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

Area of Science:

• Critical Care Medicine
• Hemodynamics
• Sepsis Pathophysiology

Background:

• Sepsis management involves resuscitation strategies aimed at improving tissue perfusion.
• Microcirculatory dysfunction is a key feature of septic shock.
• Understanding the impact of resuscitation on microcirculation is crucial for improving outcomes.

Purpose of the Study:

• To evaluate the effects of different resuscitation strategies on microcirculatory perfusion in septic shock.
• To determine the association between microcirculatory perfusion parameters and 60-day mortality in septic shock patients.

Main Methods:

• Prospective substudy of the Protocolized Care in Early Septic Shock (ProCESS) trial.
• Adult patients with septic shock received alternative resuscitation strategies.
• Sublingual microcirculatory perfusion was assessed using sidestream dark field microscopy at 6, 24, and 72 hours post-resuscitation.

Main Results:

• No significant differences in average microcirculatory perfusion parameters were observed between the treatment arms.
• An association was found between vascular density parameters (total vascular density, perfused vascular density, De Backer score) and mortality.
• Higher vascular density at 72 hours was significantly associated with survival.

Conclusions:

• Early septic shock resuscitation strategies did not differentially impact microcirculatory perfusion.
• Microcirculatory vascular density at 72 hours may serve as a prognostic indicator for mortality in septic shock.