Journal
EUROPEAN JOURNAL OF TRAUMA AND EMERGENCY SURGERY
Volume 48, Issue 6, Pages 4699-4711Publisher
SPRINGER HEIDELBERG
DOI: 10.1007/s00068-022-01991-2
Keywords
Septic shock; Microcirculation; Tissue perfusion; Critical care; Emergency surgery; Resuscitation
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Funding
- Hellenic Society of Cardiopulmonary Resuscitation
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This pilot study aimed to assess the efficacy of microcirculation-guided resuscitation strategy in patients with septic shock undergoing emergency abdominal surgery. The results showed that this strategy can improve tissue perfusion and hemodynamic coherence.
Purpose Severe sepsis and septic shock may impair microcirculatory perfusion and cause organ dysfunction. The aim of this pilot study was to assess a new microcirculation-guided resuscitation strategy in patients with septic shock undergoing emergency abdominal surgery. Methods A microcirculation-guided treatment algorithm was developed and applied intraoperatively following restoration of systemic hemodynamics. Sublingual microcirculation was monitored with Sidestream DarkField (SDF +) imaging technique. The primary objective was to investigate the change in De Backer score, Consensus Proportion of Perfused Vessels (Consensus PPV), and Consensus PPV (small) and its association with venous-to-arterial carbon dioxide difference (v-aPCO(2)). Results Thirteen consecutive patients were included in the study. Microcirculation-guided resuscitation resulted in an increase of 0.49 mm(-1) in the De Backer score (p < 0.001), an increase of 2.28% in the Consensus PPV (p < 0.001), and an increase of 2.26% in the Consensus PPV (small) (p < 0.001) for every 30 min of additional intraoperative time. All microcirculation variables were negatively correlated with v-aPCO(2) (rho = - 0.656, adj-p < 0.001; rho = - 0.623; adj-p < 0.001; rho = - 0.597, adj-p < 0.001, respectively) at each intraoperative time point. Lactate levels were negatively correlated with Consensus PPV (rho = - 0.464; adj-p = 0.002) and Consensus PPV (small) (rho = - 0.391, adj-p < 0.001). Survival at 30 days, 90 days, and 1 year were 76.9%, 76.9%, and 61.5%, respectively. Conclusions The intraoperative use of microcirculation-guided resuscitation strategy may improve tissue perfusion and hemodynamic coherence in patients with septic shock.
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