1. Testing a conceptual model on early opening of the microcirculation in severe sepsis and septic shock: a randomised controlled pilot study.
- Author
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van der Voort PH, van Zanten M, Bosman RJ, van Stijn I, Wester JP, van Raalte R, Oudemans-van Straaten HM, and Zandstra DF
- Subjects
- Aged, Female, Humans, Intensive Care Units, Intention to Treat Analysis, Length of Stay, Male, Middle Aged, Multiple Organ Failure diagnosis, Multiple Organ Failure mortality, Multiple Organ Failure physiopathology, Netherlands, Organ Dysfunction Scores, Pilot Projects, Resuscitation adverse effects, Resuscitation mortality, Risk Factors, Sepsis diagnosis, Sepsis mortality, Sepsis physiopathology, Severity of Illness Index, Shock, Septic diagnosis, Shock, Septic mortality, Shock, Septic physiopathology, Tertiary Care Centers, Time Factors, Treatment Outcome, Vasodilator Agents adverse effects, Microcirculation drug effects, Multiple Organ Failure prevention & control, Resuscitation methods, Sepsis therapy, Shock, Septic therapy, Vasodilation drug effects, Vasodilator Agents therapeutic use
- Abstract
Background: Organ failure in severe sepsis and septic shock may be caused by microcirculatory failure., Objective: 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., Design: A randomised controlled pilot study., Setting: Single-centre mixed medical and surgical tertiary ICU., Patients: Ninety severe sepsis and septic shock patients randomised to early opening microcirculation resuscitation group or standard resuscitation group., Interventions: 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., Main Outcome Measure: A decrease in organ failure score (SOFA) on day four of ICU treatment., Results: 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)., Conclusion: 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., Trial Registration: Clinicaltrials.gov identifier NCT00484133.
- Published
- 2015
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