Influence of Early Goal-Directed Therapy Targeting Capillary Refill Time, Serum Lactate or Base Deficit Levels on Morbidity and Mortality in Septic Shock Patients

Abstract

Background: For patients with septic shock, early resuscitation is crucial in preventing organ failure and mortality. This study aimed to assess influence of early goal-directed therapy targeting capillary refill time, serum lactate, or base deficit levels on 28-day mortality in septic shock patients.Methods: This Prospective randomized clinical single blinded study included 75 patients with septic shock distributed into three equal groups; Capillary Refill Time) CRT( group targeted by normalization of capillary refill time <2 seconds, Lactate group: targeted by serum lactate <2mmole/L or decrease by 20% every two hours, and 3rd group targeted by normalization of base deficit (2 to -2 mmol/L). Measuring capillary refill time, lactate level, and base deficit were performed at baseline and during follow-up. Resuscitation was done according to surviving sepsis campaign guidelines.Results: In the CRT group, CRT value differed significantly at 4,6,8,24,72 hours post-resuscitation in comparison to basal level on admission (p=0.042, 0.001, 0.001, 0.001, 0.001) respectively. In the lactate group, lactate value differed significantly at 4,6,8,24,72 hours post-resuscitation in comparison to basal level on admission (p=0.025, 0.001, 0.001, 0.001, 0.001) respectively. In the BD group, base deficit value differed significantly at 4,6,8,24,72 hours post-resuscitation in comparison to basal level on admission (p=0.015, 0.001, 0.001, 0.001, 0.001), respectively. Out of cases, mortality was reported in 33 cases (44%).Conclusion: Disturbances of lactate, base deficit, and capillary refill time are from the pathogenic mechanisms in sepsis and septic shock, and their correction is from the suggested management plan for the sepsis and septic shock