Peripheral perfusion-guided versus routine fluid therapy in sepsis: A randomized controlled pilot trial

Area of Science:

• Critical Care Medicine
• Hemodynamics
• Renal Physiology

Background:

• Sepsis is a major cause of death in critically ill patients.
• Current fluid resuscitation protocols may lead to under- or over-resuscitation due to lack of individualized perfusion assessment.
• Peripheral perfusion index (PPI) offers a noninvasive method to guide fluid therapy.

Purpose of the Study:

• To evaluate if PPI-guided fluid therapy improves clinical and microvascular outcomes in septic ICU patients compared to conventional therapy.
• To assess the impact of PPI-guided therapy on microvascular perfusion, mortality, acute kidney injury, and renal biomarkers.

Main Methods:

• A prospective, randomized trial involving 60 septic adults.
• Patients were assigned to either standard fluid therapy or PPI-guided resuscitation.
• Primary outcome: microvascular perfusion improvement within 72 hours. Secondary outcomes: 7-day mortality, AKI, fluid balance, lactate clearance, and cystatin C levels.

Main Results:

• PPI-guided therapy significantly improved microvascular perfusion (P=0.001) and reduced cystatin C levels by day 7 (P=0.0001).
• Trends favored improved lactate clearance and fluid balance in the PPI group.
• While 7-day mortality and AKI were lower in the intervention group, these did not reach statistical significance.

Conclusions:

• PPI-guided fluid therapy is a feasible and cost-effective approach for individualized resuscitation in sepsis.
• Short-term benefits include improved microvascular perfusion and renal biomarkers, suggesting renal protection.
• Larger trials are needed to confirm long-term clinical outcome benefits.