The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis

Keith Killu; Cecilia Patino-Sutton; Lynn Kysh; Richard Castriotta; John Oropello; Luis Huerta; Dominic Engracia; Karim Merchant; Choo Phei Wee; Victoria Kristence Cortessis

doi:10.1007/s40477-024-00958-w

The association between integrating echocardiography use in the management of septic shock patients and outcomes in the intensive care unit: a systematic review and meta-analysis

J Ultrasound. 2024 Oct 17. doi: 10.1007/s40477-024-00958-w. Online ahead of print.

Authors

Affiliations

¹ Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA. keith.killu@med.usc.edu.
² Keck School of Medicine, Department of Population and Public Health Sciences, University of Southern California, Los Angeles, CA, USA.
³ Keck School of Medicine, Norris Medical Library, University of Southern California, Los Angeles, CA, USA.
⁴ Davis Library, Univercity of California, Davis, CA, 95616, USA.
⁵ Keck School of Medicine, Pulmonary Critical Care and Sleep Division, Department of Internal Medicine, University of Southern California, 2020 Zonal Ave., IRD #720, Los Angeles, CA, 90033, USA.
⁶ The Ichan School of Medicine at the Mount Sinai Hospital, New York, NY, USA.

PMID: 39419883
DOI: 10.1007/s40477-024-00958-w

Abstract

Objectives: Septic shock in critically ill patients can increases morbidity and mortality. We aimed to study the effect on outcomes when integrating point of care (POC) echocardiography in the management of septic shock patients in the Intensive Care Unit (ICU) who are being treated according to the Surviving Sepsis Campaign (SSC) guidelines.

Methods: An electronic search of MEDLINE through PubMed, clinical trials.gov and google scholar was conducted for the period from January 1990-January 2024 to identify studies of septic shock adult and pediatric patients in the ICU managed according to SSC guidelines with or without POC echocardiography. Three reviewers extracted data independent of each other. Cochrane collaboration tool was used for bias assessment. Random effect meta-analysis used to pool data.

Results: A total of 1701 articles identified. Seven studies included in the final report with a total of 3885 patients. POC echocardiography guided septic shock management was associated with lower in-hospital and 28-day mortality (sOR = 0.82 [95%CI: 0.71-0.95], p = 0.01), more frequent initiation of inotropic support (sOR = 2.42 [95%CI 1.92-3.03], p < 0.0001) and shorter time to achieve lactate clearance (SMD = - 0.87 h [95%CI - 1.23 h to - 0.51 h], p < 0.0001). Summary estimates did not achieve significance for effect of POC echocardiography on 24-h fluid intake (SMD = - 2.11 ml [95%CI - 5.93 ml to 1.72 ml], p = 0.28) on mechanical ventilation-free days (SMD = 0.03 days [95%CI - 0.04 to 0.10], p = 0.94). Shock reversal time analysis was less meaningful due to the small number of studies reporting outcome.

Conclusions: POC echocardiography guided management in septic shock patients in the ICU can lead to a decrease in mortality, increase in initiation of inotropic support, and a decrease in lactate clearance time. Larger cohort studies and data collection and analysis are needed for further understanding and optimizing standardization of protocols for POC echocardiography use in septic shock patients in the ICU.

Keywords: Echocardiography; Inotropic support; Mortality; Point of care; Septic shock; Ultrasound.

Publication types

Review

Grants and funding

UL1TR001855/TR/NCATS NIH HHS/United States