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The following is a summary of “Cardiopulmonary Ultrasound to Predict Care Escalation in Early Sepsis: A Pilot Study,” published in the January 2025 issue of Emergency Medicine by Kuttab et al. 

Identifying individuals with sepsis in the emergency department (ED) who may need resources like positive-pressure ventilation, vasopressors, or intensive care unit (ICU) admission poses challenges.   

Researchers conducted a retrospective study to examine the correlation between cardiopulmonary ultrasound (CPUS) findings and the need for care escalation.  

They enrolled adults with suspected sepsis and used CPUS to evaluate left ventricular systolic function (LVF), right ventricular (RV) size and function, inferior vena cava (IVC) collapsibility, and thoracic B-lines. The primary outcome was need for care escalation within 12 hours of ED presentation, defined as ICU admission, positive-pressure ventilation, or vasopressor infusion.  

The results showed 92 individuals were enrolled, with 18 (19.6%) requiring care escalation. Logistic regression identified the presence of ≥4 thoracic B-lines as a significant predictor of care escalation (OR 7.8, 95% CI [1.3–26.4], P = 0.002). Reduced LVF (OR 4.26, 95% CI [0.06–12.9], P = 0.14) and dilated RV size (OR 2.8, 95% CI [0.4–11.8], P = 0.16) were also positively associated with care escalation. A retrospective stepwise regression model including these variables showed a curve AUROC of 0.75 (95% CI [0.63–0.88]). When 2 or more variables were abnormal, the model demonstrated a high specificity of 95% (likelihood ratio positive [LR+] 6.2) but a low sensitivity of 33% (LR- 0.7).  

Investigators concluded the patients with suspected sepsis, the combination of ≥4 B-lines on lung ultrasound with LVF and RV size assessment improved the positive predictive power for the need for care escalation. 

Source: sciencedirect.com/science/article/abs/pii/S073646792400235X