Shock

Accuracy of early shock recognition by paramedics: a multicenter prospective observational study in Japan

Objective

Early recognition of shock status by paramedics significantly affects patient prognosis; however, its accuracy remains unclear. This study assessed the diagnostic accuracy of paramedics in classifying shock and the characteristics of misdiagnoses.

Materials and Methods

This multicenter prospective observational study compared the on-scene shock diagnoses of paramedics between July 2022 and June 2023 with those of physicians upon hospital arrival.

Results

The overall diagnostic accuracy for shock revealed substantial agreement (k=0.64), whereas diagnosis by category ranged from slight to moderate agreement (k=0.11-0.51). Patients without systolic hypotension were more frequently missed during diagnosis.

Conclusions

Enhanced clinical education is needed to improve the accuracy of shock diagnosis by paramedics.

Effect of Continuous Infusion Therapy With Low-dose Terlipressin Combined With Norepinephrine on Hemodynamics, Inflammatory Markers, and Prognosis in Patients With Severe Septic Shock

OBJECTIVE

The present study investigated the impact of continuous infusion therapy with low-dose terlipressin (TP) combined with norepinephrine on hemodynamics, inflammatory markers, and prognosis in patients with severe septic shock.

MATERIALS AND METHODS

Seventy-four patients with severe septic shock were randomly assigned to either a control group (n = 37) or an observation group (n = 37). Patients in the control group received norepinephrine alone, while those in the observation group received a continuous infusion of low-dose TP in addition to norepinephrine. To assess the effect of treatment, a set of clinical parameters was evaluated in both groups before and after treatment. These parameters included hemodynamic indicators (heart rate [HR], mean arterial pressure [MAP], central venous pressure [CVP], cardiac index [CI], and systemic vascular resistance index [SVRI]), levels of serum inflammatory markers (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitivity C-reactive protein [hs-CRP]), renal function indicators (blood urea nitrogen [BUN], serum creatinine [SCr], and cystatin C [Cys-C]), serum procalcitonin (PCT), and lactate, as well as lactate clearance rate (LCR). Additionally, the acute physiology and chronic health evaluation II (APACHE II) score, 28-day mortality rate, multiple organ dysfunction syndrome (MODS) incidence rate, and adverse reaction incidence were also determined.

RESULTS

Compared to baseline values, MAP, CVP, CI, SVRI, and LCR increased in both groups after treatment, while HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate all decreased. Additionally, APACHE II scores also decreased. Furthermore, the observation group exhibited higher MAP, CVP, CI, SVRI, and LCR, along with lower HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate than the control group after treatment. The observation group also had lower APACHE II score, 28-day mortality rate, MODS incidence rate, and adverse reaction incidence than the control group after treatment (P < .05).

CONCLUSION

Continuous infusion therapy with low-dose TP combined with norepinephrine was effective in treating patients with severe septic shock, improving hemodynamic parameters, reducing the levels of inflammatory markers, promoting renal function recovery, and reducing the mortality rate.

Critical Care Echocardiography

Ultrasonography is increasingly applied in the critical care setting. With advancements in technology, ultrasonography has become easier to use, with smaller machines, and more fundamental to patient assessment. Ultrasonography is a hands-on tool that brings real-time, dynamic information to the bedside. Patients in the critical care setting often have unstable hemodynamics or a tenuous respiratory status; thus, the use of ultrasonography to augment the assessment greatly improves patient safety. This article explores how to differentiate the etiology of shock with the adjunct of critical care echocardiography. In addition, the article examines how various ultrasonography techniques can be used to diagnose other life-threatening cardiac conditions, such as pulmonary embolism or cardiac tamponade, and the role of echocardiography in cardiopulmonary resuscitation. Critical care providers can add echocardiography and the information it provides to their repertoire to improve diagnosis, treatment, and patient outcomes.

Effect of Transradial Artery Catheterization on Shock Patients

Objective. This study aimed to investigate the clinical effect of ultrasound-guided transradial catheterization (TRC) for ICU patients with shock. Methods. 120 shock patients registered in the ICU of our hospital from January 2019 to June 2022 were selected for prospective study. The control group (60 patients) were treated with palpation-guided TRC. The observation group was treated with ultrasound-guided TRC and was divided into the internal puncture group (internal TRC) and external puncture group (external TRC), with 30 cases in each. The first attempt success rate, total success rate, operation duration, complication, measurement of radial artery, and VAS scores were compared in these groups. Results. The success rate was higher in the observation group than in the control group ( $P<0.05$ ), and higher in the internal puncture group than in the external puncture group ( $P<0.05$ ). The first attempt success rate was significantly higher in the observation group than in the control group ( $P<0.05$ ), with no significant difference in between ( $P>0.05$ ). The number of attempts and operation duration were lower in the observation group than in the control group ( $P<0.05$ ), with significantly more operation duration in the internal puncture group than in the external puncture group ( $P<0.05$ ) and no significant difference in the number of attempts (both $P>0.05$ ). The complication rate was significantly lower in the observation group than in the control group ( $P<0.05$ ) and there was no significant difference in between ( $P>0.05$ ). The radial artery diameter, cross-sectional area, and depth from the skin in the observation group were larger than those in the control group ( $P<0.05$ ) and there was no significant difference in between ( $P>0.05$ ). At 1, 6, 24, and 48 h after the surgery, the observation group showed lower VAS scores than the control group ( $P<0.05$ ). Conclusion. The ultrasound-guided TRC reduced the number of attempts, the complication rates, and the operation duration. For patients with shock, if Doppler ultrasound cannot detect blood flow, the success rate in the observation group was higher than that in the control group, and its advantage is worthy of promotion in severe patients.