure (CVP), IVC maximum (max), IVC minimum (min), and UOP (urine output ( p < 0.05). At the same time, there was a significant decrease in IVC CI(collapsibility index). RConclusion Lung ultrasound is a valuable tool for differentiating between various types of shock, particularly hypovolemic and septic shock, and is useful in guiding fluid resuscitation. Predictive factors like procalcitonin, complete blood counts, CRP, D-dimer, creatinine levels, and IVC parameters can aid in assessing shock improvement, vitals parameters like MAP, IVC diameters, UOP, and CVP increasing during fluid resuscitation, while IVC ci decreases.