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Direct assessment of microcirculation in shock - a randomized-controlled multicenter study

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Direct assessment of microcirculation in shock - a randomized-controlled multicenter study. / Bruno, Raphael Romano; Wollborn, Jakob; Fengler, Karl; Flick, Moritz; Wunder, Christian; Allgäuer, Sebastian; Thiele, Holger; Schemmelmann, Mara; Hornemann, Johanna; Moecke, Helene Mathilde Emilie; Demirtas, Filiz; Palici, Lina; Franz, Marcus; Saugel, Bernd; Kattan, Eduardo; De Backer, Daniel; Bakker, Jan; Hernandez, Glenn; Kelm, Malte; Jung, Christian.

in: INTENS CARE MED, Jahrgang 49, Nr. 6, 06.2023, S. 645-655.

Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung

Harvard

Bruno, RR, Wollborn, J, Fengler, K, Flick, M, Wunder, C, Allgäuer, S, Thiele, H, Schemmelmann, M, Hornemann, J, Moecke, HME, Demirtas, F, Palici, L, Franz, M, Saugel, B, Kattan, E, De Backer, D, Bakker, J, Hernandez, G, Kelm, M & Jung, C 2023, 'Direct assessment of microcirculation in shock - a randomized-controlled multicenter study', INTENS CARE MED, Jg. 49, Nr. 6, S. 645-655. https://doi.org/10.1007/s00134-023-07098-5

APA

Bruno, R. R., Wollborn, J., Fengler, K., Flick, M., Wunder, C., Allgäuer, S., Thiele, H., Schemmelmann, M., Hornemann, J., Moecke, H. M. E., Demirtas, F., Palici, L., Franz, M., Saugel, B., Kattan, E., De Backer, D., Bakker, J., Hernandez, G., Kelm, M., & Jung, C. (2023). Direct assessment of microcirculation in shock - a randomized-controlled multicenter study. INTENS CARE MED, 49(6), 645-655. https://doi.org/10.1007/s00134-023-07098-5

Vancouver

Bruno RR, Wollborn J, Fengler K, Flick M, Wunder C, Allgäuer S et al. Direct assessment of microcirculation in shock - a randomized-controlled multicenter study. INTENS CARE MED. 2023 Jun;49(6):645-655. https://doi.org/10.1007/s00134-023-07098-5

Bibtex

@article{81d706ffdc984641a062b92180beb905,
title = "Direct assessment of microcirculation in shock - a randomized-controlled multicenter study",
abstract = "PURPOSE: Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests the hypothesis that considering sublingual microcirculatory perfusion variables in the therapeutic management reduces 30-day mortality in patients admitted to the intensive care unit (ICU) with shock.METHODS: This randomized, prospective clinical multicenter trial-recruited patients with an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of the cause of shock. All patients received sequential sublingual measurements using a sidestream-dark field (SDF) video microscope at admission to the intensive care unit (± 4 h) and 24 (± 4) hours later that was performed blindly to the treatment team. Patients were randomized to usual routine or to integrating sublingual microcirculatory perfusion variables in the therapy plan. The primary endpoint was 30-day mortality, secondary endpoints were length of stay on the ICU and the hospital, and 6-months mortality.RESULTS: Overall, we included 141 patients with cardiogenic (n = 77), post cardiac surgery (n = 27), or septic shock (n = 22). 69 patients were randomized to the intervention and 72 to routine care. No serious adverse events (SAEs) occurred. In the interventional group, significantly more patients received an adjustment (increase or decrease) in vasoactive drugs or fluids (66.7% vs. 41.8%, p = 0.009) within the next hour. Microcirculatory values 24 h after admission and 30-day mortality did not differ [crude: 32 (47.1%) patients versus 25 (34.7%), relative risk (RR) 1.39 (0.91-1.97); Cox-regression: hazard ratio (HR) 1.54 (95% confidence interval (CI) 0.90-2.66, p = 0.118)].CONCLUSION: Integrating sublingual microcirculatory perfusion variables in the therapy plan resulted in treatment changes that do not improve survival at all.",
keywords = "Humans, Microcirculation, Prospective Studies, Shock, Septic/drug therapy, Resuscitation/methods, Intensive Care Units",
author = "Bruno, {Raphael Romano} and Jakob Wollborn and Karl Fengler and Moritz Flick and Christian Wunder and Sebastian Allg{\"a}uer and Holger Thiele and Mara Schemmelmann and Johanna Hornemann and Moecke, {Helene Mathilde Emilie} and Filiz Demirtas and Lina Palici and Marcus Franz and Bernd Saugel and Eduardo Kattan and {De Backer}, Daniel and Jan Bakker and Glenn Hernandez and Malte Kelm and Christian Jung",
note = "{\textcopyright} 2023. The Author(s).",
year = "2023",
month = jun,
doi = "10.1007/s00134-023-07098-5",
language = "English",
volume = "49",
pages = "645--655",
journal = "INTENS CARE MED",
issn = "0342-4642",
publisher = "Springer",
number = "6",

}

RIS

TY - JOUR

T1 - Direct assessment of microcirculation in shock - a randomized-controlled multicenter study

AU - Bruno, Raphael Romano

AU - Wollborn, Jakob

AU - Fengler, Karl

AU - Flick, Moritz

AU - Wunder, Christian

AU - Allgäuer, Sebastian

AU - Thiele, Holger

AU - Schemmelmann, Mara

AU - Hornemann, Johanna

AU - Moecke, Helene Mathilde Emilie

AU - Demirtas, Filiz

AU - Palici, Lina

AU - Franz, Marcus

AU - Saugel, Bernd

AU - Kattan, Eduardo

AU - De Backer, Daniel

AU - Bakker, Jan

AU - Hernandez, Glenn

AU - Kelm, Malte

AU - Jung, Christian

N1 - © 2023. The Author(s).

PY - 2023/6

Y1 - 2023/6

N2 - PURPOSE: Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests the hypothesis that considering sublingual microcirculatory perfusion variables in the therapeutic management reduces 30-day mortality in patients admitted to the intensive care unit (ICU) with shock.METHODS: This randomized, prospective clinical multicenter trial-recruited patients with an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of the cause of shock. All patients received sequential sublingual measurements using a sidestream-dark field (SDF) video microscope at admission to the intensive care unit (± 4 h) and 24 (± 4) hours later that was performed blindly to the treatment team. Patients were randomized to usual routine or to integrating sublingual microcirculatory perfusion variables in the therapy plan. The primary endpoint was 30-day mortality, secondary endpoints were length of stay on the ICU and the hospital, and 6-months mortality.RESULTS: Overall, we included 141 patients with cardiogenic (n = 77), post cardiac surgery (n = 27), or septic shock (n = 22). 69 patients were randomized to the intervention and 72 to routine care. No serious adverse events (SAEs) occurred. In the interventional group, significantly more patients received an adjustment (increase or decrease) in vasoactive drugs or fluids (66.7% vs. 41.8%, p = 0.009) within the next hour. Microcirculatory values 24 h after admission and 30-day mortality did not differ [crude: 32 (47.1%) patients versus 25 (34.7%), relative risk (RR) 1.39 (0.91-1.97); Cox-regression: hazard ratio (HR) 1.54 (95% confidence interval (CI) 0.90-2.66, p = 0.118)].CONCLUSION: Integrating sublingual microcirculatory perfusion variables in the therapy plan resulted in treatment changes that do not improve survival at all.

AB - PURPOSE: Shock is a life-threatening condition characterized by substantial alterations in the microcirculation. This study tests the hypothesis that considering sublingual microcirculatory perfusion variables in the therapeutic management reduces 30-day mortality in patients admitted to the intensive care unit (ICU) with shock.METHODS: This randomized, prospective clinical multicenter trial-recruited patients with an arterial lactate value above two mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of the cause of shock. All patients received sequential sublingual measurements using a sidestream-dark field (SDF) video microscope at admission to the intensive care unit (± 4 h) and 24 (± 4) hours later that was performed blindly to the treatment team. Patients were randomized to usual routine or to integrating sublingual microcirculatory perfusion variables in the therapy plan. The primary endpoint was 30-day mortality, secondary endpoints were length of stay on the ICU and the hospital, and 6-months mortality.RESULTS: Overall, we included 141 patients with cardiogenic (n = 77), post cardiac surgery (n = 27), or septic shock (n = 22). 69 patients were randomized to the intervention and 72 to routine care. No serious adverse events (SAEs) occurred. In the interventional group, significantly more patients received an adjustment (increase or decrease) in vasoactive drugs or fluids (66.7% vs. 41.8%, p = 0.009) within the next hour. Microcirculatory values 24 h after admission and 30-day mortality did not differ [crude: 32 (47.1%) patients versus 25 (34.7%), relative risk (RR) 1.39 (0.91-1.97); Cox-regression: hazard ratio (HR) 1.54 (95% confidence interval (CI) 0.90-2.66, p = 0.118)].CONCLUSION: Integrating sublingual microcirculatory perfusion variables in the therapy plan resulted in treatment changes that do not improve survival at all.

KW - Humans

KW - Microcirculation

KW - Prospective Studies

KW - Shock, Septic/drug therapy

KW - Resuscitation/methods

KW - Intensive Care Units

U2 - 10.1007/s00134-023-07098-5

DO - 10.1007/s00134-023-07098-5

M3 - SCORING: Journal article

C2 - 37278760

VL - 49

SP - 645

EP - 655

JO - INTENS CARE MED

JF - INTENS CARE MED

SN - 0342-4642

IS - 6

ER -