ArticleRevista Brasileira de terapia intensiva
Hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: The ANDROMEDA-SHOCK-2 Randomized Clinical Trial study protocol.
Article in Revista Brasileira de terapia intensiva. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 2 of them syntheses that pooled it.
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
30 citing papers in PubMed, 2 syntheses or guidelines pooled it, 23 citations in OpenAlex.
- Critical Care Ultrasonography for Volume Management: A Systematic Review, Meta-Analysis, and Trial Sequential Analysis of Randomized Trials.Critical care explorations · 2025Pooled it
- European Society of Intensive Care Medicine (ESICM) 2025 clinical practice guideline on fluid therapy in adult critically ill patients: part 2-the volume of resuscitation fluids.Intensive care medicine · 2025Guideline
- Persistent tissue hypoperfusion improves risk stratification beyond vasopressor dose in refractory septic shock: a secondary analysis of the ANDROMEDA-SHOCK-2 trial.Intensive care medicine · 2026Trial
- Effects of restrictive fluid therapy on the time to resolution of hyperlactatemia in ICU patients with septic shock. A secondary post hoc analysis of the CLASSIC randomized trial.Intensive care medicine · 2024Trial
- Perioperative Point-of-Care Ultrasound Utilization in Abdominal Organ Transplantation. Part II: Postoperative Care.Clinical transplantation · 2026Review
- Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2026.Intensive care medicine · 2026Article
- Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion.Acute and critical care · 2026Article
- Comparison of four noninvasive tools for predicting sepsis and septic shock mortality: a prospective cohort study.Clinical and experimental emergency medicine · 2026Article
- Improving sepsis care with Artificial Intelligence. What would Illich say?Critical care science · 2026Article
- Applied physiology at the bedside: using invasive blood pressure as a true monitoring tool.Annals of intensive care · 2025Review
- A Novel Approach to Early Personalized Hemodynamic Resuscitation: Non-Invasive Peripheral Photoplethysmography for Identifying Predominant Vasodilatory Shock in Sepsis.Acta anaesthesiologica Scandinavica · 2025Article
- Dobutamine administration: a proposal for a standardized approach.Intensive care medicine experimental · 2025Article
- Can we reliably use pulse pressure as a surrogate for stroke volume? Physiological background and potential clinical implications for shock resuscitation.Critical care (London, England) · 2025Review
- Mean arterial pressure targets in intensive care unit patients receiving noradrenaline: An international survey.Critical care and resuscitation : journal of the Australasian Academy of Critical Care Medicine · 2025Article
- Statistical analysis plan for hemodynamic phenotype-based, capillary refill time-targeted resuscitation in early septic shock: the ANDROMEDA-SHOCK-2 randomized clinical trial.Critical care science · 2025Article
- Research Progress on the Measurement Methods and Clinical Significance of Capillary Refill Time.Sensors (Basel, Switzerland) · 2024Review
- A Multivariate Phenotypical Approach of Sepsis and Septic Shock-A Comprehensive Narrative Literature Review.Medicina (Kaunas, Lithuania) · 2024Review
- ANDROMEDA-SHOCK protocol in obstetrics.Intensive care medicine · 2024Article
- Microvascular Autoregulation in Skeletal Muscle Using Near-Infrared Spectroscopy and Derivation of Optimal Mean Arterial Pressure in the ICU: Pilot Study and Comparison With Cerebral Near-Infrared Spectroscopy.Critical care explorations · 2024Observational
- Norepinephrine dose reporting: are we looking at different sides of the same coin?Intensive care medicine · 2024Article
Corrections and comments
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Authors and funding
10 authors at 8 institutions in 7 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundEarly reversion of sepsis-induced tissue hypoperfusion is essential for survival in septic shock. However, consensus regarding the best initial resuscitation strategy is lacking given that interventions designed for the entire population with septic shock might produce unnecessary fluid administration. This article reports the rationale, study design and analysis plan of the ANDROMEDA-2 study, which aims to determine whether a peripheral perfusion-guided strategy consisting of capillary refill time-targeted resuscitation based on clinical and hemodynamic phenotypes is associated with a decrease in a composite outcome of mortality, time to organ support cessation, and hospital length of stay compared to standard care in patients with early (< 4 hours of diagnosis) septic shock.
methodsThe ANDROMEDA-2 study is a multicenter, multinational randomized controlled trial. In the intervention group, capillary refill time will be measured hourly for 6 hours. If abnormal, patients will enter an algorithm starting with pulse pressure assessment. Patients with pulse pressure less than 40mmHg will be tested for fluid responsiveness and receive fluids accordingly. In patients with pulse pressure > 40mmHg, norepinephrine will be titrated to maintain diastolic arterial pressure > 50mmHg. Patients who fail to normalize capillary refill time after the previous steps will be subjected to critical care echocardiography for cardiac dysfunction evaluation and subsequent management. Finally, vasopressor and inodilator tests will be performed to further optimize perfusion. A sample size of 1,500 patients will provide 88% power to demonstrate superiority of the capillary refill time-targeted strategy.
conclusionsIf hemodynamic phenotype-based, capillary refill time-targeted resuscitation demonstrates to be a superior strategy, care processes in septic shock resuscitation can be optimized with bedside tools.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.