The Effect of Resuscitation Guided by Two Different Dynamic Parameters on Time to Normalization of the Capillary Refill Time in Adult Patients with Septic Shock: A Randomized Controlled Prospective Study

Background: With a mortality risk of up to 30–60%, septic shock is a potentially fatal illness. Limiting the course of multiple organ dysfunction requires early detection and reversion of tissue hypoperfusion. Objectives: This study aimed to compare the effect of resuscitation with intravascular fluids and norepinephrine when guided by left ventricular outflow tract velocity time integral (LVOT-VTI) versus when guided by inferior vena cava variability index on time to normalization of the capillary refill time (CRT) in adult patients with septic shock. Methods: This study included 90 adult patients diagnosed as septic shock patients with prolonged CRT (> 3 sec.) and were randomly divided into, group VTI (n=45) underwent LVOT-VTI-guided resuscitation and group IVC (n=45) underwent IVC variability-guided resuscitation. The outcomes evaluations were CRT, fluid requirements, norepinephrine dose, evolution of SOFA score and KDIGO classification and ICU length of stay. Results: There was a significant decline in the prolonged CRT in both studied groups compared to the corresponding baseline values throughout the 6-hour study period. However, group VTI showed significant shorter time needed to CRT normalization. Group IVC showed significant more accelerated reduction in responders’ number over the 6-hour study period and consequently less fluid requirements and more norepinephrine dose in the first 24 hour. Group VTI showed significant higher number of patients with no acute kidney injury AKI or those who recovered from AKI in the first 72 hour. Conclusion: LVOT-VTI guided resuscitation displayed significant less time needed for CRT normalization. Also, LVOT-VTI guided resuscitation resulted in significant less AKI.