ArticleCritical care (London, England)2014
Nitroglycerin reverts clinical manifestations of poor peripheral perfusion in patients with circulatory shock.
Article in Critical care (London, England), 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03078712 (Early Goal Directed Therapy Using a Physiological Holistic View. A Multicenter Study in Latin America), which is not on this map. Cited by 20 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Early Goal Directed Therapy Using a Physiological Holistic View. A Multicenter Study in Latin America: The ANDROMEDA-SHOCK Study
Who cites it
20 citing papers in PubMed, 55 citations in OpenAlex.
- Effects of nitroglycerin versus labetalol on peripheral perfusion during deliberate hypotension for sinus endoscopic surgery: a randomized, controlled, double-blinded trial.BMC anesthesiology · 2020Trial
- Trial
- Twenty-five years of septic shock hemodynamic resuscitation trials: a conceptual perspective.Critical care (London, England) · 2026Review
- Refractory septic shock: our updated pragmatic approach.Journal of anesthesia, analgesia and critical care · 2026Review
- Clinical outcomes and peripheral tissue oxygen saturation monitoring of the knee region by near-infrared spectroscopy in circulatory shock: a prospective observational cohort study.Critical care (London, England) · 2025Observational
- Early peripheral perfusion monitoring in septic shock.European journal of medical research · 2024Review
- Local carbachol application induces oral microvascular recruitment and improves gastric tissue oxygenation during hemorrhagic shock in dogs.Frontiers in immunology · 2024Article
- Cerebral Oximetry-Monitored Nitroglycerin Infusion and Tissue Perfusion during Rewarming of Cardiopulmonary Bypass in Cardiac Surgery: A Prospective Randomized Trial.Journal of clinical medicine · 2022Article
- Anesthesia management of patients undergoing off-pump coronary artery bypass grafting: A retrospective study of single center.Frontiers in surgery · 2022Article
- Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods.Journal of clinical monitoring and computing · 2020Observational
- Bedside prediction of intradialytic hemodynamic instability in critically ill patients: the SOCRATE study.Annals of intensive care · 2020Article
- Can Peripheral Skin Perfusion Be Used to Assess Organ Perfusion and Guide Resuscitation Interventions?Frontiers in medicine · 2020Review
- Narrative review: clinical assessment of peripheral tissue perfusion in septic shock.Annals of intensive care · 2019Review
- Alternatives to the Swan-Ganz catheter.Intensive care medicine · 2018Review
- Understanding clinical signs of poor tissue perfusion during septic shock.Intensive care medicine · 2016Article
- Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections.Annals of intensive care · 2016Article
- Intravenous loading of nitroglycerin during rewarming of cardiopulmonary bypass improves metabolic homeostasis in cardiac surgery: a retrospective analysis.Journal of anesthesia · 2016Article
- Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index.Critical care (London, England) · 2015Observational
- Year in review in Intensive Care Medicine 2014: III. Severe infections, septic shock, healthcare-associated infections, highly resistant bacteria, invasive fungal infections, severe viral infections, Ebola virus disease and paediatrics.Intensive care medicine · 2015Review
- Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients.Intensive care medicine · 2015Observational
Corrections and comments
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Authors and funding
6 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionRecent clinical studies have shown a relationship between abnormalities in peripheral perfusion and unfavorable outcome in patients with circulatory shock. Nitroglycerin is effective in restoring alterations in microcirculatory blood flow. The aim of this study was to investigate whether nitroglycerin could correct the parameters of abnormal peripheral circulation in resuscitated circulatory shock patients.
methodsThis interventional study recruited patients who had circulatory shock and who persisted with abnormal peripheral perfusion despite normalization of global hemodynamic parameters. Nitroglycerin started at 2 mg/hour and doubled stepwise (4, 8, and 16 mg/hour) each 15 minutes until an improvement in peripheral perfusion was observed. Peripheral circulation parameters included capillary refill time (CRT), skin-temperature gradient (Tskin-diff), perfusion index (PI), and tissue oxygen saturation (StO2) during a reactive hyperemia test (RincStO2). Measurements were performed before, at the maximum dose, and after cessation of nitroglycerin infusion. Data were analyzed by using linear model for repeated measurements and are presented as mean (standard error).
resultsOf the 15 patients included, four patients (27%) responded with an initial nitroglycerin dose of 2 mg/hour. In all patients, nitroglycerin infusion resulted in significant changes in CRT, Tskin-diff, and PI toward normal at the maximum dose of nitroglycerin: from 9.4 (0.6) seconds to 4.8 (0.3) seconds (P < 0.05), from 3.3 °C (0.7 °C) to 0.7 °C (0.6 °C) (P < 0.05), and from [log] -0.5% (0.2%) to 0.7% (0.1%) (P < 0.05), respectively. Similar changes in StO2 and RincStO2 were observed: from 75% (3.4%) to 84% (2.7%) (P < 0.05) and 1.9%/second (0.08%/second) to 2.8%/second (0.05%/second) (P < 0.05), respectively. The magnitude of changes in StO2 was more pronounced for StO2 of less than 75%: 11% versus 4%, respectively (P < 0.05).
conclusionsDose-dependent infusion of nitroglycerin reverted abnormal peripheral perfusion and poor tissue oxygenation in patients following circulatory shock resuscitation. Individual requirements of nitroglycerin dose to improve peripheral circulation vary between patients. A simple and fast physical examination of peripheral circulation at the bedside can be used to titrate nitroglycerin infusion.
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