Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock

Simple item page
dc.catalogadorjlo
dc.contributor.authorHernández Poblete, Glenn Wilson
dc.contributor.authorOspina-Tascón, Gustavo A.
dc.contributor.authorKattan Tala, Eduardo José
dc.contributor.authorIbarra-Estrada, Miguel
dc.contributor.authorRamasco, Fernando
dc.contributor.authorOrozco, Nicolás
dc.contributor.authorRamos, Karla
dc.contributor.authorLuis Aldana, José
dc.contributor.authorFerri, Giorgio
dc.contributor.authorHamzaoui, Olfa
dc.contributor.authorDe Backer, Daniel
dc.contributor.authorTeboul, Jean-Louis
dc.contributor.authorVieillard-Baron, Antoine
dc.contributor.authorPetri Damiani, Lucas
dc.contributor.authorGarcía-Gallardo, Gustavo A.
dc.contributor.authorMorales Zapata, Sebastián Andrés
dc.contributor.authorCarmona García, Paula
dc.contributor.authorAmthauer Rojas, Macarena Paz
dc.contributor.authorAlegria Vargas, Leyla
dc.contributor.authorBakker, Jan
dc.date.accessioned2025-12-15T14:54:03Z
dc.date.available2025-12-15T14:54:03Z
dc.date.issued2025
dc.description.abstractImportance: The optimal strategy for hemodynamic resuscitation in early septic shock remains uncertain.Objective: To determine the effect of a personalized hemodynamic resuscitation protocol targeting capillary refill time (CRT-PHR) on a hierarchical composite outcome of mortality, duration of vital support, and length of hospital stay.Design, setting, and participants: This randomized clinical trial was conducted in 86 centers in 19 countries. Patients within the first 4 hours of septic shock were included between March 2022 and April 2025, with last follow-up in July 2025.Interventions: Patients were randomized to undergo CRT-PHR (n = 720), including assessment of pulse pressure, diastolic arterial pressure, fluid responsiveness, and bedside echocardiography, to tailor fluids, vasopressors, and inotropes, vs usual care (n = 747).Main outcomes and measures: The primary outcome was a hierarchical composite of mortality, duration of vital support (vasoactives, mechanical ventilation, and kidney replacement therapy), and length of hospital stay assessed at 28 days. A win ratio was calculated for the primary outcome by comparing all possible patient pairs, starting with the first event in the hierarchy and stratified by median APACHE (Acute Physiology and Chronic Health Evaluation) II score at admission. Secondary outcomes were mortality, vital support-free days, and length of hospital stay at 28 days.Results: From 1501 randomized patients, 1467 were included in the primary analysis (mean age, 66 [17] years; 43.3% female). There were 131 131 wins (48.9%) in the CRT-PHR group vs 112 787 (42.1%) in the usual care group for the hierarchical composite primary outcome, with a win ratio of 1.16 (95% CI, 1.02-1.33; P = .04). Individual wins for death were 19.1% vs 17.8%; duration of vital support, 26.4% vs 21.1%; and length of hospital stay, 3.4% vs 3.2% in the intervention vs usual care groups, respectively.Conclusions and relevance: Among patients with early septic shock, a personalized hemodynamic resuscitation protocol targeting capillary refill time was superior to usual care for the primary composite outcome, primarily due to a lower duration of vital support.
dc.format.extent12 páginas
dc.fuente.origenORCID
dc.identifier.doi10.1001/JAMA.2025.20402
dc.identifier.urihttps://doi.org/10.1001/JAMA.2025.20402
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/107412
dc.information.autorucEscuela de Medicina; Hernández Poblete, Glenn Wilson; 0000-0002-3032-4087; 98874
dc.information.autorucEscuela de Medicina; Kattan Tala, Eduardo José; 0000-0002-1997-6893; 172152
dc.information.autorucEscuela de Medicina; Morales Zapata, Sebastián Andres; S/I; 178242
dc.information.autorucEscuela de Medicina; Amthauer Rojas, Macarena Paz; 0000-0002-0505-7407; 163666
dc.information.autorucEscuela de Medicina; Alegria Vargas, Leyla; 0000-0002-0930-4452; 121090
dc.information.autorucEscuela de Medicina; Bakker, Jan; 0000-0003-2236-7391; 1044227
dc.language.isoen
dc.nota.accesocontenido parcial
dc.revistaJAMA
dc.rightsacceso restringido
dc.subject.ddc610
dc.titlePersonalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock
dc.typeartículo
sipa.codpersvinculados98874
sipa.codpersvinculados172152
sipa.codpersvinculados178242
sipa.codpersvinculados163666
sipa.codpersvinculados121090
sipa.codpersvinculados1044227
sipa.trazabilidadORCID;2025-12-09
Files
Collections
Artículos de revistas