Background. Shock is one of the causes of mortality in the intensive care unit (ICU). Traditionally, hemodynamics related to shock have been monitored by broad-spectrum devices with treatment guided by many inaccurate variables to describe the pathophysiological changes. Critical care ultrasound (CCUS) has been widely advocated as a preferred tool to monitor shock patients. The purpose of this study was to analyze and broaden current knowledge of the characteristics of ultrasonic hemodynamic pattern and investigate their relationship to outcome. Methods. This prospective study of shock patients in CCUS was conducted in 181 adult patients between April 2016 and June 2017 in the Department of Intensive Care Unit of West China Hospital. CCUS was performed within the initial 6 hours after shock patients were enrolled. The demographic and clinical characteristics, ultrasonic pattern of hemodynamics, and outcome were recorded. A stepwise bivariate logistic regression model was established to identify the correlation between ultrasonic variables and the 28-day mortality. Results. A total of 181 patients with shock were included in our study (male/female: 113/68). The mean age was ; the mean Acute Physiology and Chronic Health Evaluation II (APACHE II score) was , and the 28-day mortality was 44.8% (81/181). The details of ultrasonic pattern were well represented, and the multivariate analysis revealed that mitral annular plane systolic excursion (MAPSE), mitral annular peak systolic velocity (S-MV), tricuspid annular plane systolic excursion (TAPSE), and lung ultrasound score (LUSS) were the independent risk factors for 28-day mortality in our study, as well as APACHE II score, PaO₂/FiO₂, and lactate (, 0.041, 0.022, 0.002, 0.027, 0.028, and 0.01, respectively). Conclusions. CCUS exam on admission provided valuable information to describe the pathophysiological changes of shock patients and the mechanism of shock. Several critical variables obtained by CCUS were related to outcome, hence deserving more attention in clinical decision-making. Trial Registration. The study was approved by the Ethics Committee of West China Hospital Review Board for human research with the following reference number 201736 and was registered on ClinicalTrials. This trial is registered with NCT03082326 on 3 March 2017 (retrospectively registered).

中文翻译：

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通过重症监护超声评估休克患者的血流动力学及其与结果的关系：一项前瞻性研究


背景。休克是重症监护病房（ICU）的死亡原因之一。传统上，与休克相关的血流动力学通过广谱设备进行监测，并通过许多不准确的变量来描述病理生理变化来指导治疗。重症监护超声 (CCUS) 已被广泛提倡作为监测休克患者的首选工具。本研究的目的是分析和拓宽目前对超声血流动力学模式特征的认识，并研究它们与结果的关系。方法。这项针对 CCUS 休克患者的前瞻性研究是在 2016 年 4 月至 2017 年 6 月期间在华西医院重症监护室的 181 名成年患者中进行的。 CCUS 在休克患者入组后最初 6 小时内进行。记录人口统计学和临床​​特征、血流动力学超声模式和结果。建立逐步二元逻辑回归模型来确定超声变量与 28 天死亡率之间的相关性。结果。我们的研究共纳入 181 名休克患者（男/女：113/68）。 平均年龄是 ;平均急性生理学和慢性健康评估 II（APACHE II 评分）为， 28天死亡率为44.8%（81/181）。超声模式的细节得到了很好的体现，多变量分析显示二尖瓣环平面收缩期偏移（MAPSE）、二尖瓣环收缩期峰值速度（S - MV）、三尖瓣环收缩期平面偏移（TAPSE）和肺部超声评分（LUSS）是我们研究中28天死亡率的独立危险因素，还有APACHE II评分、PaO ₂ /FiO ₂和乳酸（ 、 0.041、0.022、0.002、0.027、0.028 和 0.01）。结论。入院时的CCUS检查为描述休克患者的病理生理变化和休克机制提供了有价值的信息。 CCUS 获得的几个关键变量与结果相关，因此在临床决策中值得更多关注。试用注册。 该研究经华西医院审查委员会伦理委员会批准用于人体研究，参考编号为201736，并在临床试验上注册。该试验于2017年3月3日在NCT03082326注册（追溯注册）。