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, Vol. 49, No. 6, 06.2023, p. 645-655.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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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 -