Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial

<b>IMPORTANCE</b>: Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been establishe...

Descripción completa

Guardado en:
Detalles Bibliográficos
Autores principales: Hernández, Glenn, Ospina-Tascón, Gustavo A., Petri Damiani, Lucas, Estenssoro, Elisa, Dubin, Arnaldo, Hurtado, Javier, Friedman, Gilberto, Castro, Ricardo, Alegría, Leyla, Teboul, Jean-Louis, Cecconi, Maurizio, Ferri, Giorgio, Jibaja, Manuel, Pairumani, Ronald, Fernández, Paula Virginia, Barahona, Diego, Granda-Luna, Vladimir, Biasi Cavalcanti, Alexandre, Bakker, Jan
Formato: Articulo
Lenguaje:Español
Publicado: 2019
Materias:
Ciencias Médicas
Peripheral perfusion
Septic shock
Resuscitation Strategy
Acceso en línea:http://sedici.unlp.edu.ar/handle/10915/107704
http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6439620&blobtype=pdf
Aporte de:
SEDICI (UNLP) de Universidad Nacional de La Plata
id I19-R120-10915-107704
record_format dspace
institution Universidad Nacional de La Plata
institution_str I-19
repository_str R-120
collection SEDICI (UNLP)
language Español
topic Ciencias Médicas
Peripheral perfusion
Septic shock
Resuscitation Strategy
spellingShingle Ciencias Médicas
Peripheral perfusion
Septic shock
Resuscitation Strategy
Hernández, Glenn
Ospina-Tascón, Gustavo A.
Petri Damiani, Lucas
Estenssoro, Elisa
Dubin, Arnaldo
Hurtado, Javier
Friedman, Gilberto
Castro, Ricardo
Alegría, Leyla
Teboul, Jean-Louis
Cecconi, Maurizio
Ferri, Giorgio
Jibaja, Manuel
Pairumani, Ronald
Fernández, Paula Virginia
Barahona, Diego
Granda-Luna, Vladimir
Biasi Cavalcanti, Alexandre
Bakker, Jan
Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial
topic_facet Ciencias Médicas
Peripheral perfusion
Septic shock
Resuscitation Strategy
description <b>IMPORTANCE</b>: Abnormal peripheral perfusion after septic shock resuscitation has been associated with organ dysfunction and mortality. The potential role of the clinical assessment of peripheral perfusion as a target during resuscitation in early septic shock has not been established. <b>OBJECTIVE</b>: To determine if a peripheral perfusion–targeted resuscitation during early septic shock in adults is more effective than a lactate level–targeted resuscitation for reducing mortality. <b>DESIGN, SETTING, AND PARTICIPANTS</b> Multicenter, randomized trial conducted at 28 intensive care units in 5 countries. Four-hundred twenty-four patients with septic shock were included between March 2017 and March 2018. The last date of follow-up was June 12, 2018. <b>INTERVENTIONS</b>: Patients were randomized to a step-by-step resuscitation protocol aimed at either normalizing capillary refill time (n = 212) or normalizing or decreasing lactate levels at rates greater than 20% per 2 hours (n = 212), during an 8-hour intervention period. <b>MAIN OUTCOMES AND MEASURES</b> The primary outcome was all-cause mortality at 28 days. Secondary outcomes were organ dysfunction at 72 hours after randomization, as assessed by Sequential Organ Failure Assessment (SOFA) score (range, 0 [best] to 24 [worst]); death within 90 days; mechanical ventilation–, renal replacement therapy–, and vasopressor-free days within 28 days; intensive care unit and hospital length of stay. <b>RESULTS</b>: Among 424 patients randomized (mean age, 63 years; 226 [53%] women), 416 (98%) completed the trial. By day 28, 74 patients (34.9%) in the peripheral perfusion group and 92 patients (43.4%) in the lactate group had died (hazard ratio, 0.75 [95% CI, 0.55 to 1.02]; P = .06; risk difference, −8.5% [95% CI, −18.2% to 1.2%]). Peripheral perfusion–targeted resuscitation was associated with less organ dysfunction at 72 hours (mean SOFA score, 5.6 [SD, 4.3] vs 6.6 [SD, 4.7]; mean difference, −1.00 [95% CI, −1.97 to −0.02]; P = .045). There were no significant differences in the other 6 secondary outcomes. No protocol-related serious adverse reactions were confirmed. <b>CONCLUSIONS AND RELEVANCE</b>: Among patients with septic shock, a resuscitation strategy targeting normalization of capillary refill time, compared with a strategy targeting serum lactate levels, did not reduce all-cause 28-day mortality.
format Articulo
Articulo
author Hernández, Glenn
Ospina-Tascón, Gustavo A.
Petri Damiani, Lucas
Estenssoro, Elisa
Dubin, Arnaldo
Hurtado, Javier
Friedman, Gilberto
Castro, Ricardo
Alegría, Leyla
Teboul, Jean-Louis
Cecconi, Maurizio
Ferri, Giorgio
Jibaja, Manuel
Pairumani, Ronald
Fernández, Paula Virginia
Barahona, Diego
Granda-Luna, Vladimir
Biasi Cavalcanti, Alexandre
Bakker, Jan
author_facet Hernández, Glenn
Ospina-Tascón, Gustavo A.
Petri Damiani, Lucas
Estenssoro, Elisa
Dubin, Arnaldo
Hurtado, Javier
Friedman, Gilberto
Castro, Ricardo
Alegría, Leyla
Teboul, Jean-Louis
Cecconi, Maurizio
Ferri, Giorgio
Jibaja, Manuel
Pairumani, Ronald
Fernández, Paula Virginia
Barahona, Diego
Granda-Luna, Vladimir
Biasi Cavalcanti, Alexandre
Bakker, Jan
author_sort Hernández, Glenn
title Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial
title_short Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial
title_full Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial
title_fullStr Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial
title_full_unstemmed Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock : The ANDROMEDA-SHOCK Randomized Clinical Trial
title_sort effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock : the andromeda-shock randomized clinical trial
publishDate 2019
url http://sedici.unlp.edu.ar/handle/10915/107704
http://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC6439620&blobtype=pdf
work_keys_str_mv AT hernandezglenn effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT ospinatascongustavoa effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT petridamianilucas effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT estenssoroelisa effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT dubinarnaldo effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT hurtadojavier effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT friedmangilberto effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT castroricardo effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT alegrialeyla effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT tebouljeanlouis effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT cecconimaurizio effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT ferrigiorgio effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT jibajamanuel effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT pairumanironald effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT fernandezpaulavirginia effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT barahonadiego effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT grandalunavladimir effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT biasicavalcantialexandre effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
AT bakkerjan effectofaresuscitationstrategytargetingperipheralperfusionstatusvsserumlactatelevelson28daymortalityamongpatientswithsepticshocktheandromedashockrandomizedclinicaltrial
bdutipo_str Repositorios
_version_ 1764820443528691713

Ejemplares similares