(1479) Rapid Ultrasound Evaluation of Patients With Sepsis-Associated Hypotension Using Pattern Recognition

Introduction: Intravenous (IV) volume resuscitation and vasoactive medications are cornerstones of hemodynamic management in patients with septic shock. However, their optimal use remains a matter of debate. Recent guidelines have signaled a shift away from universal large volume crystalloids in favor of more individualized strategies to assess each patient’s volume status and tolerance. We propose that point-of-care ultrasound exams can provide insight into targeted hemodynamic management of patients with sepsis.

Methods: In this single-center, retrospective, observational study, we enrolled patients who developed hypotension (MAP < 65 mmHg) in a critical care or perioperative setting and who were subsequently evaluated with an Echocardiographic Assessment using Subxiphoid OnlY (EASy) exam by a trained clinician. Exams consisted of subcostal views of the heart and inferior vena cava (IVC); if this initial exam was inconclusive, additional views were obtained. Patients were categorized into one of 3 clusters based on ventricular function (further divided into 8 cardiac phenotypes); one of 3 IVC phenotypes based on its size and collapsibility.

Results: 100 were diagnosed with sepsis or septic shock at any point. Their mean age was 62.7 years; 62% were male. EASy exam quality was rated as “good” or “adequate” in 75% of exams; mean time to acquire all images was 3 ± 1 minutes. In the 3 hours following the exam, patients with a Cluster 1 phenotypes (preserved systolic function) were more likely to receive a fluid bolus of 500 mL or greater, whereas patients with Cluster 3 phenotypes (right ventricular dysfunction) were more likely to have IV fluids discontinued, receive diuresis, and have vasopressin added or increased. Total IV volume received was associated with IVC phenotype.

Conclusions: In patients with sepsis-associated hypotension, EASy exam phenotyping of the heart and IVC is associated with significant differences in management. While this suggests that EASy exams are sufficient to rapidly assess hemodynamic status and its changes, the effects of EASy exam-based hemodynamic management on clinical outcomes remain unknown.