Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2018 Nov 20;22(1):308.
doi: 10.1186/s13054-018-2240-5.

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

Michael J Massey  1 , Peter C Hou  2 , Michael Filbin  3 , Henry Wang  4 , Long Ngo  5 , David T Huang  6 , William C Aird  7 , Victor Novack  8 , Stephen Trzeciak  9 , Donald M Yealy  10 , John A Kellum  6 , Derek C Angus  6 , Nathan I Shapiro  11 ; ProCESS investigators
Collaborators, Affiliations
Randomized Controlled Trial

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

Michael J Massey et al. Crit Care. .

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.

Keywords: Microcirculation; Mortality; Pathophysiology; Sepsis.

PubMed Disclaimer

Conflict of interest statement

Authors’ information

No additional information provided.

Ethics approval and consent to participate

The Beth Israel Deaconess Medical Center Committee for Clinical Investigations and each site’s review board approved the study design. Each subject or legal representative gave written informed consent.

Consent for publication

Not applicable.

Competing interests

No nonfinancial conflicts of interest exist for any of the authors. NIS and MJM have previously received equipment support from MicroVision Medical BV.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
a–f Changes in the microcirculatory perfusion parameters over time. These parameters include De Backer score (a), heterogeneity score (b), microcirculatory flow index (c), perfused vascular density (d), proportion of perfused vessels (e), and total vascular density (f). *Significance at a level of p < 0.05
See this image and copyright information in PMC

References

    1. Ince C. The microcirculation is the motor of sepsis. Crit Care. 2005;9(Suppl 4):S13–S19. doi: 10.1186/cc3753. - DOI - PMC - PubMed
    1. Lam C, Tyml K, Martin C, Sibbald W. Microvascular perfusion is impaired in a rat model of normotensive sepsis. J Clin Invest. 1994;94:2077–2083. doi: 10.1172/JCI117562. - DOI - PMC - PubMed
    1. De Backer D, Creteur J, Preiser JC, Dubois MJ, Vincent JL. Microvascular Blood Flow Is Altered in Patients with Sepsis. Am J Respir Crit Care Med. 2002;166:98–104. doi: 10.1164/rccm.200109-016OC. - DOI - PubMed
    1. Sakr Y, Dubois MJ, De Backer D, Creteur J, Vincent JL. Persistent microcirculatory alterations are associated with organ failure and death in patients with septic shock. Crit Care Med. 2004;32:1825–1831. doi: 10.1097/01.CCM.0000138558.16257.3F. - DOI - PubMed
    1. Vincent JL, De Backer D. Microvascular dysfunction as a cause of organ dysfunction in severe sepsis. Crit Care. 2005;9(Suppl 4):S9–12. doi: 10.1186/cc3748. - DOI - PMC - PubMed

Publication types

Associated data