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Critical Care
Published in: Critical Care 1/2018

Open Access 01-12-2018 | Research

Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial

Authors: Michael J. Massey, Peter C. Hou, Michael Filbin, Henry Wang, Long Ngo, David T. Huang, William C. Aird, Victor Novack, Stephen Trzeciak, Donald M. Yealy, John A. Kellum, Derek C. Angus, Nathan I. Shapiro, for the ProCESS investigators

Published in: Critical Care | Issue 1/2018

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Abstract

Background

We sought to determine the effects of alternative resuscitation strategies on microcirculatory perfusion and examine any association between microcirculatory perfusion and mortality in sepsis.

Methods

This was a prospective, formally designed substudy of participants in the Protocolized Care in Early Septic Shock (ProCESS) trial. We recruited from six sites with the equipment and training to perform these study procedures. All subjects were adults with septic shock, and each was assigned to alternative resuscitation strategies. The two main analyses assessed (1) the impact of resuscitation strategies on microcirculatory perfusion parameters and (2) the association of microcirculatory perfusion with 60-day in-hospital mortality. We measured sublingual microcirculatory perfusion using sidestream dark field in vivo video microscopy at the completion of the 6-h ProCESS resuscitation protocol and then again at 24 and 72 h.

Results

We enrolled 207 subjects (demographics were similar to the overall ProCESS cohort) and observed 40 (19.3%) deaths. There were no differences in average perfusion characteristics between treatment arms. Analyzing the relationship between microcirculatory perfusion and mortality, we found an association between vascular density parameters and mortality. Total vascular density (beta = 0.006, p < 0.003), perfused vascular density (beta = 0.005, p < 0.04), and De Backer score (beta = 0.009, p < 0.01) were higher overall in survivors in a generalized estimating equation model, and this association was significant at the 72-h time point (p < 0.05 for each parameter).

Conclusions

Microcirculatory perfusion did not differ between three early septic shock treatment arms. We found an association between microcirculatory perfusion parameters of vascular density at 72 h and mortality.

Trial registration

ClinicalTrials.gov, NCT00510835. Registered on August 2, 2007.
Appendix
Available only for authorised users
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Metadata
Title
Microcirculatory perfusion disturbances in septic shock: results from the ProCESS trial
Authors
Michael J. Massey
Peter C. Hou
Michael Filbin
Henry Wang
Long Ngo
David T. Huang
William C. Aird
Victor Novack
Stephen Trzeciak
Donald M. Yealy
John A. Kellum
Derek C. Angus
Nathan I. Shapiro
for the ProCESS investigators
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2018
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2240-5

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