(900) Hemodynamic Point-of-Care Ultrasound in Pediatric Sepsis is Associated With Decreased Fluid Overload

Introduction: Fluid overload (FO) after pediatric septic shock resuscitation is associated with an increased risk of secondary organ failure and long-term morbidity. Optimal measures to reduce FO are lacking. We hypothesized that early utilization of hemodynamic point-of-care ultrasound (hPOCUS) in pediatric septic shock would be associated with decreased FO.

Methods: A single-center, retrospective, observational study of children < 18 years with septic shock in a large academic PICU between 2015-2018. Inclusion criteria: ≥40 ml/kg of bolus fluids or vasoactive infusion. %FO at 72 hours after shock onset was calculated as [(fluid in – out)/weight at admission]*100. Primary outcome: severe FO was defined as %FO ≥15% based on existing literature. Secondary outcomes were shock duration, PICU length of stay, and complicated course (≥2 organ failures on day 7 or death by day 28 of sepsis). Median and interquartile range (IQR) and comparison between groups made with Chi2. Multivariate logistic regression was used to determine the association between hPOCUS within 6 hours of septic shock onset and severe FO.

Results: 637 children met eligibility criteria and 591 were included in the final analysis (15 died and 31 were transferred from the PICU prior to primary outcome ascertainment). 140 children (23.6%) had hPOCUS within 6 hrs. Children exposed to hPOCUS vs. without had higher PIM3; median 4.3: IQR 2.7-9.4 vs. 3.1: IQR 0.9-5.6, p< 0.0001. Those with hPOCUS had a lower occurrence of severe FO 14.1% vs. 22.5%, p=0.036. hPOCUS exposure was independently associated with decreased odds of severe FO after controlling for age, PIM3, and history of oncologic diagnosis, bone marrow transplant, and chronic renal failure: OR 0.57, 95%CI 0.33-0.98, p=0.043. %FO between the two groups did not reach statistical significance: median 6.7% (IQR 2.3-11.2) vs. 7.4% (IQR 2.0-14.0), p=0.19. There was no significant association between hPOCUS exposure and shock duration (p=0.69), ICU length of stay (p=0.68), and complicated course (p=0.27).

Conclusions: Early exposure to hPOCUS during sepsis resuscitation was associated with decreased odds of severe FO. Further prospective research is needed to optimize the use of hPOCUS in pediatric septic shock management.