TY - JOUR
TI - Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock
AU - Chalkias, A.
AU - Laou, E.
AU - Mermiri, M.
AU - Michou, A.
AU - Ntalarizou, N.
AU - Koutsona, S.
AU - Chasiotis, G.
AU - Garoufalis, G.
AU - Agorogiannis, V.
AU - Kyriakaki, A.
AU - Papagiannakis, N.
JO - European Journal of Trauma and Emergency Surgery
PY - 2022
VL - null
TODO - null
SP - null
PB - Springer Science and Business Media Deutschland GmbH
SN - 1863-9933, 1863-9941
TODO - 10.1007/s00068-022-01991-2
TODO - null
TODO - Purpose: Severe sepsis and septic shock may impair microcirculatory perfusion and cause organ dysfunction. The aim of this pilot study was to assess a new microcirculation-guided resuscitation strategy in patients with septic shock undergoing emergency abdominal surgery. Methods: A microcirculation-guided treatment algorithm was developed and applied intraoperatively following restoration of systemic hemodynamics. Sublingual microcirculation was monitored with Sidestream DarkField (SDF +) imaging technique. The primary objective was to investigate the change in De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and Consensus PPV (small) and its association with venous-to-arterial carbon dioxide difference (v-aPCO2). Results: Thirteen consecutive patients were included in the study. Microcirculation-guided resuscitation resulted in an increase of 0.49 mm−1 in the De Backer score (p < 0.001), an increase of 2.28% in the Consensus PPV (p < 0.001), and an increase of 2.26% in the Consensus PPV (small) (p < 0.001) for every 30 min of additional intraoperative time. All microcirculation variables were negatively correlated with v-aPCO2 (rho = − 0.656, adj-p < 0.001; rho = − 0.623; adj-p < 0.001; rho = − 0.597, adj-p < 0.001, respectively) at each intraoperative time point. Lactate levels were negatively correlated with Consensus PPV (rho = − 0.464; adj-p = 0.002) and Consensus PPV (small) (rho = − 0.391, adj-p < 0.001). Survival at 30 days, 90 days, and 1 year were 76.9%, 76.9%, and 61.5%, respectively. Conclusions: The intraoperative use of microcirculation-guided resuscitation strategy may improve tissue perfusion and hemodynamic coherence in patients with septic shock. © 2022, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.
ER -