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

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dc.contributor.authorBruno, Raphael Romano
dc.contributor.authorWollborn, Jakob
dc.contributor.authorFengler, Karl
dc.contributor.authorFlick, Moritz
dc.contributor.authorJung, Christian
dc.contributor.authorAllgaeuer, Sebastian
dc.contributor.authorThiele, Holger
dc.contributor.authorSchemmelmann, Mara
dc.contributor.authorHornemann, Johanna
dc.contributor.authorMoecke, Helene Mathilde Emilie
dc.contributor.authorDemirtas, Filiz
dc.contributor.authorPalici, Lina
dc.contributor.authorFranz, Marcus
dc.contributor.authorSaugel, Bernd
dc.contributor.authorKattan, Eduardo
dc.contributor.authorDe Backer, Daniel
dc.contributor.authorBakker, Jan
dc.contributor.authorHernandez, Glenn
dc.contributor.authorKelm, Malte
dc.contributor.authorJung, Christian
dc.date.accessioned2025-01-20T20:09:25Z
dc.date.available2025-01-20T20:09:25Z
dc.date.issued2023
dc.description.abstractPurpose: 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.
dc.description.abstractMethods: 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.
dc.description.abstractResults: 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)].
dc.description.abstractConclusion: Integrating sublingual microcirculatory perfusion variables in the therapy plan resulted in treatment changes that do not improve survival at all.
dc.fuente.origenWOS
dc.identifier.doi10.1007/s00134-023-07098-5
dc.identifier.eissn1432-1238
dc.identifier.issn0342-4642
dc.identifier.urihttps://doi.org/10.1007/s00134-023-07098-5
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/91996
dc.identifier.wosidWOS:001007618300002
dc.issue.numero6
dc.language.isoen
dc.pagina.final655
dc.pagina.inicio645
dc.revistaIntensive care medicine
dc.rightsacceso restringido
dc.subjectMicrocirculation
dc.subjectShock
dc.subjectIntensive care
dc.subjectSidestream-dark field video microscope
dc.subjectIntravital microscopy
dc.subject.ods03 Good Health and Well-being
dc.subject.odspa03 Salud y bienestar
dc.titleDirect assessment of microcirculation in shock: a randomized-controlled multicenter study
dc.typeartículo
dc.volumen49
sipa.indexWOS
sipa.trazabilidadWOS;2025-01-12
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