Bedside Ultrasound and Noninvasive Cardiac Output Monitoring in Children with Septic Shock: A Retrospective Comparative Study.

To evaluate the clinical value of point-of-care ultrasound (POCUS) and noninvasive cardiac output monitoring (NICaS) in the management of pediatric septic shock. A retrospective analysis was conducted on children with septic shock admitted to our hospital. Patients were divided into three groups: The POCUS group received therapy guided by dynamic monitoring of cardiac index (CI), inferior vena cava variability (IVCV), and left ventricular ejection fraction (LVEF). The NICaS group was managed based on CI, stroke volume variability, and the Granov-Goor index (GGI). The control group received clinical evaluation and conventional hemodynamic management only. Outcomes were compared across the groups. A total of 116 children were enrolled, with no significant differences in baseline characteristics among the groups. The peak vasoactive-inotropic score (VIS) was significantly lower in the POCUS and NICaS groups than in the control group [(40.8 ± 16.3) and (42.9 ± 18.2) vs. (56.1 ± 23.7), P < 0.05]. The resuscitation fluid volume was significantly reduced in the POCUS and NICaS groups compared with the control group [(36.4 ± 7.4) and (38.9 ± 14.8) vs. (46.7 ± 17.5) mL/kg, P < 0.05]. The time to achieve a negative fluid balance was significantly shorter in the POCUS and NICaS groups than in the control group [(36.4 ± 7.4) and (38.9 ± 14.8) vs. (46.7 ± 17.5) hours, P < 0.05]. The 28-day survival rate was significantly higher in the POCUS and NICaS groups than in the control group [(73.5%, 66.7%) vs. (45.2%), P < 0.05]. No significant differences in VIS, resuscitation fluid volume, time to negative fluid balance, or 28-day survival (P > 0.05) were observed between the POCUS and NICaS groups. CI values were comparable between the POCUS and NICaS groups [(2.8 ± 1.2) vs. (2.7 ± 1.1) L/(min·m²)], with no significant difference on the paired t-test (t = 0.931, P = 0.353). Pearson correlation analysis indicated a weak correlation between the two methods (r = 0.380, P = 0.546), whereas the Bland-Altman analysis demonstrated good agreement (mean difference: 0.09255, 95% CI - 0.1031 to 0.2882). A significant positive correlation was observed between IVCV [(20.1% ± 7.6%)] and stroke volume variation (SVV) [(17.4% ± 7.2%)] (r = 0.705, P < 0.001) and between LVEF [(39.5% ± 14.2)] and GGI [(8.5% ± 4.0)] (r = 0.813, P < 0.001). In the management of pediatric septic shock, POCUS and NICaS facilitated earlier achievement of negative fluid balance, reduced the peak VIS, and increased the 28-day survival rate compared with conventional therapy.