February 17, 2019
Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock.
What was the research question?
Is peripheral perfusion–targeted resuscitation more effective than a lactate level–targeted resuscitation during early septic shock in adults for reducing mortality.
How did they do it?
Multicenter, randomized trial conducted at 28 intensive care units in 5 countries.
Four-hundred twenty-four patients with septic shock were randomized to protocol that aims to 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.
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, death within 90 days; mechanical ventilation-, renal replacement therapy-, and vasopressor-free days within 28 days; intensive care unit and hospital length of stay.
What did they find?
Among 424 patients randomized (mean age, 63 years; 226 [53%] women), 416 (98%) completed the trial.
28-day mortality was 34.9% in the peripheral perfusion group compared to 43.4% in the lactate group had died (P = .06).
Organ dysfunction at 72 hours was lower in the peripheral perfusion–targeted resuscitation compared to the lactate group (mean SOFA score 5.6 vs 6.6; P = .045).
There were no significant differences in the other secondary outcomes, and no protocol-related serious adverse reactions were confirmed.
What are the limitations of the study?
Nonblinded study but low potential for bias.
No previous data were available to facilitate a power calculation.
Interrater variability for capillary refill time was not evaluated.
What does it mean?
28-day mortality was not lower with a resuscitation strategy targeting normalization of capillary refill time compared with a strategy targeting serum lactate levels in patients with septic shock.