Direct assessment of microcirculation in shock: a randomized-controlled multicenter study
Raphael Romano Bruno1, Jakob Wollborn2, Karl Fengler3
1Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany.
Intensive Care Medicine
|June 6, 2023
Summary
This study found that using sublingual microcirculatory perfusion variables in shock management did not reduce 30-day mortality. While it led to more treatment adjustments, patient survival rates remained unchanged.
Area of Science:
- Critical Care Medicine
- Cardiovascular Research
- Medical Technology
Background:
- Shock is a critical condition involving microcirculatory dysfunction.
- Early identification and management of microcirculatory alterations are crucial for patient outcomes.
Purpose of the Study:
- To test if integrating sublingual microcirculatory perfusion variables into therapeutic management reduces 30-day mortality in intensive care unit (ICU) patients with shock.
- To evaluate the impact of microcirculatory-guided therapy on patient survival and other clinical outcomes.
Main Methods:
- A randomized, prospective, multicenter clinical trial involving 141 ICU patients with shock.
- Sublingual microcirculation was assessed using sidestream-dark field (SDF) microscopy at ICU admission and 24 hours.
- Patients were randomized to either routine care or therapy guided by microcirculatory variables.
Main Results:
- The intervention group showed significantly more adjustments in vasoactive drugs or fluids (66.7% vs. 41.8%, p=0.009).
- No significant difference was observed in 30-day mortality between the intervention and routine care groups (47.1% vs. 34.7%, HR 1.54, p=0.118).
- Secondary endpoints like ICU and hospital length of stay and 6-month mortality were not significantly different.
Conclusions:
- Integrating sublingual microcirculatory perfusion variables into shock management led to treatment modifications but did not improve 30-day survival.
- Current evidence does not support the routine use of sublingual microcirculatory monitoring to enhance mortality outcomes in shock patients.
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