Effects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled trial

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dc.contributor.authorCastro López, Ricardo
dc.contributor.authorKattan Tala, Eduardo José
dc.contributor.authorValenzuela, Emilio Daniel
dc.contributor.authorAlegría, Leyla
dc.contributor.authorOviedo, Vanessa
dc.contributor.authorSoto, Dagoberto
dc.contributor.authorVera Alarcón, María Magdalena
dc.contributor.authorBravo Morales, Sebastián
dc.contributor.authorBakker, Jan
dc.contributor.authorHernández P., Glenn
dc.date.accessioned2020-11-12T15:10:47Z
dc.date.available2020-11-12T15:10:47Z
dc.date.issued2020
dc.date.updated2020-11-08T01:09:17Z
dc.description.abstractAbstract Background Persistent hyperlactatemia has been considered as a signal of tissue hypoperfusion in septic shock patients, but multiple non-hypoperfusion-related pathogenic mechanisms could be involved. Therefore, pursuing lactate normalization may lead to the risk of fluid overload. Peripheral perfusion, assessed by the capillary refill time (CRT), could be an effective alternative resuscitation target as recently demonstrated by the ANDROMEDA-SHOCK trial. We designed the present randomized controlled trial to address the impact of a CRT-targeted (CRT-T) vs. a lactate-targeted (LAC-T) fluid resuscitation strategy on fluid balances within 24 h of septic shock diagnosis. In addition, we compared the effects of both strategies on organ dysfunction, regional and microcirculatory flow, and tissue hypoxia surrogates. Results Forty-two fluid-responsive septic shock patients were randomized into CRT-T or LAC-T groups. Fluids were administered until target achievement during the 6 h intervention period, or until safety criteria were met. CRT-T was aimed at CRT normalization (≤ 3 s), whereas in LAC-T the goal was lactate normalization (≤ 2 mmol/L) or a 20% decrease every 2 h. Multimodal perfusion monitoring included sublingual microcirculatory assessment; plasma-disappearance rate of indocyanine green; muscle oxygen saturation; central venous-arterial pCO2 gradient/ arterial-venous O2 content difference ratio; and lactate/pyruvate ratio. There was no difference between CRT-T vs. LAC-T in 6 h-fluid boluses (875 [375–2625] vs. 1500 [1000–2000], p = 0.3), or balances (982[249–2833] vs. 15,800 [740–6587, p = 0.2]). CRT-T was associated with a higher achievement of the predefined perfusion target (62 vs. 24, p = 0.03). No significant differences in perfusion-related variables or hypoxia surrogates were observed. Conclusions CRT-targeted fluid resuscitation was not superior to a lactate-targeted one on fluid administration or balances. However, it was associated with comparable effects on regional and microcirculatory flow parameters and hypoxia surrogates, and a faster achievement of the predefined resuscitation target. Our data suggest that stopping fluids in patients with CRT ≤ 3 s appears as safe in terms of tissue perfusion. Clinical Trials: ClinicalTrials.gov Identifier: NCT03762005 (Retrospectively registered on December 3rd 2018)
dc.format.extent9 páginas
dc.identifier.citationAnnals of Intensive Care. 2020 Nov 02;10(1):150
dc.identifier.doi10.1186/s13613-020-00767-4
dc.identifier.urihttps://doi.org/10.1186/s13613-020-00767-4
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/48234
dc.issue.numeroNo. 150
dc.language.isoen
dc.pagina.final9
dc.pagina.inicio1
dc.revistaAnnals of Intensive Carees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectSepsises_ES
dc.subjectSeptic shockes_ES
dc.subjectLactatees_ES
dc.subjectHypoxiaes_ES
dc.subjectCapillary refll timees_ES
dc.subject.ddc616.0475
dc.subject.deweyMedicina y saludes_ES
dc.titleEffects of capillary refill time-vs. lactate-targeted fluid resuscitation on regional, microcirculatory and hypoxia-related perfusion parameters in septic shock: a randomized controlled triales_ES
dc.typeartículo
dc.volumenVol. 10
sipa.codpersvinculados4537
sipa.codpersvinculados226652
sipa.codpersvinculados13431
sipa.codpersvinculados1044227
sipa.codpersvinculados98874
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