OBJECTIVE: Despite the restoration of macro-hemodynamic parameters in sepsis treatment, microcirculatory changes can lead to organ failure. This study aims to investigate the effect of patient management guided by PPI in assessing microcirculation on the survival of patients with sepsis and septic shock.

MATERIALS AND METHODS: The study was conducted as a single-center, prospective, randomized controlled trial in the emergency department. The control group was managed according to SSC guidelines using macro-hemodynamic parameters, aiming to maintain MAP =65 mmHg. In the study group, patient management was carried out under the guidance of PPI measurement. Patients with PPI <1.4 were rapidly brought to a euvolemic state when macro-hemodynamic parameters were maintained. If adequate perfusion was not achieved with fluid resuscitation, vasopressor and/or inotropic support was used without regard to the MAP target. The target in this group was to increase PPI above 1.4. The 30-day mortality rate, length of hospital stays and in the intensive care unit were evaluated.

RESULTS: The study included 100 patients in the control group and 100 in the study group. The 30-day mortality rate was significantly lower in the study group (p = 0.03). Lactate clearance was significantly better in the study group (p < 0.001). No significant difference was found between the groups in terms of hospital and ICU length of stay (p = 0.26 and p = 0.68, respectively).

CONCLUSION: Our study has demonstrated that peripheral perfusion-targeted resuscitation is an innovative and effective approach with the potential to reduce mortality compared to standard methods in the management of sepsis and septic shock.

Emergency Medicine rater

Sepsis continues to be difficult to identify and treat. In this single-center Turkish study, the authors studied the effectiveness of Peripheral Perfusion Index (PPI: an analysis of pulse ox waveforms reflecting vasoconstriction vs vasodilation) in guiding sepsis therapy. The study looked at the first 6 hours of treatment in the ER. The authors compared it wit the usual (macrociculatory) method: HR, MAP and lactate clearance. 100 patients were in each group. Patients with low PPI (<1.4) were rapidly made euvolemic. Inotropes were added if fluids were insufficient, as is standard. 30-day mortality was lower in the study group (24.0% vs 31.5%, p=0.03) with swifter lactate clearance. There was no difference in ICU or hospital LOS. Using PPI to guide initial resuscitation is an intriguing idea. This study indicated the need for more trials in this area to guide resuscitation in identified sepsis in the ER. It still does not help us identify septic patients before they are in shock.

Intensivist/Critical Care rater

The study is interesting and novel. The results suggest there may be utility in using PPI to evaluate resuscitation, but further research required.