Authors: Glenn Hernández, Emilio Daniel Valenzuela, Eduardo Kattan, et al.
Published in: Annals of Intensive Care, April 2, 2024
Conclusions:
- FC generally improved or stabilized CRT in fluid-responsive patients, suggesting beneficial effects on tissue perfusion.
- Increasing MAP via norepinephrine in hypertensive, fluid-unresponsive patients showed mixed CRT responses. While it improved in most, some experienced deterioration in skin perfusion, indicating the need for cautious use and further investigation.
Methods:
- Participants: 34 patients with septic shock and abnormal CRT post-initial resuscitation.
- Interventions:
- FC: 500 ml over 30 mins in 9 fluid-responsive patients.
- VPT: Increased norepinephrine dosage to achieve MAP of 80-85 mmHg for 30 mins in 25 patients.
- Measurements: CRT was measured before and after interventions.
Results:
- Fluid Challenge Results: Significant decrease in CRT post-FC (from 5 [3.5-7.6] to 4 [2.4-5.1] sec, p=0.008).
- Vasopressor Test Results: CRT also decreased following VPT (from 4.0 [3.3-5.6] to 3 [2.6-5] sec, p=0.03), although 4 patients showed worsened CRT, potentially linked to concurrent low-dose vasopressin use.