Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock.

Abstract

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. 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). Thirteen consecutive patients were included in the study. Microcirculation-guided resuscitation resulted in an increase of 0.49mm-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 30min of additional intraoperative time. All microcirculation variables were negativelycorrelated 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 30days, 90days, and 1year were 76.9%, 76.9%, and 61.5%, respectively. The intraoperative use of microcirculation-guided resuscitation strategy may improve tissue perfusion and hemodynamic coherence in patients with septic shock.