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

  • Original Article
  • Published:
European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Severe 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.

Methods

A 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).

Results

Thirteen 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.

Conclusions

The intraoperative use of microcirculation-guided resuscitation strategy may improve tissue perfusion and hemodynamic coherence in patients with septic shock.

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Data availability

Data can be made available upon request after publication through a collaborative process. Researchers should provide a methodically sound proposal with specific objectives in an approval proposal. Please contact the corresponding author for additional information.

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Acknowledgements

This research was partially supported by the Hellenic Society of Cardiopulmonary Resuscitation. The authors would like to thank the medical and nursing stuff of the Department of Anesthesiology, University Hospital of Larisa, Greece, for their assistance during the study period. We are also thankful to Z. Hossain, medical software engineer at Microvision Medical (Amsterdam, The Netherlands), who provided technical expertise that greatly assisted the research.

Funding

None declared.

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Faculty of Medicine, University of Thessaly, Larisa, Greece

    Athanasios Chalkias, Eleni Laou, Maria Mermiri, Anastasia Michou, Nicoleta Ntalarizou, Stamatia Koutsona & Aikaterini Kyriakaki

  2. Outcomes Research Consortium, Cleveland, OH, 44195, USA

    Athanasios Chalkias

  3. Committee on Shock, Hellenic Society of Cardiopulmonary Resuscitation, Athens, Greece

    Athanasios Chalkias

  4. Department of Urology, Faculty of Medicine, University of Thessaly, Larisa, Greece

    Georgios Chasiotis

  5. Department of General Surgery, Faculty of Medicine, University of Thessaly, Larisa, Greece

    Grigorios Garoufalis & Vasileios Agorogiannis

  6. First Department of Neurology, Medical School, Aiginition University Hospital, National and Kapodistrian University of Athens, Athens, Greece

    Nikolaos Papagiannakis

  7. Department of Anesthesiology, University Hospital of Larisa, Biopolis, Mezourlo, 41110, Larisa, Greece

    Athanasios Chalkias

Authors
  1. Athanasios Chalkias
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  2. Eleni Laou
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Contributions

Conceptualization: AC; methodology: AC; investigation: AC, EL, SK, GG, VA, and AK; data curation: AC, EL, MM, AM, NN, GC, and AK; formal analysis: NP; writing—original draft preparation: AC; writing—review and editing: AC, EL, MM, AM, NN, SK, GC, GG, VA, AK, and NP; visualization: AC, EL, and NP; supervision: AC; project administration: AC.

Corresponding author

Correspondence to Athanasios Chalkias.

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Conflict of interest

The authors declare no conflict of interest.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 Supplementary Figure 1: Correlation of v-aPCO2 with PGVR, RVR, and Eh. (TIFF 125 KB)

Supplementary file2 Supplementary Figure 2: Correlation between O2ER and microcirculation variables. (TIFF 157 KB)

Supplementary file3 Supplementary Figure 3: Correlation of O2ER with PGVR, RVR, and Eh. (TIFF 129 KB)

68_2022_1991_MOESM4_ESM.tiff

Supplementary file4 Supplementary Figure 4: Correlation between glucose levels and microcirculation variables. (TIFF 169 KB)

Supplementary file5 Supplementary Figure 5: Correlation between Pmca and microcirculation variables. (TIFF 141 KB)

68_2022_1991_MOESM6_ESM.tiff

Supplementary file6 Supplementary Figure 6: Correlation of microcirculation variables with PGVR, RVR, and Eh. (TIFF 405 KB)

Supplementary file7 Supplementary Figure 7: Correlation of Pmca with PGVR, RVR, and Eh. (TIFF 137 KB)

68_2022_1991_MOESM8_ESM.tiff

Supplementary file8 Supplementary Figure 8: Variation of macrocirculatory and microcirculation variables during the intraoperative period. (TIFF 352 KB)

Supplementary file9 (DOCX 12 KB)

Supplementary file10 (DOCX 18 KB)

Supplementary file11 (DOCX 14 KB)

Supplementary file12 (DOCX 14 KB)

Supplementary file13 (DOCX 15 KB)

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Chalkias, A., Laou, E., Mermiri, M. et al. Microcirculation-guided treatment improves tissue perfusion and hemodynamic coherence in surgical patients with septic shock. Eur J Trauma Emerg Surg 48, 4699–4711 (2022). https://doi.org/10.1007/s00068-022-01991-2

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  • DOI: https://doi.org/10.1007/s00068-022-01991-2

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