To explore the application value of critical care ultrasound (CCUS) in fluid administration of ICU patients with severe pneumonia.

A total of 99 patients with severe pneumonia admitted to the ICU of the Affiliated People's Hospital of Jiangsu University from July 2017 to February 2020 were divided into three groups according to different monitoring methods in fluid management. The central venous pressure (CVP) group included 32 patients, who were instructed according to the CVP and routine hemodynamic indexes (heart rate, mean arterial pressure, etc.); the pulse-indicated continuous cardiac output (PICCO) group included 31 patients, who were administered with PICCO; the CCUS group included 36 patients, who applied CCUS to dynamically monitor heart, lung and inferior vena cava indexes to guide fluid management. By comparing the differences in lung function (oxygenation index, relevant respiratory mechanical parameters and mechanical ventilation time), positive fluid balance volume and related prognostic parameters among the three groups, we evaluated the advantages of CCUS in guiding the fluid management of patients with severe pneumonia.

The positive fluid balance volume, oxygenation index, lung static compliance (Clst), airway plateau pressure (P_plat) and positive end-expiratory pressure (PEEP) of the three groups at the 1st, 3rd, 5th and 7th days after treatment were statistically significantly different (F = 8.035, 22.514, 41.080, 67.002, 6.677; all P < 0.05). Further pairwise comparison showed that the oxygenation index and Clst of the PICCO group and CCUS group were higher than those of the CVP group at the 5th and 7th days after treatment (all P < 0.05). The P_plat on the 5th and 7th days after treatment and the positive fluid balance volume and PEEP on the 7th day after treatment were lower in the PICCO and CCUS groups than in the CVP group (all P < 0.05). There were statistically significant differences in the mechanical ventilation time, incidence of pulmonary edema and extrapulmonary organ injury rate among the three groups (H = 13.281; χ² = 8.949, 8.655; P = 0.001, 0.007, 0.013). The mechanical ventilation time (P < 0.05), extrapulmonary organ injury rate (P < 0.017) in the CCUS group and the incidence of pulmonary edema (both P < 0.017) in the PICCO and CCUS groups were significantly lower than those in the CVP group.

CCUS can dynamically monitor volume status and responsiveness, optimize fluid administration, improve lung oxygenation, facilitate lung function recovery and shorten mechanical ventilation time of patients with severe pneumonia.