Acute Circulatory Failure
Conditions
Keywords
Tissue perfusion, Capillary refill time, Skin blood flow, Fluid challenge, Inotrope
Brief summary
Tissue perfusion has been identified as an early prognosis factor in patients admitted to intensive care. However, little is known about the effects of different hemodynamic interventions performed in clinical routine on peripheral tissue perfusion. The aim of this work is to study the kinetics of CRT and local skin blood flow following therapeutic intervention (fluid challenge, vasopressor or inotropic drug).
Detailed description
Sepsis is today a major cause of morbidity and mortality worldwide. Septic shock, the most serious manifestation of the infection, affects 2 to 20% of intensive care patients. Despite appropriate antibiotic therapy and improved resuscitation strategies based on early treatment, volume expansion and rational use of vasopressors, the mortality rate of shock states remains too high, between 40 and 50%. Over the past two decades, great advances have been made in the understanding the pathophysiology of septic shock. Microcirculatory abnormalities have been identified as the main cause of organ hypoperfusion and visceral failure leading to death. In addition, several studies in animals and humans have highlighted a discordance between systemic hemodynamic parameters and alterations of small vessels during shock suggesting that microvascular blood flow and tissue perfusion should be analyzed in patients with acute circulatory failure in association with blood pressure and cardiac output. Capillary refill time (CRT), is an easy-to-use, easy-to learn tool to evaluate peripheral tissue perfusion. CRT is a strong predictive factor of organ failure severity and poor outcome in critically ill patients with sepsis. A recent randomized trial reported promising results regarding the use of CRT to guide resuscitation. However, little is known about the impact of treatment on CRT. The aim of this work is to study the kinetics of CRT and local skin blood flow following therapeutic intervention (fluid challenge, vasopressor or inotropic drug).
Interventions
None listed
Sponsors
Assistance Publique - Hôpitaux de Paris
Study design
Observational model
COHORT
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
* Patients in intensive care unit with acute circulatory failure related to sepsis or cardiac failure requiring therapeutic intervention
Exclusion criteria
* Agitation * Hemorrhagic shock * Severe skin lesions
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Skin blood flow variations | continuous monitoring during 1 hour maximum starting just before intervention | Measurement using laser doppler probe in the finger tip |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Capillary refill time | at baseline, 3 timepoints after starting interventions (10, 30 and 60 minutes) | Clinical measurement at bedside |
| Mottling score | at baseline, 3 timepoints after starting interventions (10, 30 and 60 minutes) | Clinical measurement at bedside |
| correlation between Skin blood flow and CRT (baseline and variations) | at baseline, at 10, 30 and 60 minutes after intervention | Measurement using laser doppler probe in the finger tip |
| correlation between skin blood flow and Cardiac output | at baseline, at 10, 30 and 60 minutes after intervention | Laser doppler with skin probe and echocardiography |
| correlation between skin blood flow and mean arterial pressure | at baseline, at 10, 30 and 60 minutes after intervention | Laser doppler with skin probe and arterial catheter |
Countries
France
Contacts
Primary ContactHafid Ait-Oufella
Outcome results
None listed