The effectiveness and feasibility of fluid resuscitation directed by microcirculation monitoring in patients with septic shock: a randomized controlled trial.

BACKGROUND: This study sought to examine fluid resuscitation in septic shock patients by monitoring their sublabial point of care microcirculation score (POEM) scores (a 3.5 cut-off value was used as the end point of recovery). It also sought to explore the effectiveness and safety of using the POEM score in the fluid resuscitation of septic shock. METHODS: Patients were randomly allocated to the experimental group or the control group. In the experimental group, a POEM score >3 was used as the end point of fluid resuscitation. In the control group, the doctor just monitor, don't know the data. Patients' heart rates, mean arterial pressure (MAP), Acute Physiology and Chronic Health Disease Classification System II (APACHE II) scores, Sequential Organ Failure Assessment (SOFA) scores, and oxygenation index scores were recorded at 2, 24, 48, 72 h, and on the 7th day after admission to the study. Statistically significant differences between the 2 groups were examined. RESULTS: Thirty-one septic shock patients (comprising 14 patients in the experimental group and 17 patients in the control group) participated in our study. Patients' parameters upon admission to the study, including MAP, blood lactate and APACHE score, SOFA score, POEM score, cardiac output (CO), and central venous pressure (CVP), were recorded at 2 h; There was no significant difference in the APACHE II scores, SOFA scores, and oxygenation index scores at 48 h between the 2 groups; however, at 72 h, the scores of the experimental group were significantly better than those of the control group (P<0.05). CONCLUSIONS: Under the guidance of POEM scores, limited fluid resuscitation reduced the intake of fluid any unnecessary amounts of fluids. POEM scores also offered certain protective effects to organ function at the early stage of septic shock, and did not affect patients' circulation. TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR2100049510).