Ultrasound-guided fluid resuscitation versus usual care guided fluid resuscitation in patients with septic shock: a systematic review and meta-analysis

Abstract

Background: Ultrasound is widely used in critical care for fluid resuscitation in critically ill patients. We conducted a systematic review to assess the relationship between ultrasound-guided fluid resuscitation strategies and usual care in septic shock.

Methods: We searched PubMed, Embase, Cochrane Library, Web of Science, and registers for randomized controlled trials to evaluate the prognosis of ultrasound-guided fluid resuscitation in patients with septic shock.

Results: Twelve randomized controlled studies with 947 participants were included. Ultrasound-guided fluid resuscitation in patients with septic shock was associated with reduced mortality (risk ratio: 0.78; 95% confidence interval [CI]: 0.65 to 0.94; P = 0.007) and 24-hour fluid volume (mean differences [MD]: −1.02; 95% CI: −1.28 to −0.75; P < 0.001), low heterogeneity (I² = 29%, I² = 0%), and increased dose of norepinephrine (MD: 0.07; 95% CI: 0.02-0.11; P = 0.002) and dobutamine dose (MD: 2.2; 95% CI: 0.35-4.04; P = 0.02), with low heterogeneity (I² = 45%, I² = 0%). There was no reduction in the risk of dobutamine use (risk ratio: 1.67; 95% CI: 0.52 to 5.36; P = 0.39; I² = 0%). Inferior vena cava-related measures reduced the length of hospital stay (MD: −2.91; 95% CI: −5.2 to −0.62; P = 0.01; low heterogeneity, I² = 8%) and length of intensive care unit stay (MD: −2.77; 95% CI: −4.51 to −1.02; P = 0.002; low heterogeneity, I² = 0%). The use of the passive leg-raising test combined with echocardiography to assess fluid reactivity was superior. Ultrasound-guided fluid resuscitation did not significantly change the length of the free intensive care unit stay (MD: 1.5; 95% CI: −3.81 to 6.81; P = 0.58; I² = 0%).

Conclusion: Ultrasound-guided fluid resuscitation in patients with septic shock is beneficial, especially when using inferior vena cava-related measures and the passive leg-raising test combined with echocardiography.

Keywords

Meta-analysis / Mortality / Resuscitation / Septic shock / Systematic review / Ultrasonography

Conflict of interest statement

The authors declare no conflict of interest.

Author contributions

Chen Z conceived and designed the study, acquired the data, and drafted the manuscript. Han X conceived the study, extracted the data, and performed the statistical analysis. Liu Y and Wang M interpreted the data and drafted the manuscript. Wang BB collected the data and designed the study. Wang L contributed to the study design, and Jin HX edited and examined the manuscript. All authors have read and approved the final manuscript.

Funding

None.

Ethical approval of studies and informed consent

All studies included in this study followed the principles of the Declaration of Helsinki as revised in 2013.

Acknowledgments

The authors are grateful to Xingshun Qi for providing consultation regarding this study.

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