Testing a conceptual model on early opening of the microcirculation in severe sepsis and septic shock. Issue 3 (March 2015)

• Record Type: Journal Article
• Authors: van der Voort, Peter H.J.; van Zanten, Mark; Bosman, Rob J.; van Stijn, Ilse; Wester, Jos P.J.; van Raalte, Rutger; Oudemans-van Straaten, Heleen M.; Zandstra, Durk F.
• Is Part Of: European journal of anaesthesiology. Volume 32:Issue 3(2015:Mar.)
• Publication Date: 2015-03
• Subjects: Anesthesiology -- Periodicals; Anesthesiology -- Periodicals; Anesthésiologie -- Périodiques; Anesthesiology; Periodicals; Electronic journals; 617.96
• DOI: 10.1097/EJA.0000000000000126
• Languages: English
• ISSNs: 0265-0215

Abstract

<abstract> <title> <x xml:space="preserve">Abstract</x> </title> <sec> <title>BACKGROUND</title> <p>Organ failure in severe sepsis and septic shock may be caused by microcirculatory failure.</p> </sec> <sec> <title>OBJECTIVE</title> <p>The objective of this study is to test a conceptual model of microcirculatory failure by using a resuscitation strategy targeting early opening of the constricted microcirculation with active vasodilatation.</p> </sec> <sec> <title>DESIGN</title> <p>A randomised controlled pilot study.</p> </sec> <sec> <title>SETTING</title> <p>Single-centre mixed medical and surgical tertiary ICU.</p> </sec> <sec> <title>PATIENTS</title> <p>Ninety severe sepsis and septic shock patients randomised to early opening microcirculation resuscitation group or standard resuscitation group.</p> </sec> <sec> <title>INTERVENTIONS</title> <p>Standard resuscitation group: fluids, noradrenaline, dobutamine and hydrocortisone were given to achieve a mean arterial pressure (MAP) of more than 60 mmHg, cardiac index more than 2.5 l min<sup>−1</sup> m<sup>−2</sup> and ScvO<sub>2</sub> more than 70%. Microcirculation resuscitation group: nitroglycerin, enoximone, dopamine and dexamethasone targeting a microvascular flow index (MFI), measured by sublingual side-stream dark field imaging, more than 2.5.</p> </sec> <sec> <title>MAIN OUTCOME MEASURE</title> <p>A decrease in organ failure score (SOFA) on day four of ICU treatment.</p> </sec> <sec> <title>RESULTS</title> <p>Data from 37 microcirculation resuscitation and 28 standard resuscitation patients were analysed. In the microcirculation resuscitation group, MFI of more than 2.5 was achieved after a mean ± SD of 7.0 ± 4.6 h. The microcirculation resuscitation group received more fluids, and noradrenaline was equally prescribed in both groups. Per protocol, the decrease in SOFA score at day 4 was not different between groups (<italic>P</italic> = 0.64). There was a significant reduction in SOFA score in both groups compared with admission (1.2 and 1.6 in microcirculation resuscitation and standard resuscitation groups, respectively; <italic>P</italic> = 0.028 and <italic>P</italic> = 0.045).</p> </sec> <sec> <title>CONCLUSION</title> <p>Early opening of the microcirculation in patients with severe sepsis and septic shock using nitroglycerin, enoximone, dopamine and corticosteroids did not result in a faster reduction in organ failure than standard resuscitation.</p> </sec> <sec> <title>TRIAL REGISTRATION</title> <p>Clinicaltrials.gov identifier NCT00484133.</p> </sec> </abstract>