Perfusion, perfusion, perfusion- the name of the game. Ever wonder why we activate a rapid response for severe sepsis? What is severe sepsis?
Yes, severe sepsis is when that infectious process has affected the body to go into an overdrive with a SYSTEMIC INFLAMMATORY RESPONSE SYNDROME and has now affected central organs with low perfusion. An end organ, or an organ dysfunction.
On the floor, your best early signs of perfusion issue can be as simple as delayed capillary refill. Lets dive into a trial that’s rivalled early marker (lactic acid) for tissue perfusion issue. Here is a Link to our severe sepsis activation tip sheet.
What is the Andromeda shock trial?
It’s not an interstellar million of years time travel. It is a simple 10 second capillary refill study.
The impact of a resuscitation approach that focuses on how well blood flows to the limbs compared to checking serum lactate levels on the survival rates of patients dealing with septic shock after 28 days.
The surviving sepsis campaign suggests that when you’re trying to get patients with septic shock back on their feet, aiming for normal lactate levels is key. But, there are some hiccups with using lactate as a target because there are other things at play, like liver or kidney issues, metabolic shifts, or even certain meds.
Capillary refill time (CRT) is a handy way to check how well blood is flowing to your extremities and how active your sympathetic nervous system is. It’s linked to organ failures and mortality, which isn’t great, but it could be an alternative to using lactate for guiding resuscitation. Plus, it has some cool perks over lactate—like responding quickly to resuscitation and being super easy to use.
The study
peripheral perfusion-targeted resuscitation: Capillary refill time was measured every 30 mins, and then hourly after normalization for 8 hours. The time to return to normal skin color was measured using a chronometer., cool stuff.
Control: lactate level-targeted resuscitation: Lactate levels every 2 hours for 8 hours. The aim was to get those levels down by 20% every 2 hours or at least bring them back to normal.
Conclusion
On Day 28, the mortality rate was observed to be higher in the lactate group. The CRT group received 408 mL less fluid during the first 8 hours and demonstrated reduced use of adrenaline. The SOFA score was lower in the CRT group during the initial 72 hours. Furthermore, among patients experiencing septic shock, a resuscitation strategy aimed at normalizing capillary refill time did not result in a reduction in all-cause 28-day mortality when compared to a strategy that focused on serum lactate levels.
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