Very Old Intensive Care Patients - Perfusion

Heinrich-Heine University, Duesseldorf47 enrolled

Overview

Shock is a frequent, etiologically heterogeneous and often lethal clinical condition of intensive care medicine. This is particularly true for very old intensive care patients (VIPs), who are among the fastest-growing subgroups of all intensive care unit (ICU) patients and who suffer from a significantly impaired outcome. In addition to the treatment of the causes of shock, current therapeutic approaches focus on the stabilization of vital parameters, which in general all reflect macrocirculatory measured values such as blood pressure. In contrast, a disturbance of the microcirculation (blood circulation of the smaller blood vessels \<100 µm) is only poorly measurable and delayed. The last generation of AVA-Software (MicroVisionMedical) will calculate different parameters about the capillary densitiv and perfusion in a user-independent way. VIPPER investigates whether a non-invasive measurement of microcirculation using the sublingual mucosa in very old intensive care patients in shock leads to faster recognition and specific treatment of organ dysfunctions. Secondly, this study checks whether this measurement predicts outcome.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Microcirculation Intensive Care Very Old Intensive Care Patients

Interventions

As a simple clinical test, every patient will receive the assessment capillary refill time and mottling-score. Additionally, repetitive measurements of lactate will be done. The SDF-camera (MicroVision Medical®, Amsterdam, Netherlands) will measure sublingual microcirculation at different time points (Admission and 24h).

Eligibility

Sex: ALLMin age: 80 Years

Medical Language ↔ Plain English

Inclusion Criteria: * ≥ 80 years * Acute ICU admission * Shock at the time point of admission to the ICU or in the first 3 hours defined as Lactate ≥ 2 mmol/l AND need for vasoactive substances to maintain a MAP ≥ 65 mmHg in the presence of adequate volume status Exclusion Criteria: * \< 80 years * Inaccessibility for sublingual measurement * no informed consent

Outcomes

Primary Outcomes

bedside measurement of sublingual microcirculation

measurement of sublingual microcirculation by using MicroScan® microscope

Time frame: admission of the intensive care unit

bedside measurement of sublingual microcirculation

measurement of sublingual microcirculation by using MicroScan® microscope

Time frame: after 24 hours

Secondary Outcomes

Mortality

Time frame: after 30 days, 6 months and 12 months

Length of stay at ICU

Time frame: tdays from admission of the intensive care unit until discharge

Use of Vasopressors and fluids

Time frame: days from admission of the intensive care unit until discharge