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  • International study on microcirculatory shock occurrence in acutely ill patients

    Author(s)
    Vellinga, Namkje A. R.
    Boerma, E. Christiaan
    Koopmans, Matty
    Donati, Abele
    Dubin, Arnaldo
    Shapiro, Nathan I.
    Pearse, Rupert M.
    Machado, F
    Fries, Michael
    Akarsu-Ayazoglu, Tulin
    Pranskunas, Andrius
    Hollenberg, Steven
    Balestra, Gianmarco
    van Iterson, Mat
    van der Voort, Peter H.
    Sadaka, Farid
    Minto, Gary
    Aypar, Ulku
    Hurtado, F. Javier
    Martinelli, Giampaolo
    Payen, Didier
    van Haren, Frank M.
    Holley, Anthony
    Pattnaik, Rajyabardhan
    Gomez, Hernando
    Mehta, Ravindra L.
    Rodriguez, Alejandro H.
    microSOAP Study Group
    Paratz, Jennifer D.
    et al.
    Griffith University Author(s)
    Paratz, Jenny D.
    Year published
    2015
    Metadata
    Show full item record
    Abstract
    bjectives: Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables. Design: Multicenter observational point prevalence study. Setting: The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. Patients: A heterogeneous ICU population consisting ...
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    bjectives: Microcirculatory alterations are associated with adverse outcome in subsets of critically ill patients. The prevalence and significance of microcirculatory alterations in the general ICU population are unknown. We studied the prevalence of microcirculatory alterations in a heterogeneous ICU population and its predictive value in an integrative model of macro- and microcirculatory variables. Design: Multicenter observational point prevalence study. Setting: The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. Patients: A heterogeneous ICU population consisting of 501 patients. Interventions: None. Measurements and Main Results: Demographic, hemodynamic, and laboratory data were collected in all ICU patients who were 18 years old or older. Sublingual Sidestream Dark Field imaging was performed to determine the prevalence of an abnormal capillary microvascular flow index (< 2.6) and its additional value in predicting hospital mortality. In 501 patients with a median Acute Physiology and Chronic Health Evaluation II score of 15 (10–21), a Sequential Organ Failure Assessment score of 5 (2–8), and a hospital mortality of 28.4%, 17% exhibited an abnormal capillary microvascular flow index. Tachycardia (heart rate > 90 beats/min) (odds ratio, 2.71; 95% CI, 1.67–4.39; p < 0.001), mean arterial pressure (odds ratio, 0.979; 95% CI, 0.963–0.996; p = 0.013), vasopressor use (odds ratio, 1.84; 95% CI, 1.11–3.07; p = 0.019), and lactate level more than 1.5 mEq/L (odds ratio, 2.15; 95% CI, 1.28–3.62; p = 0.004) were independent risk factors for hospital mortality, but not abnormal microvascular flow index. In reference to microvascular flow index, a significant interaction was observed with tachycardia. In patients with tachycardia, the presence of an abnormal microvascular flow index was an independent, additive predictor for in-hospital mortality (odds ratio, 3.24; 95% CI, 1.30–8.06; p = 0.011). This was not true for nontachycardic patients nor for the total group of patients. Conclusions: In a heterogeneous ICU population, an abnormal microvascular flow index was present in 17% of patients. This was not associated with mortality. However, in patients with tachycardia, an abnormal microvascular flow index was independently associated with an increased risk of hospital death.
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    Journal Title
    Critical Care Medicine
    Volume
    43
    Issue
    1
    DOI
    https://doi.org/10.1097/CCM.0000000000000553
    Subject
    Clinical Sciences not elsewhere classified
    Clinical Sciences
    Nursing
    Public Health and Health Services
    Publication URI
    http://hdl.handle.net/10072/172218
    Collection
    • Journal articles

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