医学
复苏
感染性休克
沙发评分
随机化
器官功能障碍
危险系数
灌注
休克(循环)
重症监护室
内科学
肾脏替代疗法
重症监护
机械通风
随机对照试验
麻醉
败血症
重症监护医学
置信区间
作者
Glenn Hernández,Gustavo Adolfo Ospina-Tascón,Lucas Petri Damiani,Jan Bakker,Arnaldo Dubin,Javier Hurtado,Gilberto Friedman,Ricardo Castro,Leyla Alegría,Jean–Louis Teboul,Maurizio Cecconi,Giorgio Ferri,Manuel Jibaja,Ronald Pairumani,Paula Virginia Fernández,D. Barahona,Vladimir Granda-Luna,Alexandre Biasi Cavalcanti,Jan Bakker
出处
期刊:JAMA
[American Medical Association]
日期:2019-02-19
卷期号:321 (7): 654-654
被引量:486
标识
DOI:10.1001/jama.2019.0071
摘要
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.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.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.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.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.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.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.ClinicalTrials.gov Identifier: NCT03078712.
科研通智能强力驱动
Strongly Powered by AbleSci AI