Sublingual microcirculatory assessment on admission independently predicts the outcome of old intensive care patients suffering from shock.

Autor: Bruno RR; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Schemmelmann M; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Hornemann J; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Moecke HME; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Demirtas F; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Palici L; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Marinova R; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Kanschik D; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Binnebößel S; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Spomer A; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany., Guidet B; Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, 75012, France.; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, 75012, France., Leaver S; General Intensive care, St George's University Hospitals NHS Foundation trust, London, UK., Flaatten H; Department of Clinical Medicine, Department of Anaestesia and Intensive Care, University of Bergen, Haukeland University Hospital, Bergen, Norway., Szczeklik W; Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland., Mikiewicz M; Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland., De Lange DW; Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, the Netherlands., Quenard S; Equipe: épidémiologie hospitalière qualité et organisation des soins, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, 75012, France.; Assistance Publique-Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, Paris, 75012, France., Beil M; General and Medical Intensive Care Units, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel., Kelm M; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.; CARID (Cardiovascular Research Institute Düsseldorf), Duesseldorf, Germany., Jung C; Medical Faculty, Department of Cardiology, Pulmonology and Vascular Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany. christian.jung@med.uni-duesseldorf.de.; CARID (Cardiovascular Research Institute Düsseldorf), Duesseldorf, Germany. christian.jung@med.uni-duesseldorf.de.; Division of Cardiology, Pulmonology, and Vascular Medicine, University Duesseldorf, Moorenstraße 5, 40225, Duesseldorf, Germany. christian.jung@med.uni-duesseldorf.de.
Jazyk: angličtina
Zdroj: Scientific reports [Sci Rep] 2024 Oct 27; Vol. 14 (1), pp. 25668. Date of Electronic Publication: 2024 Oct 27.
DOI: 10.1038/s41598-024-77357-y
Abstrakt: Shock is a life-threatening condition. This study evaluated if sublingual microcirculatory perfusion on admission is associated with 30-day mortality in older intensive care unit (ICU) shock patients. This trial prospectively recruited ICU patients (≥ 80 years old) with arterial lactate above 2 mmol/L, requiring vasopressors despite adequate fluid resuscitation, regardless of shock cause. All patients received sequential sublingual measurements on ICU admission (± 4 h) and 24 (± 4) hours later. The primary endpoint was 30-day mortality. From September 4th, 2022, to May 30th, 2023, 271 patients were screened, and 44 included. Patients were categorized based on the median percentage of perfused small vessels (sPPV) into those with impaired and sustained microcirculation. 71% of videos were of good or acceptable quality without safety issues. Patients with impaired microcirculation had significantly shorter ICU and hospital stays (p = 0.015 and p = 0.019) and higher 30-day mortality (90.0% vs. 62.5%, p = 0.036). Cox regression confirmed the independent association of impaired microcirculation with 30-day mortality (adjusted hazard ratio 3.245 (95% CI 1.178 to 8.943, p = 0.023). Measuring sublingual microcirculation in critically ill older patients with shock on ICU admission is safe, feasible, and provides independent prognostic information about outcomes.Trial registration NCT04169204.
(© 2024. The Author(s).)
Databáze: MEDLINE
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