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

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; Amber E. Barnato; Tammy L. Eaton; Elizabeth Gimbel; Christopher Keener; Kyle Landis; Francis Pike; Diana K. Stapleton; Lisa A. Weissfeld; Michael Willochell; Kourtney A. Wofford; Erik Kulstad; Hannah Watts; Arvind Venkat; Anthony Massaro; Siddharth Parmar; Alexander T. Limkakeng; Kori Brewer; Theodore R. Delbridge; Allison Mainhart; Lakhmir S. Chawla; James R. Miner; Todd L. Allen; Colin K. Grissom; Stuart Swadron; Steven A. Conrad; Richard Carlson; Frank Lovecchio; Ednan K. Bajwa; Michael R. Filbin; Blair A. Parry; Timothy J. Ellender; Andrew E. Sama; Jonathan Fine; Soheil Nafeei; Thomas Terndrup; Margaret Wojnar; Ronald G. Pearl; Scott T. Wilber; Richard Sinert; David J. Orban; Jason W. Wilson; Jacob W. Ufberg; Timothy Albertson; Edward A. Panacek; Sohan Parekh; Scott R. Gunn; Jon S. Rittenberger; Richard J. Wadas; Andrew R. Edwards; Matthew Kelly; Henry E. Wang; Talmage M. Holmes; Michael T. McCurdy; Craig Weinert; Estelle S. Harris; Wesley H. Self; Diane Dubinski; Carolyn A. Phillips; Ronald M. Migues

doi:10.1186/s13054-018-2240-5

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

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, Amber E. Barnato, Tammy L. Eaton, Elizabeth Gimbel, Christopher Keener, Kyle Landis, Francis Pike, Diana K. StapletonLisa A. Weissfeld, Michael Willochell, Kourtney A. Wofford, Erik Kulstad, Hannah Watts, Arvind Venkat, Anthony Massaro, Siddharth Parmar, Alexander T. Limkakeng, Kori Brewer, Theodore R. Delbridge, Allison Mainhart, Lakhmir S. Chawla, James R. Miner, Todd L. Allen, Colin K. Grissom, Stuart Swadron, Steven A. Conrad, Richard Carlson, Frank Lovecchio, Ednan K. Bajwa, Michael R. Filbin, Blair A. Parry, Timothy J. Ellender, Andrew E. Sama, Jonathan Fine, Soheil Nafeei, Thomas Terndrup, Margaret Wojnar, Ronald G. Pearl, Scott T. Wilber, Richard Sinert, David J. Orban, Jason W. Wilson, Jacob W. Ufberg, Timothy Albertson, Edward A. Panacek, Sohan Parekh, Scott R. Gunn, Jon S. Rittenberger, Richard J. Wadas, Andrew R. Edwards, Matthew Kelly, Henry E. Wang, Talmage M. Holmes, Michael T. McCurdy, Craig Weinert, Estelle S. Harris, Wesley H. Self, Diane Dubinski, Carolyn A. Phillips, Ronald M. Migues

Research output: Contribution to journal › Article › peer-review

51 Scopus citations

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.

Original language	English (US)
Article number	308
Journal	Critical Care
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s13054-018-2240-5
State	Published - Nov 20 2018

Keywords

Microcirculation
Mortality
Pathophysiology
Sepsis

ASJC Scopus subject areas

Critical Care and Intensive Care Medicine

Access to Document

10.1186/s13054-018-2240-5

Cite this

Massey, M. J., Hou, P. C., Filbin, M., Wang, H., Ngo, L., Huang, D. T., Aird, W. C., Novack, V., Trzeciak, S., Yealy, D. M., Kellum, J. A., Angus, D. C., Shapiro, N. I., Barnato, A. E., Eaton, T. L., Gimbel, E., Keener, C., Landis, K., Pike, F., ... Migues, R. M. (2018). Microcirculatory perfusion disturbances in septic shock: Results from the ProCESS trial. Critical Care, 22(1), Article 308. https://doi.org/10.1186/s13054-018-2240-5

Massey, MJ, Hou, PC, Filbin, M, Wang, H, Ngo, L, Huang, DT, Aird, WC, Novack, V, Trzeciak, S, Yealy, DM, Kellum, JA, Angus, DC, Shapiro, NI, Barnato, AE, Eaton, TL, Gimbel, E, Keener, C, Landis, K, Pike, F, Stapleton, DK, Weissfeld, LA, Willochell, M, Wofford, KA, Kulstad, E, Watts, H, Venkat, A, Massaro, A, Parmar, S, Limkakeng, AT, Brewer, K, Delbridge, TR, Mainhart, A, Chawla, LS, Miner, JR, Allen, TL, Grissom, CK, Swadron, S, Conrad, SA, Carlson, R, Lovecchio, F, Bajwa, EK, Filbin, MR, Parry, BA, Ellender, TJ, Sama, AE, Fine, J, Nafeei, S, Terndrup, T, Wojnar, M, Pearl, RG, Wilber, ST, Sinert, R, Orban, DJ, Wilson, JW, Ufberg, JW, Albertson, T, Panacek, EA, Parekh, S, Gunn, SR, Rittenberger, JS, Wadas, RJ, Edwards, AR, Kelly, M, Wang, HE, Holmes, TM, McCurdy, MT, Weinert, C, Harris, ES, Self, WH, Dubinski, D, Phillips, CA & Migues, RM 2018, 'Microcirculatory perfusion disturbances in septic shock: Results from the ProCESS trial', Critical Care, vol. 22, no. 1, 308. https://doi.org/10.1186/s13054-018-2240-5

@article{aad3b277cac64d28ab95dd3b3c33130f,

title = "Microcirculatory perfusion disturbances in septic shock: Results from the ProCESS trial",

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",

author = "Massey, {Michael J.} and Hou, {Peter C.} and Michael Filbin and Henry Wang and Long Ngo and Huang, {David T.} and Aird, {William C.} and Victor Novack and Stephen Trzeciak and Yealy, {Donald M.} and Kellum, {John A.} and Angus, {Derek C.} and Shapiro, {Nathan I.} and Barnato, {Amber E.} and Eaton, {Tammy L.} and Elizabeth Gimbel and Christopher Keener and Kyle Landis and Francis Pike and Stapleton, {Diana K.} and Weissfeld, {Lisa A.} and Michael Willochell and Wofford, {Kourtney A.} and Erik Kulstad and Hannah Watts and Arvind Venkat and Anthony Massaro and Siddharth Parmar and Limkakeng, {Alexander T.} and Kori Brewer and Delbridge, {Theodore R.} and Allison Mainhart and Chawla, {Lakhmir S.} and Miner, {James R.} and Allen, {Todd L.} and Grissom, {Colin K.} and Stuart Swadron and Conrad, {Steven A.} and Richard Carlson and Frank Lovecchio and Bajwa, {Ednan K.} and Filbin, {Michael R.} and Parry, {Blair A.} and Ellender, {Timothy J.} and Sama, {Andrew E.} and Jonathan Fine and Soheil Nafeei and Thomas Terndrup and Margaret Wojnar and Pearl, {Ronald G.} and Wilber, {Scott T.} and Richard Sinert and Orban, {David J.} and Wilson, {Jason W.} and Ufberg, {Jacob W.} and Timothy Albertson and Panacek, {Edward A.} and Sohan Parekh and Gunn, {Scott R.} and Rittenberger, {Jon S.} and Wadas, {Richard J.} and Edwards, {Andrew R.} and Matthew Kelly and Wang, {Henry E.} and Holmes, {Talmage M.} and McCurdy, {Michael T.} and Craig Weinert and Harris, {Estelle S.} and Self, {Wesley H.} and Diane Dubinski and Phillips, {Carolyn A.} and Migues, {Ronald M.}",

note = "Publisher Copyright: {\textcopyright} 2018 The Author(s).",

year = "2018",

month = nov,

day = "20",

doi = "10.1186/s13054-018-2240-5",

language = "English (US)",

volume = "22",

journal = "Critical Care",

issn = "1364-8535",

publisher = "Springer Science + Business Media",

number = "1",

}

TY - JOUR

T1 - Microcirculatory perfusion disturbances in septic shock

T2 - Results from the ProCESS trial

AU - Massey, Michael J.

AU - Hou, Peter C.

AU - Filbin, Michael

AU - Wang, Henry

AU - Ngo, Long

AU - Huang, David T.

AU - Aird, William C.

AU - Novack, Victor

AU - Trzeciak, Stephen

AU - Yealy, Donald M.

AU - Kellum, John A.

AU - Angus, Derek C.

AU - Shapiro, Nathan I.

AU - Barnato, Amber E.

AU - Eaton, Tammy L.

AU - Gimbel, Elizabeth

AU - Keener, Christopher

AU - Landis, Kyle

AU - Pike, Francis

AU - Stapleton, Diana K.

AU - Weissfeld, Lisa A.

AU - Willochell, Michael

AU - Wofford, Kourtney A.

AU - Kulstad, Erik

AU - Watts, Hannah

AU - Venkat, Arvind

AU - Massaro, Anthony

AU - Parmar, Siddharth

AU - Limkakeng, Alexander T.

AU - Brewer, Kori

AU - Delbridge, Theodore R.

AU - Mainhart, Allison

AU - Chawla, Lakhmir S.

AU - Miner, James R.

AU - Allen, Todd L.

AU - Grissom, Colin K.

AU - Swadron, Stuart

AU - Conrad, Steven A.

AU - Carlson, Richard

AU - Lovecchio, Frank

AU - Bajwa, Ednan K.

AU - Filbin, Michael R.

AU - Parry, Blair A.

AU - Ellender, Timothy J.

AU - Sama, Andrew E.

AU - Fine, Jonathan

AU - Nafeei, Soheil

AU - Terndrup, Thomas

AU - Wojnar, Margaret

AU - Pearl, Ronald G.

AU - Wilber, Scott T.

AU - Sinert, Richard

AU - Orban, David J.

AU - Wilson, Jason W.

AU - Ufberg, Jacob W.

AU - Albertson, Timothy

AU - Panacek, Edward A.

AU - Parekh, Sohan

AU - Gunn, Scott R.

AU - Rittenberger, Jon S.

AU - Wadas, Richard J.

AU - Edwards, Andrew R.

AU - Kelly, Matthew

AU - Wang, Henry E.

AU - Holmes, Talmage M.

AU - McCurdy, Michael T.

AU - Weinert, Craig

AU - Harris, Estelle S.

AU - Self, Wesley H.

AU - Dubinski, Diane

AU - Phillips, Carolyn A.

AU - Migues, Ronald M.

PY - 2018/11/20

Y1 - 2018/11/20

N2 - 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.

AB - 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.

KW - Microcirculation

KW - Mortality

KW - Pathophysiology

KW - Sepsis

UR - http://www.scopus.com/inward/record.url?scp=85056803119&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85056803119&partnerID=8YFLogxK

U2 - 10.1186/s13054-018-2240-5

DO - 10.1186/s13054-018-2240-5

M3 - Article

C2 - 30458880

AN - SCOPUS:85056803119

SN - 1364-8535

VL - 22

JO - Critical Care

JF - Critical Care

IS - 1

M1 - 308

ER -

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

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this