Early Detection of Volume Status by Point-of-Care Ultrasound in Patients with Hypovolemic Shock

Abstract

Background: Early identification of volume changes in critically ill patients is crucial for optimizing fluid management and improving outcomes. This study aimed to assess the impact of early volume change detection on morbidity and mortality in critically ill patients.

Methods: A total of 80 critically ill patients were enrolled in this prospective observational study. Patients were included if they met at least one of the following criteria: trauma, severe vomiting and diarrhea, malnutrition, mechanical ventilation, burn injuries, or if they were receiving fluid therapy. Patients who did not meet these inclusion criteria or had unrelated conditions were excluded. Comprehensive evaluations were performed on all participants. Demographic data (age, sex, height, weight, and BMI) and clinical parameters (vital signs and relevant laboratory values) were collected upon admission. Point-of-care ultrasound (POCUS) was utilized to assess the inferior vena cava (IVC), with measurements taken 2–3 cm from the right atrium to determine maximum and minimum IVC diameters. The IVC collapsibility and dispensability indices were calculated to evaluate fluid responsiveness.

Results: Among the 80 patients, early volume change detection was achieved in 45 (56%), while 35 (44%) experienced late detection. Patients with early volume detection had significantly lower morbidity (31% vs. 63%, P=0.01) and mortality (9% vs. 29%, P=0.01). Early detection was associated with a shorter hospital stay (9 ± 3 vs. 14 ± 5 days, P=0.02) and ICU stay (4 ± 1.5 vs. 7 ± 2.5 days, P=0.03). Ultrasound findings showed a higher IVC collapsibility index in the early detection group (55 ± 10% vs. 35 ± 10%, P<0.01). Furthermore, early detection reduced the need for mechanical ventilation (44% vs. 71%, P=0.029) and diuretic therapy (27% vs. 51%, P=0.042).

Conclusion: Early detection of volume changes in critically ill patients significantly reduces morbidity and mortality, shortens hospital and ICU stays, and decreases the need for invasive interventions. Implementing routine ultrasound-guided volume assessment may enhance fluid management strategies and improve patient outcomes.