• Yi Li, Tongjuan Zou, Xueying Zeng, Yao Qin, Ran Zhou, Lianghai Cao, Jian Hu, Xianying Lei, Qionglan Dong, Yiwei Qin, Ge Zhang, Yan Kang, Bo Wang, Zhongwei Zhang, Xiaoting Wang, Yangong Chao, Wanhong Yin, and Critical Care Ultrasound Study Group (CCUSG); Committee on Critical Care Ultrasound and Hemodynamics (CCUSH, SCIMEA).
• Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu, PR China.
• Eur. J. Intern. Med. 2024 Dec 26.

ObjectivesThe purpose of this study was to determine whether our new thinking guidance named OPACCUS (oxygen metabolism, perfusion, arterial tension, cardiac output, systemic congestion, unregulated host response and search for inciting illness event) with 7 questions you need to ask before shock therapy and evidences provided by critical ultrasound considering hemodynamics, the unregulated host response and inciting illness event would improve mortality in shock patients.DesignA multicenter, prospective, observational cohort study.SettingIntensive care units of 20 hospitals in Southwest China.PatientsShock patients between October 2022 and February 2024 were divided into three groups, namely, the full-compliance group (n = 171), moderate-compliance group (n = 149) and low-compliance group (n = 220), according to the compliance rate with the OPACCUS guidance.InterventionsAdoption of the OPACCUS guidance in every repeat assessment MEASUREMENTS AND MAIN RESULTS: Demographics, clinical information, hemodynamics parameters and critical care ultrasound evaluations were recorded. The primary outcome was all-cause mortality within 30 days. A total of 540 patients completed the study and were ultimately included in the analysis. After multivariate regression adjustment, the 30-day mortality of shock patients in the full-compliance group (21.05 %) was significantly lower than that in the low-compliance group (36.82 %) (HR=1.646*, RMST=-3.223*). Restricted mean survival time (RMST) univariate analysis showed that the higher the OPACCUS compliance rate was, the longer the survival time. ICU and hospital costs were lower in the full-compliance group than in the moderate-compliance group.ConclusionsCompliance to the new OPACCUS guidance could improve 30-day mortality and reduce costs for shock patients.Trial RegistrationClinicalTrials.gov Identifier: ChiCTR2200061952. Registration date: 13/07/2022.Copyright © 2024. Published by Elsevier B.V.

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