Peripheral Perfusion vs Standard Management in Sepsis/Septic Shock: A Prospective Randomized ED Study

Yılmaz Ferhat; Yilmaz Serkan; Özturan İbrahim Ulaş; Doğan Nurettin Özgür; Yaka Elif; Yılmaz Kıvrak Gamze; Pekdemir Murat

doi:10.1016/j.ajem.2025.09.024

Peripheral Perfusion vs Standard Management in Sepsis/Septic Shock: A Prospective Randomized ED Study

Am J Emerg Med. 2025 Sep 20:99:167-175. doi: 10.1016/j.ajem.2025.09.024. Online ahead of print.

Authors

Yılmaz Ferhat¹, Yilmaz Serkan², Özturan İbrahim Ulaş¹, Doğan Nurettin Özgür¹, Yaka Elif¹, Yılmaz Kıvrak Gamze¹, Pekdemir Murat¹

Affiliations

¹ Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey.
² Kocaeli University, Faculty of Medicine, Department of Emergency Medicine, Kocaeli, Turkey. Electronic address: syilmazmd@gmail.com.

PMID: 41033063
DOI: 10.1016/j.ajem.2025.09.024

Abstract

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.

Keywords: Microcirculation; Peripheral perfusion; Sepsis; Septic shock; Treatment endpoints.