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

Publication ,  Journal Article
Massey, MJ; Hou, PC; Filbin, M; Wang, H; Ngo, L; Huang, DT; Aird, WC; Novack, V; Trzeciak, S; Yealy, DM; Kellum, JA; Angus, DC; Shapiro, NI ...
Published in: Crit Care
November 20, 2018

BACKGROUND: We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis. METHODS: 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. RESULTS: 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 < 0.003), perfused vascular density (beta = 0.005, p < 0.04), and De Backer score (beta = 0.009, p < 0.01) were higher overall in survivors in a generalized estimating equation model, and this association was significant at the 72-h time point (p < 0.05 for each parameter). CONCLUSIONS: Microcirculatory perfusion did not differ between three early septic shock treatment arms. We found an association between microcirculatory perfusion parameters of vascular density at 72 h and mortality. TRIAL REGISTRATION: ClinicalTrials.gov, NCT00510835 . Registered on August 2, 2007.

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Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

November 20, 2018

Volume

22

Issue

1

Start / End Page

308

Location

England

Related Subject Headings

  • Shock, Septic
  • Resuscitation
  • Prospective Studies
  • Organ Dysfunction Scores
  • Middle Aged
  • Microcirculation
  • Male
  • Humans
  • Hemodynamics
  • Female
 

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Massey, M. J., Hou, P. C., Filbin, M., Wang, H., Ngo, L., Huang, D. T., … ProCESS investigators, . (2018). Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial. Crit Care, 22(1), 308. https://doi.org/10.1186/s13054-018-2240-5
Massey, Michael J., Peter C. Hou, Michael Filbin, Henry Wang, Long Ngo, David T. Huang, William C. Aird, et al. “Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial.Crit Care 22, no. 1 (November 20, 2018): 308. https://doi.org/10.1186/s13054-018-2240-5.
Massey MJ, Hou PC, Filbin M, Wang H, Ngo L, Huang DT, et al. Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial. Crit Care. 2018 Nov 20;22(1):308.
Massey, Michael J., et al. “Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial.Crit Care, vol. 22, no. 1, Nov. 2018, p. 308. Pubmed, doi:10.1186/s13054-018-2240-5.
Massey MJ, Hou PC, Filbin M, Wang H, Ngo L, Huang DT, Aird WC, Novack V, Trzeciak S, Yealy DM, Kellum JA, Angus DC, Shapiro NI, ProCESS investigators. Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial. Crit Care. 2018 Nov 20;22(1):308.

Published In

Crit Care

DOI

EISSN

1466-609X

Publication Date

November 20, 2018

Volume

22

Issue

1

Start / End Page

308

Location

England

Related Subject Headings

  • Shock, Septic
  • Resuscitation
  • Prospective Studies
  • Organ Dysfunction Scores
  • Middle Aged
  • Microcirculation
  • Male
  • Humans
  • Hemodynamics
  • Female