Testing a conceptual model on early opening of the microcirculation in severe sepsis and septic shock
| Autor: | Mark van Zanten, Jos P.J. Wester, Rob J. Bosman, Heleen M. Oudemans-van Straaten, Peter H. J. van der Voort, Ilse van Stijn, Rutger van Raalte, Durk F. Zandstra |
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| Přispěvatelé: | Intensive care medicine, ICaR - Circulation and metabolism |
| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Resuscitation Time Factors Organ Dysfunction Scores Sepsis mortality Multiple Organ Failure Vasodilator Agents Treatment outcome Pilot Projects Severity of Illness Index Microcirculation Tertiary Care Centers Risk Factors Sepsis Humans Medicine Intensive care medicine Severe sepsis Aged Netherlands business.industry Septic shock Length of Stay Middle Aged medicine.disease Shock Septic Intention to Treat Analysis Vasodilation Intensive Care Units Treatment Outcome Anesthesiology and Pain Medicine Shock (circulatory) Female medicine.symptom business |
| Zdroj: | van der Voort, P H, van Zanten, M, Bosman, R J, van Stijn, I, Wester, J P, van Raalta, R, van Straaten, H M & Zandstra, D F 2015, ' Testing a conceptual model on early opening of the microcirculation in severe sepsis and septic shock: A randomised, controlled pilot study. ', European Journal of Anaesthesiology, vol. 32, no. 3, pp. 189-198 . https://doi.org/10.1097/EJA.0000000000000126 European Journal of Anaesthesiology, 32(3), 189-198. Wolters Kluwer Health |
| ISSN: | 0265-0215 |
| Popis: | Organ failure in severe sepsis and septic shock may be caused by microcirculatory failure.The objective of this study is to test a conceptual model of microcirculatory failure by using a resuscitation strategy targeting early opening of the constricted microcirculation with active vasodilatation.A randomised controlled pilot study.Single-centre mixed medical and surgical tertiary ICU.Ninety severe sepsis and septic shock patients randomised to early opening microcirculation resuscitation group or standard resuscitation group.Standard resuscitation group: fluids, noradrenaline, dobutamine and hydrocortisone were given to achieve a mean arterial pressure (MAP) of more than 60 mmHg, cardiac index more than 2.5 l min m and ScvO2 more than 70%. Microcirculation resuscitation group: nitroglycerin, enoximone, dopamine and dexamethasone targeting a microvascular flow index (MFI), measured by sublingual side-stream dark field imaging, more than 2.5.A decrease in organ failure score (SOFA) on day four of ICU treatment.Data from 37 microcirculation resuscitation and 28 standard resuscitation patients were analysed. In the microcirculation resuscitation group, MFI of more than 2.5 was achieved after a mean ± SD of 7.0 ± 4.6 h. The microcirculation resuscitation group received more fluids, and noradrenaline was equally prescribed in both groups. Per protocol, the decrease in SOFA score at day 4 was not different between groups (P = 0.64). There was a significant reduction in SOFA score in both groups compared with admission (1.2 and 1.6 in microcirculation resuscitation and standard resuscitation groups, respectively; P = 0.028 and P = 0.045).Early opening of the microcirculation in patients with severe sepsis and septic shock using nitroglycerin, enoximone, dopamine and corticosteroids did not result in a faster reduction in organ failure than standard resuscitation.Clinicaltrials.gov identifier NCT00484133. |
| Databáze: | OpenAIRE |
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