IMPACT OF POINT-OF-CARE ULTRASOUND (POCUS) GUIDED FLUID RESUSCITATION IN MANAGEMENT OF SEPSIS AND SEPTIC SHOCK: A SYSTEMAIC REVIEW AND META-ANALYSIS

SESSION TITLE: Critical Care Posters 15 SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/11/2023 12:00 pm - 12:45 pm PURPOSE: There has been a rise in the point-of-care ultrasound (POCUS) guided approach to help clinicians prescribe fluid therapy. However, the effectiveness of POCUS-guided fluid resuscitation to target adequate perfusion in sepsis and septic shock has not been established. METHODS: We conducted a systematic literature search of PubMed, Cochrane Library, PubMed Central, Embase, and Scopus for potential literature till April 23, 2022. Data were pooled by Odds Ratio (OR) for outcome estimation with a 95% Confidence Interval using a random/fixed-effect model for pooling selected studies based on heterogeneity. RESULTS: We included a total of 4 studies in our meta-analysis. There were 2 RCTs, 1 case-control, and 1 cohort study. Pooling of the data from four studies using the random effect model did not show a statistically significant difference in 30-day mortality (OR 0.98, 95% CI 0.66 to 1.44; n= 6042; I2 = 58%). Vasopressor use was reported in 4 studies. Pooling of the data using the random effect model could not reach level of statistical significance (OR 1.21, 95% CI 0.39 to 3.76; n = 6033; I2 = 93%). Cumulative fluid requirement was reported in only two studies. Pooling of the data showed on average 494 ml of extra fluid requirements in No-POCUS group (MD 494.22, 95% CI -534.44 to 1522.87; n= 475; studies = 2; I2 = 78%). Length of hospitalization was reported in 3 studies. Data showed a trend towards more extended hospital stay in No-POCUS group however effect could not reach a level of statistical significance (MD 0.40, 95% CI -0.14 to 0.94; n= 601; I2 = 0%). Mechanical ventilation (MV) requirement was reported in 2 studies. Pooling of the data using a fixed effect model showed 1.73 higher odds of MV requirement in no POCUS group (OR 1.73, 95% CI 1.09 to 2.76; n= 331; I2 = 0%) CONCLUSIONS: POCUS is a widely used clinical tool both in critical care and non-critical care clinical settings. In the eminent future use of POCUS is going to be even wider given its potential for rapid, noninvasive, and easily repeatable assessments of hemodynamics. Our findings suggest that there is no significant difference in 30-day mortality compared between No-POCUS and POCUS-guided fluid resuscitation among patients with sepsis and septic shock. However, the data is limited to four studies and two randomized controlled trials. CLINICAL IMPLICATIONS: While POCUS is universally used as a clinical tool in ICU and non-ICU settings, data from high-quality study is limited. Thus, more extensive studies and validation is still required to fathom the multitudinous roles of POCUS, especially in the era of precision-based volume resuscitation in sepsis and septic shock. DISCLOSURES: No relevant relationships by Yusra Ansari No disclosure on file for Nisarfathima Kazimuddin No relevant relationships by Tahir Muhammad Abdullah Khan No relevant relationships by Gyabina Maharjan No relevant relationships by Fawaz Mohammed No relevant relationships by Anubhav Poudel No relevant relationships by Yub Raj Sedhai No relevant relationships by Dhan Shrestha No relevant relationships by Karan Singh No relevant relationships by Hamza Sohail No disclosure on file for Irfan Waheed No disclosure on file for Stuti Yadav