Determination of end point of fluid resuscitation using simplified lung ultrasound protocol in patients with septic shock

Context Fluid administration requires dynamic measures that are preferred over static ones as they are easy to apply and noninvasive. Thoracic ultrasound could be used in assessing extravascular lung water by visualizing the so-called B-lines. Aim To assess the role of a new simple ultrasound protocol in identifying the end point of fluid resuscitation in patients with septic shock. Settings and design A single-blinded randomized controlled trial was carried out on 80 consecutive adult patients with septic shock. Patients and methods Patients were divided into two groups: the first received fluid resuscitation according to early goal-directed therapy with a target central venous pressure of 8-12 mmHg, whereas the second received fluids guided by simplified lung ultrasound protocol till reaching a score of 16. Statistical analysis used IBM SPSS software package, version 20.0 was used for statistical analyses. Results The ultrasound score showed a negative significant weak correlation with the hypoxic index (Spearman's r=−0.39, P=0.012), whereas it showed a positive moderate significant correlation with the central venous pressure readings (Spearman's r=0.50, P=0.001), and positive moderate significant correlation with the congestion by chest radiography (Spearman's r=0.47, P=0.002). A score of more than or equal to 10 in patients with septic shock with a sensitivity of 84.21% and specificity of 90.48% was concluded, upon which resuscitation should be terminated (area under the curve was 0.818 with a significant correlation of P=0.001). Conclusion Simplified lung ultrasound protocol could be used as an end point of fluid resuscitation in patients with septic shock to avoid fluid overload effects.