TY - JOUR
T1 - International study on microcirculatory shock occurrence in acutely ill patients
AU - Vellinga, Namkje A. R.
AU - Boerma, E. Christiaan
AU - Koopmans, Matty
AU - Donati, Abele
AU - Dubin, Arnaldo
AU - Shapiro, Nathan I.
AU - Pearse, Rupert M.
AU - Machado, Flavia R.
AU - Fries, Michael
AU - Akarsu-Ayazoglu, Tulin
AU - Pranskunas, Andrius
AU - Hollenberg, Steven
AU - Balestra, Gianmarco
AU - van Iterson, Mat
AU - van der Voort, Peter H. J.
AU - Sadaka, Farid
AU - Minto, Gary
AU - Aypar, Ulku
AU - Hurtado, F. Javier
AU - Martinelli, Giampaolo
AU - Payen, Didier
AU - van Haren, Frank
AU - Holley, Anthony
AU - Pattnaik, Rajyabardhan
AU - Gomez, Hernando
AU - Mehta, Ravindra L.
AU - Rodriguez, Alejandro H.
AU - Ruiz, Carolina
AU - Canales, Héctor S.
AU - Duranteau, Jacques
AU - Spronk, Peter E.
AU - Jhanji, Shaman
AU - Hubble, Sheena
AU - Chierego, Marialuisa
AU - Jung, Christian
AU - Martin, Daniel
AU - Sorbara, Carlo
AU - Tijssen, Jan G. P.
AU - Bakker, Jan
AU - Ince, Can
AU - AUTHOR GROUP
AU - Koopmans, M.
AU - van Iterson, M.
AU - van der Voort, P. H. J.
AU - Bakker, J.
AU - van Bommel, J.
AU - Ruiz, C.
AU - Hernandez, G.
AU - Machado, F. R.
AU - Bafi, A. T.
AU - Dubin, A.
PY - 2015
Y1 - 2015
N2 - 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. Multicenter observational point prevalence study. The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. A heterogeneous ICU population consisting of 501 patients. None. 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. 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
AB - 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. Multicenter observational point prevalence study. The Microcirculatory Shock Occurrence in Acutely ill Patients study was conducted in 36 ICUs worldwide. A heterogeneous ICU population consisting of 501 patients. None. 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. 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
U2 - 10.1097/CCM.0000000000000553
DO - 10.1097/CCM.0000000000000553
M3 - Article
C2 - 25126880
SN - 0090-3493
VL - 43
SP - 48
EP - 56
JO - Critical care medicine
JF - Critical care medicine
IS - 1
ER -