Emergency Care, Microcirculation, Sepsis
Conditions
Keywords
microcirculation, septic patient, organ dysfunction, sepsis, peripheral perfusion index, emergency unit
Brief summary
Despite early treatment, the deterioration and mortality of sepsis patients remains high. A possible explanation could be persistent tissue hypoperfusion, or undetected in the early phase despite the normalization of macro-hemodynamic parameters. This interventional study evaluates the impact of measuring microcirculation parameters by nurses on patient prognosis through early initiation of vascular filling.
Detailed description
Sepsis and its most serious form, septic shock, are a public health problem. Sepsis is defined by the presence of organ failure, including acute circulatory failure, which combines hypovolemia, vasoplegia and cardiac dysfunction. Vascular filling is therefore a pillar of the management of septic patients to correct hypovolemia and improve perfusion and tissue oxygenation. Following numerous studies, the evaluation of peripheral microcirculation is becoming a clinical trigger making it possible to identify patients at risk, particularly in emergency department. In a meta-analysis, it has been showed that alterations in microcirculatory perfusion predict deterioration and mortality during severe infections. Currently, no interventional study has evaluated the impact of measuring microcirculatory perfusion (peripheral perfusion index and marbling) by nurses on patient prognosis through early initiation of vascular filling. In this study, patients will be assessed hemodynamically using peripheral perfusion index and/or presence of mottling. If peripheral perfusion index \> 3s and/or presence of marbling a first vascular filling test of 500 cc over 30 minutes will be started after a medical control. Patient will be followed up 7 days to determine outcome.
Interventions
DIAGNOSTIC_TESTmeasurement of the peripheral perfusion index and marbling assessment
in addition to the classic hemodynamic parameters measured in all patients, a measurement of the peripheral perfusion index (from 1 sec to 10 sec) and marbling assessment (scale from 0 to 5) will be performed
Sponsors
University Hospital, Limoges
Study design
Allocation
NON_RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Intervention model description
Quasi-experimental interventional study of the here-elsewhere type, open and multicenter
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
No
Inclusion criteria
1. Age ≥ 18 years 2. Admitted to the Emergency Department for suspected Sepsis for less than 6 hours according to international Sepsis-3 definitions (high probability of infection defined by a fever greater than or equal tol to 38.3°C with a suspected infectious source + Score NEWS 2 greater than or equal to 2) 3. Affiliated to a social security system 4. Having agreed to participate in this study
Exclusion criteria
1. Patient with arterial hypotension (SBP ≤ 100 mmHg) on admission 2. Patient having already received a 500mL filling test over 30 minutes 3. Patients moribund according to the investigator 4. Pregnancy or breastfeeding 5. Patient under guardianship, curatorship or safeguard of justice
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Number and proportion of patients presenting clinical deterioration during emergency care | between time of inclusion and 24 hours after | Clinical deterioration is defined by (composite criterion): 1. Arterial hypotension defined by systolic blood pressure (SBP) ≤ 100 mmHg 2. Implementation of treatment for organ support: * Vasopressor or inotrope * Invasive ventilation 3. Abnormal lactate concentration (\> 2mmol/L), without improvement (absence of decay) 4. Patient admitted in intensive care unit 5. Death |
Secondary
| Measure | Time frame |
|---|---|
| Difference in SOFA score (≥ 2 points) between Hours 0 and Hours 24 (24h±6h) | between Hours 0 and Hours 24 |
| Number and proportion of deaths on Day 7 | from enrollement to the end of the patient participation at Day 7 |
| Number and proportion of patients who received bundles (i) one hour and (ii) 3 hours of admission to the Emergency Department | from admission to the Emergency Department to 3 hours after |
| The correlation of the peripheral perfusion index measurement (pathological : yes/no) between the nurse and the emergency physician | hour 0 |
| Number and proportion of patients sent home, conventional hospitalization or intensive care | from enrollment to the end of the subject participation at day 7 |
| Number and proportion of patients with hydrostatic pulmonary oedema (cardiogenic or volume overload) or receiving diuretic treatment during emergency care | from enrollment to the end of the subject participation at day 7 |
Countries
France
Contacts
Primary ContactAnaelle NARDOT-SUCHAUD
Outcome results
None listed