Chalkias A, Laou E, Mermiri M, Michou A, Ntalarizou N, Koutsona S, Chasiotis G, Garoufalis G, Agorogiannis V, Kyriakaki A, Papagiannakis N: Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock. Eur J Trauma Emerg Surg 2022; 48: 4699-4711- Outcomes Research Consortium

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Chalkias A, Laou E, Mermiri M, Michou A, Ntalarizou N, Koutsona S, Chasiotis G, Garoufalis G, Agorogiannis V, Kyriakaki A, Papagiannakis N: Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock. Eur J Trauma Emerg Surg 2022; 48: 4699-4711

July 27, 2022

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 (Con- sensus 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 micro- circulation variables were negatively correlated with v-aPCO2 (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.
Keywords
Septic shock · Microcirculation · Tissue perfusion · Critical care · Emergency surgery · Resuscitation