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The ANDROMEDA-SHOCK trial compared two ways of guiding early haemodynamic resuscitation in septic shock: targeting peripheral perfusion through capillary refill time versus targeting serum lactate. The study asked whether a readily available bedside marker of peripheral perfusion could provide a more physiologically focused resuscitation target than serial lactate measurements. Patients were randomised to protocols designed to normalise capillary refill time or reduce serum lactate, with treatment adjusted according to predefined haemodynamic steps. The primary outcome, 28-day mortality, was not statistically different between groups, so the trial did not establish superiority of capillary refill-guided resuscitation for mortality. However, the capillary refill strategy was associated with less organ dysfunction at 72 hours, supporting the concept that peripheral perfusion can add useful real-time information during shock management. The practical implication is not that lactate should be abandoned, but that perfusion assessment can be broadened beyond a single laboratory marker. Capillary refill is inexpensive, rapid and repeatable, making it attractive where advanced monitoring is limited. The study therefore fits an increasingly personalised model of sepsis care in which clinicians combine clinical examination, perfusion markers and haemodynamic data to decide when further fluids or vasopressors are appropriate.
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The ANDROMEDA-SHOCK trial compared two ways of guiding early haemodynamic resuscitation in septic shock: targeting peripheral perfusion through capillary refill time versus targeting serum lactate. The study asked whether a readily available bedside marker of peripheral perfusion could provide a more physiologically focused resuscitation target than serial lactate measurements. Patients were randomised to protocols designed to normalise capillary refill time or reduce serum lactate, with treatment adjusted according to predefined haemodynamic steps. The primary outcome, 28-day mortality, was not statistically different between groups, so the trial did not establish superiority of capillary refill-guided resuscitation for mortality. However, the capillary refill strategy was associated with less organ dysfunction at 72 hours, supporting the concept that peripheral perfusion can add useful real-time information during shock management. The practical implication is not that lactate should be abandoned, but that perfusion assessment can be broadened beyond a single laboratory marker. Capillary refill is inexpensive, rapid and repeatable, making it attractive where advanced monitoring is limited. The study therefore fits an increasingly personalised model of sepsis care in which clinicians combine clinical examination, perfusion markers and haemodynamic data to decide when further fluids or vasopressors are appropriate.
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