• Eur J Trauma Emerg Surg · Dec 2022

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

    • Athanasios Chalkias, Eleni Laou, Maria Mermiri, Anastasia Michou, Nicoleta Ntalarizou, Stamatia Koutsona, Georgios Chasiotis, Grigorios Garoufalis, Vasileios Agorogiannis, Aikaterini Kyriakaki, and Nikolaos Papagiannakis.
    • Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece. thanoschalkias@yahoo.gr.
    • Eur J Trauma Emerg Surg. 2022 Dec 1; 48 (6): 469947114699-4711.

    PurposeSevere 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.MethodsA 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).ResultsThirteen 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.ConclusionsThe intraoperative use of microcirculation-guided resuscitation strategy may improve tissue perfusion and hemodynamic coherence in patients with septic shock.© 2022. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany.

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