• Peter H J van der Voort, Mark van Zanten, Rob J Bosman, Ilse van Stijn, Jos P J Wester, Rutger van Raalte, Heleen M Oudemans-van Straaten, and Durk F Zandstra.
• From the Department of Intensive Care, Onze Lieve Vrouwe Gasthuis, Amsterdam (PHJvdV, MvZ, RJB, IvS, JPJ W, HMO-vS, DFK), the Department of Intensive Care, Tergooi Hospital, Hilversum (RvR), and the Department of Intensive Care, Free University Medical Centre, Amsterdam (HMO-vS), The Netherlands.
• Eur J Anaesthesiol. 2015 Mar 1;32(3):189-98.

BackgroundOrgan failure in severe sepsis and septic shock may be caused by microcirculatory failure.ObjectiveThe 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.DesignA randomised controlled pilot study.SettingSingle-centre mixed medical and surgical tertiary ICU.PatientsNinety severe sepsis and septic shock patients randomised to early opening microcirculation resuscitation group or standard resuscitation group.InterventionsStandard 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 MeasureA decrease in organ failure score (SOFA) on day four of ICU treatment.ResultsData 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).ConclusionEarly 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 RegistrationClinicaltrials.gov identifier NCT00484133.

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