Athanasios Chalkias1,2,3,4, Eleni Laou5, Maria Mermiri5, Anastasia Michou5, Nicoleta Ntalarizou5, Stamatia Koutsona5, Georgios Chasiotis6, Grigorios Garoufalis7, Vasileios Agorogiannis7, Aikaterini Kyriakaki5, Nikolaos Papagiannakis8. 1. Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece. thanoschalkias@yahoo.gr. 2. Outcomes Research Consortium, Cleveland, OH, 44195, USA. thanoschalkias@yahoo.gr. 3. Committee on Shock, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece. thanoschalkias@yahoo.gr. 4. Department of Anesthesiology, University Hospital of Larisa, Biopolis, Mezourlo, 41110, Larisa, Greece. thanoschalkias@yahoo.gr. 5. Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece. 6. Department of Urology, Faculty of Medicine, University of Thessaly, Larisa, Greece. 7. Department of General Surgery, Faculty of Medicine, University of Thessaly, Larisa, Greece. 8. First Department of Neurology, Medical School, Aiginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Abstract
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-aPCO2). 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-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.
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-aPCO2). 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-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.