Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial

We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis. This was a prospective, formally designed substudy of participants in the Protocolized Care in Early Septic...

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Veröffentlicht in:Critical care (London, England) England), 2018-11, Vol.22 (1), p.308-308, Article 308
Hauptverfasser: Massey, Michael J, Hou, Peter C, Filbin, Michael, Wang, Henry, Ngo, Long, Huang, David T, Aird, William C, Novack, Victor, Trzeciak, Stephen, Yealy, Donald M, Kellum, John A, Angus, Derek C, Shapiro, Nathan I
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Sprache:eng
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Zusammenfassung:We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis. This was a prospective, formally designed substudy of participants in the Protocolized Care in Early Septic Shock (ProCESS) trial. We recruited from six sites with the equipment and training to perform these study procedures. All subjects were adults with septic shock, and each was assigned to alternative resuscitation strategies. The two main analyses assessed (1) the impact of resuscitation strategies on microcirculatory perfusion parameters and (2) the association of microcirculatory perfusion with 60-day in-hospital mortality. We measured sublingual microcirculatory perfusion using sidestream dark field in vivo video microscopy at the completion of the 6-h ProCESS resuscitation protocol and then again at 24 and 72 h. We enrolled 207 subjects (demographics were similar to the overall ProCESS cohort) and observed 40 (19.3%) deaths. There were no differences in average perfusion characteristics between treatment arms. Analyzing the relationship between microcirculatory perfusion and mortality, we found an association between vascular density parameters and mortality. Total vascular density (beta = 0.006, p 
ISSN:1364-8535
1466-609X
1364-8535
1366-609X
DOI:10.1186/s13054-018-2240-5