CHEST Guidelines-Usefulness-of-Ultrasound-to-Help-Solve-Severe-Seps (1)

Usefulness-of-Ultrasound-to-Help-Solve-Severe-Seps (1)

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This case study from "CHEST" journal explores the role of ultrasound in diagnosing and managing severe sepsis, particularly in a 65-year-old male with multiple existing health conditions including schizophrenia, benign prostatic hyperplasia, and hypertension. He presented at the emergency department (ED) with fever and fatigue but without typical urinary tract infection (UTI) symptoms, despite having a chronic suprapubic catheter. His vital signs indicated sepsis, and lab reports showed acute kidney injury alongside neutrophil-predominant leukocytosis.<br /><br />Upon admittance, broad-spectrum antibiotics were initiated, and point-of-care ultrasound was used strategically to identify the infection source and monitor patient response. The ultrasound detected bilateral hydronephrosis, suggesting blockage potentially due to bladder outlet obstruction from a non-draining suprapubic catheter due to purulent urine. This result led to urgency in both diagnosis and intervention.<br /><br />A follow-up bladder ultrasound revealed a distended bladder despite visible urine clearance, indicating obstruction. This prompted urgent urology consultation and replacement of the suprapubic catheter, leading to the drainage of 600 mL of purulent urine. This intervention, combined with targeted antibiotic therapy, notably improved the patient's condition. He was diagnosed with a Proteus mirabilis UTI and was discharged stable post-treatment.<br /><br />The study underscores the significance of thorough ultrasonography (USG) in detecting and managing sepsis. Recommendations include using whole-body USG in sepsis to locate infections, employing renal and bladder USG for patients with acute kidney injury to assess potential genitourinary issues, and examining Foley catheter function if bladder obstruction is suspected. This case exemplifies how ultrasound can be pivotal in the rapid identification and rectification of critical issues, enhancing patient outcomes in sepsis management.

Keywords

ultrasound

sepsis management

acute kidney injury

suprapubic catheter

Proteus mirabilis

bladder obstruction

broad-spectrum antibiotics

urology consultation

point-of-care ultrasound

ultrasonography