Feasibility of Ultrasound-guided Assessment of Volume Status in Sepsis in a Resource-Limited Medical Setting: a Pilot Study
This combined feasibility and quality improvement study has the following objectives:
1. Over a two month period, 50 adult patients admitted to the general medicine wards and MSICU meeting sepsis criteria, as defined by the International Sepsis Definitions Conference, will be enrolled. Patients will be ineligible if ultrasonographic measurement of the inferior vena cava cannot be performed because of technical limitations. This may include patients with central obesity, abdominal wounds, or extreme agitation.
After collection of basic data (history and physical examination, vital signs, relevant laboratory values, and current therapies), bedside ultrasound using a handheld Sonoscan will be performed by the investigator to measure IVC collapsibility at 0, 3, 6, and 24 hours. Other dynamic measures will be collected as well. Treating physicians will neither be informed of ultrasound results nor will results be used to guide or change therapy. Prior to each ultrasound assessment, the investigator and the treating medical officer or consultant will classify the patient as hypovolemic, euvolemic, or hypervolemic. Endpoints of the study will be:
a. Concordance between physician determination of volume status, non-invasive dynamic measures, and ultrasound measurements.
b. Investigator rating of adequacy of resuscitation.
c. Disposition and outcome of the patient.
2. As a quality improvement and capacity building protocol, we are incorporating training in the use of handheld ultrasound into this two month study. Consultants and medical officers will receive training in critical care applications of bedside ultrasound not limited to assessment of IVC collapsibility. In addition, we are exploring the potential for the use of ultrasound in triage and decisions for ICU transfer of unstable patients on the wards of MTRH. The leadership of the MSICU has appropriately identified the need to develop better protocols for evaluation of such patients.