Personalized Hemodynamic Resuscitation Targeting Capillary Refill Time in Early Septic Shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial.
JAMA, 2025 · Multicenter randomized trial
What the trial found
Win ratio 1.16 (95% CI 1.02–1.33), mainly shorter support. Mortality 26.5% versus 26.6%, HR 0.99 (0.81–1.21).
Clinical interpretation
Tests a multicomponent strategy, not CRT alone or a proven independent mortality reduction.
From arterial and venous waveforms to PA catheterization, echo, fluid responsiveness, pressure-volume loops, and integrated shock phenotyping.
Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.