{"id":29939,"date":"2026-03-07T04:21:00","date_gmt":"2026-03-06T20:21:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=29939"},"modified":"2026-03-07T06:42:31","modified_gmt":"2026-03-06T22:42:31","slug":"29939","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=29939","title":{"rendered":"[Crit Care Med\u53d1\u8868\u8bba\u6587]\uff1a\u611f\u67d3\u6027\u4f11\u514b\u7684\u76ee\u6807\u6027\u7ec4\u7ec7\u704c\u6ce8\u6cbb\u7597\u4e0e\u5927\u5faa\u73af\u6307\u5bfc\u7684\u6807\u51c6\u6cbb\u7597"},"content":{"rendered":"\n

CLINICAL INVESTIGATION<\/p>\n\n\n\n

Targeted Tissue Perfusion Versus Macrocirculatory-Guided Standard Care in Patients With Septic Shock: A Randomized Clinical Trial\u2014The TARTARE-2S Trial<\/h1>\n\n\n\n

Pettil\u00e4, Ville; Pfortm\u00fcller, Carmen A; Perner, Anders; et al<\/h3>\n\n\n\n

Critical Care Medicine\u00a0<\/em>54(1):p 24-34, January 2026.<\/a>\u00a0|\u00a0DOI:\u00a0<\/em>10.1097\/CCM.0000000000006899<\/h3>\n\n\n\n

Abstract<\/p>\n\n\n\n

\n\n\n\n

Objectives: <\/h3>\n\n\n\n

To determine whether treatment targeting improving tissue perfusion while allowing lower than recommended blood pressure (targeted tissue perfusion [TTP]) improves outcome compared with mean arterial pressure (MAP)-guided standard care (SC).<\/p>\n\n\n\n

Design: <\/h3>\n\n\n\n

A randomized, parallel-group, open-label clinical trial with 30-day follow-up. Allocation was stratified according to trial site and presence of chronic arterial hypertension.<\/p>\n\n\n\n

Setting: <\/h3>\n\n\n\n

Three European university hospital ICUs with enrollment from 2016 to 2022.<\/p>\n\n\n\n

Patients: <\/h3>\n\n\n\n

Two hundred nineteen patients with septic shock and blood lactate greater than 3 mmol\/L allocated to TTP (n<\/em> = 111) vs. SC (n<\/em> = 108).<\/p>\n\n\n\n

Interventions: <\/h3>\n\n\n\n

The TTP protocol comprised capillary refill time, peripheral skin temperature, arterial lactate concentrations, and MAP 50\u201365\u2009mm Hg. The SC protocol comprised the hemodynamic targets of 2012 Surviving Sepsis Campaign.<\/p>\n\n\n\n

Measurements and Main Results: <\/h3>\n\n\n\n

Ninety-seven (87.4%) in TTP and 97 (89.8%) in SC group (total\u00a0n<\/em>\u00a0= 194) were analyzed for the primary outcome. The median (interquartile range) of days alive in 30 days with normal lactate and without vasopressor\/inotropic drugs (primary outcome) was 23 (10\u201327) in TTP group and 22 (1\u201327) in SC group (difference in medians, 0.59; 95% CI, \u20133 to 4). Secondary outcomes (single components of the primary outcome, days alive without organ support and mortality, all at 30 d) and serious adverse reactions were not significantly different between intervention groups. At day 30, 24 patients (24.7%) in TTP group vs. 27 patients (27.8%) in SC group had died. MAP levels were lower in the TTP group vs. the SC group.<\/p>\n\n\n\n

\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n
\"\"<\/a><\/figure>\n\n\n\n

TABLE 1. - Patient and Treatment Characteristics at Baseline<\/em><\/p>\n\n\n\n

Demographics, Diagnoses, Laboratory Values, and Baseline Treatment<\/th>Targeted Tissue Perfusion Group (n<\/em> = 97)<\/th>Standard Care Group (n<\/em> = 97)<\/th><\/tr><\/thead>
Age, mean (sd<\/small>), yr<\/td>62 (14)<\/td>62 (12)<\/td><\/tr>
Number of patients, n<\/em> (%)<\/td><\/td><\/td><\/tr>
\u2003Men<\/td>45 (46)<\/td>36 (38)<\/td><\/tr>
\u2003Women<\/td>52 (54)<\/td>60 (62)<\/td><\/tr>
Body mass index, mean (sd<\/small>), kg\/m2<\/sup><\/td>27 (7.8)<\/td>28 (6.2)<\/td><\/tr>
Concomitant disease, n<\/em> (%)<\/td><\/td><\/td><\/tr>
\u2003Hypertension<\/td>37 (38)<\/td>41 (42)<\/td><\/tr>
\u2003Chronic heart failure<\/td>7 (7)<\/td>10 (10)<\/td><\/tr>
\u2003Previous myocardial infarction<\/td>4 (4)<\/td>8 (8)<\/td><\/tr>
\u2003Previous stroke<\/td>5 (5)<\/td>6 (6)<\/td><\/tr>
\u2003Chronic obstructive pulmonary disease<\/td>8 (8)<\/td>10 (10)<\/td><\/tr>
\u2003Diabetes<\/td>21 (22)<\/td>18 (19)<\/td><\/tr>
\u2003Hematological malignancy<\/td>3 (3)<\/td>2 (2)<\/td><\/tr>
\u2003Metastatic cancer<\/td>6 (6)<\/td>7 (7)<\/td><\/tr>
Suspected or proven site of infection, n<\/em> (%)<\/td><\/td><\/td><\/tr>
\u2003Pulmonary<\/td>18 (19)<\/td>23 (24)<\/td><\/tr>
\u2003Abdominal<\/td>30 (31)<\/td>29 (30)<\/td><\/tr>
\u2003Urinary<\/td>1 (1)<\/td>2 (2)<\/td><\/tr>
\u2003Soft tissue<\/td>13 (13)<\/td>11 (11)<\/td><\/tr>
\u2003Other, including unknown<\/td>34 (35)<\/td>31 (32)<\/td><\/tr>
Baseline values, mean (sd<\/small>)<\/td><\/td><\/td><\/tr>
\u2003Creatinine, \u00b5mol\/L, n<\/em> = 105a<\/a><\/sup><\/td>81 (21)<\/td>81 (26)<\/td><\/tr>
\u2003Lactate, mmol\/L<\/td>6.2 (3.2)<\/td>5.6 (2.8)<\/td><\/tr>
\u2003Hemoglobin, g\/L<\/td>116 (20)<\/td>111 (26)<\/td><\/tr>
\u2003Mean arterial pressure<\/td>65 (9)<\/td>66 (10)<\/td><\/tr>
Treatment at randomization, n<\/em> (%)<\/td><\/td><\/td><\/tr>
\u2003Mechanical ventilationa<\/a><\/sup><\/td>59 (61)<\/td>71 (73)<\/td><\/tr>
\u2003Renal replacement therapya<\/a><\/sup><\/td>21 (21.6)<\/td>23 (23.7)<\/td><\/tr>
\u2003Norepinephrine dose, \u03bcg\/kg\/min<\/td>0.2 (0.2)<\/td>0.2 (0.2)<\/td><\/tr>
\u2003Use of inotropic agentsa<\/a><\/sup><\/td>45 (46.4)<\/td>42 (43.3)<\/td><\/tr>
Fluid volume given\u2014the last 2\u2009hr, mL, mean (sd<\/small>)<\/td>1100 (1033)<\/td>1129 (1061)<\/td><\/tr>
Simplified Acute Physiology Score II score, mean (sd<\/small>)<\/td>57 (17)<\/td>55 (17)<\/td><\/tr>
Sequential Organ Failure Assessment score, mean (sd<\/small>)<\/td>8.9 (2.5)<\/td>8.6 (2.4)<\/td><\/tr><\/tbody><\/table>
a<\/sup>During the preceding 24\u2009hr.<\/figcaption><\/figure>\n\n\n\n

TABLE 2. - Primary Composite Outcomes and Secondary Outcomes<\/em><\/p>\n\n\n\n

Outcomes<\/th>Targeted Tissue Perfusion Group (n<\/em> = 97)<\/th>Standard Care Group (n<\/em> = 97)<\/th>Difference in Medians\/Proportions (95% CI)<\/th>p<\/em><\/th><\/tr><\/thead>
Primary outcome<\/td><\/td><\/td><\/td><\/td><\/tr>
\u2003Days alive in 30 d with normal lactate and without vasopressor or inotropic agents, d, median (IQR)<\/td>23 (10\u201327)<\/td>22 (1\u201327)<\/td>0.59 (\u20133 to 4)<\/td>0.418<\/td><\/tr>
Secondary outcomes<\/td><\/td><\/td><\/td><\/td><\/tr>
\u2003Days alive in 30 d, median (IQR)<\/td>30 (30\u201330)<\/td>30 (16\u201330)<\/td>1.12 (0.59\u20132.12)b<\/a><\/sup><\/td>0.740a<\/a><\/sup><\/td><\/tr>
\u2003Deaths at day 30, count (%)<\/td>24 (24.7)<\/td>27 (27.8)<\/td>\u20133.1 (\u201316.5 to 10.3)<\/td>0.745<\/td><\/tr>
\u2003Time to normal lactate, d, median (IQR)<\/td>2 (0\u20136)<\/td>2 (0\u20135)<\/td>0.15 (\u20132 to 2)<\/td>0.917<\/td><\/tr>
\u2003Days alive with normal lactate in 30 d, median (IQR)<\/td>25 (15\u201329)<\/td>25 (8\u201329)<\/td>0.37 (\u20132 to 4)<\/td>0.597<\/td><\/tr>
\u2003Time to no vasopressor or inotropic agents, d, median (IQR)<\/td>3 (1\u20135)<\/td>3 (2\u20136)<\/td>\u20130.46 (\u20132 to 0)<\/td>0.211<\/td><\/tr>
\u2003Time to normal lactate and no vasopressor or inotropic agents, median (IQR)<\/td>4 (2\u20139)<\/td>5 (2\u20138)<\/td>\u20130.44 (\u20132 to 1)<\/td>0.553<\/td><\/tr>
\u2003Days alive in 30 d without vasopressor or inotropic agents, median (IQR)<\/td>26 (13\u201328)<\/td>24 (3\u201327)<\/td>1.03 (\u20132 to 3)<\/td>0.239<\/td><\/tr>
\u2003Days alive without RRT in 30 d, median (IQR)<\/td>30 (15\u201330)<\/td>30 (14\u201330)<\/td>\u20130.23 (\u20136 to 5)<\/td>0.920<\/td><\/tr>
\u2003Days alive without MV in 30 d, median (IQR)<\/td>25 (11\u201328)<\/td>24 (4\u201328)<\/td>0.37 (\u20133 to 3)<\/td>0.626<\/td><\/tr>
\u2003Days alive without any organ support (RRT, MV) in 30 d, median (IQR)<\/td>24 (8\u201328)<\/td>24 (4\u201328)<\/td>0.06 (\u20134 to 4)<\/td>0.959<\/td><\/tr>
\u2003AKI, n<\/em> (%)<\/td>78 (80)<\/td>69 (71)<\/td>9.3 (\u20133.7 to 22.2)c<\/a><\/sup><\/td>0.180<\/td><\/tr>
\u2003AKI with RRT, n<\/em> (%)<\/td>35 (36)<\/td>31 (32)<\/td>4.1 (\u201310.2 to 18.5)c<\/a><\/sup><\/td>0.650<\/td><\/tr>
\u2003Total amount of norepinephrine given in 96\u2009hr, \u00b5g\/kg, n<\/em> (%)<\/td>766 (819)<\/td>947 (1061)<\/td>12.2 (\u2013293 to 295)<\/td>0.340<\/td><\/tr><\/tbody><\/table>
AKI = acute kidney injury, IQR = interquartile range, MV = mechanical ventilation, RRT = renal replacement therapy.
a<\/sup>Adjusted by site and hypertension.
b<\/sup>Competing risk analysis, difference as hazard ratio adjusted by site and hypertension.
c<\/sup>Difference in risk (95% CI).<\/figcaption><\/figure>\n\n\n\n

Conclusions: <\/h3>\n\n\n\n

In ICU patients with septic shock and lactate greater than 3 mmol\/L, targeting tissue perfusion and allowing lower than recommended MAP did not increase the number of days alive with normal lactate and without vasopressor\/inotropic drugs at 30 days. No additional safety concerns with the TTP strategy were detected compared with SC.<\/p>\n","protected":false},"excerpt":{"rendered":"

CLINICAL INVESTIGATION Targeted Tissue Perfusion Versus […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29939"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=29939"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29939\/revisions"}],"predecessor-version":[{"id":29945,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/29939\/revisions\/29945"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=29939"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=29939"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=29939"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}