Mortality effect of peripheral perfusion-guided resuscitation in vasodilatory shock
Mendes H, et al., 2026 · 7 studies included
Summary
Seven randomized trials in 2408 septic shock patients: 28-day mortality RR 0.87 (95% CI 0.76–1.01; P=.06). Bayesian estimates favored benefit, with uncertain magnitude.
Conclusion
A possible benefit remains unconfirmed by the primary frequentist comparison. Peripheral perfusion is one part of serial assessment, not proof that fluids should continue until lactate or refill normalizes.
Clinical Context & Relevant Topics (4)
Disease ReferenceCellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.
The subset of sepsis with profound circulatory and cellular/metabolic abnormality — clinically identified by a vasopressor requirement to maintain MAP ≥ 65 mmHg plus lactate > 2 mmol/L despite adequate fluid resuscitation.
From arterial and venous waveforms to PA catheterization, echo, fluid responsiveness, pressure-volume loops, and integrated shock phenotyping.
Life-threatening organ dysfunction caused by a dysregulated host response to infection — recognized by an acute rise in SOFA score, not by infection plus fever alone.