Targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S):...

Area of Science:

• Critical Care Medicine
• Hemodynamics
• Septic Shock Pathophysiology

Background:

• Septic shock carries a high 90-day mortality risk, up to 50%.
• Current hemodynamic targets, like mean arterial pressure (MAP), lack robust clinical evidence.
• Both severe hypotension and high vasopressor doses may be detrimental.

Purpose of the Study:

• To evaluate if a tissue perfusion-guided strategy improves shock resolution compared to standard macrocirculation targets in septic shock patients.
• To assess the impact of a novel treatment approach on key clinical outcomes.

Main Methods:

• Prospective, randomized, open-label, multicenter trial (TARTARE-2S) involving at least 200 septic shock patients.
• Intervention group: tissue perfusion-guided treatment (capillary refill time, peripheral temperature, lactate, lower MAP).
• Control group: standard macrocirculation-guided care; primary outcome: days alive with normal lactate and without vasopressors/inotropes within 30 days.

Main Results:

• The trial is designed to detect a significant difference in the primary outcome measure.
• Sample size recalculation will occur after 150 patients, potentially increasing to 300.
• Safety data will be reviewed by a Data Safety and Monitoring Board after 100 patients.

Conclusions:

• The TARTARE-2S trial will yield crucial clinical data on optimizing hemodynamic targets in septic shock.
• It evaluates the effectiveness of tissue perfusion-guided therapy on shock resolution and 30-day mortality.
• Findings may lead to revised treatment protocols for septic shock management.