In patients with early septic shock, the ANDROMEDA‑SHOCK‑2 randomized clinical trial evaluated a personalized hemodynamic resuscitation protocol targeting normalization of capillary refill time. Compared with usual care, this strategy was superior for a hierarchical composite outcome of mortality, duration of vital support, and length of hospital stay at 28 days, with the overall benefit primarily attributable to a shorter duration of organ support. 🧵

The first Colloquium of the ANDROMEDA-SHOCK- NETWORK! Prof Ricardo Castro, MPH, PhD, our vascular physiologist! Masterclass: 25 years of septic shock resuscitation trials! From EGDT to ANDROMEDA-SHOCK-2! Please share around💪 youtu.be/Dr7DKuWAqa4

Here it is

Dear friends! A reminder that this Wednesday at 9 AM Chilean time (GMT-4) we have the first colloquium of the ANDROMEDA-SHOCK network “25 years of septic shock resuscitation trials” Dr Ricardo Castro PUC Chile (free w/o registration). us02web.zoom.us/launch/jc/88…

🫀In cardiogenic shock, we still focus heavily on MACROcirculation: 📉 blood pressure 📉 cardiac output 📉 LVEF 📉 vasopressor dose But what if the real battle is happening deeper? 🩸 At the microcirculatory level. This excellent ATS viewpoint highlights one of the most important evolving concepts in shock physiology: ⚠️ normalization of macrocirculation does not necessarily mean restoration of tissue perfusion. Despite advances in cardiogenic shock management, mortality remains >40%. Even more striking, up to 45% of deaths occur in patients with normalized cardiac index. That disconnect may be explained by persistent: 🩸 microvascular dysfunction 🩸 impaired capillary perfusion 🩸 endothelial dysfunction 🩸 tissue hypoxia despite “acceptable” hemodynamics The review reinforces that: Microcirculation is not a passive bystander. It may be a central driver of: • organ dysfunction • lactate persistence • shock progression • mortality Particularly interesting is the emphasis on simple bedside tools. We often think microcirculation requires advanced devices, yet: 📌 capillary refill time (CRT) 📌 mottling 📌 ΔPCO₂ 📌 lactate trends still carry strong prognostic value. A CRT >3 seconds at ICU admission was associated with worse outcomes, and combining CRT with the CardShock score achieved an impressive AUC of 0.93 for outcome prediction. The article also reviews modern technologies: 🔬 handheld vital microscopy 🔬 sublingual microcirculation imaging 🔬 NIRS 🔬 laser Doppler assessment bringing “real time” bedside microcirculatory monitoring closer to clinical practice. One of the strongest physiological messages: ⚠️ Shock is not only about flow. It is about effective tissue level oxygen delivery. The review beautifully summarizes the four major mechanisms of microvascular dysfunction: • heterogeneity • hemodilution • congestion • edema Particularly relevant for intensivists: 📌 venous congestion itself may worsen microvascular flow 📌 elevated filling pressures impair driving pressure 📌 edema increases oxygen diffusion distance This is highly relevant in: • advanced heart failure • VA ECMO • mixed shock states • fluid overloaded patients Another important takeaway: Persistent microcirculatory dysfunction after VA ECMO initiation was associated with increased mortality, even when macrocirculation improved. Perhaps the key message of this paper is: 🩸 Microcirculation should no longer be considered a secondary endpoint in cardiogenic shock. It may become one of the most important physiological targets of the next decade. 📖 Merdji H, American Journal of Respiratory and Critical Care Medicine. 2026, 212(3), 410–413 doi.org/10.1093/ajrccm/aamaf….

Beautiful View Santiago, Chile 🇨🇱

Webinar “Hantavirus Cardiopulmonary Syndrome: Lessons Learned from Chile”. 🗓️ Lunes 11 de Mayo 2026 ⏰ 10:00 horas, (GMT-4) Modalidad: Online, Gratuita. Inscripciones: forms.gle/H6pJWVPm4j3MCdnq5

重症患者の気管挿管における循環動態の総説が、編集後のPDFとして見られるようになりました！ 全文フリーでダウンロードできます👇 link.springer.com/article/10…

Save the Date!

Do you titrate norepinephrine by weight-based dosing (mcg/kg/min) Well, you might be underestimating the predicted mortality by >20% in obese patients with septic shock. Absolute dosing (mcg/min) would be more accurate. Check our latest manuscript out in @_Anesthesiology

Do you use norepinephrine with weight-based or absolute dosing strategies in septic shock pts? Does it really matter? Check the results of our latest research published in @_Anesthesiology ! @DrMiguelIbarra1 @cjungMD @AndromedaShock @RCastro_L et al.! journals.lww.com/anesthesiol…

El Estudio ANDROMEDA SHOCK-2 fue elegido como el Mejor Estudio Clínico de 2025 por el Editor de @JAMANetwork por su importancia (Choque Séptico, causa número 1 de muerte hospitalaria) e innovación (manejo por perfusión, resultado compuesto y jerárquico) Si aún no lo has leído, qué esperas? jamanetwork.com/journals/jam…

During the next days will explain in a series of posts what AS2 is about: rationale, design, results, perspectives😍😍😍

ANDROMEDA-SHOCK-2 selected by JAMA as trial of the year 😍😍😍😍😍😍😍😍😍😍😍 jamanetwork.com/channels/tri…

We are just submitting a Survey to >300 PIs and centers that participated in the ANDROMEDA-SHOCK Network studies!! The idea is to built up a comprehensive and dynamic database that helps our affiliates to plan future studies!! The Network is getting stronger and more to come!!

We are analyzing the results of ANDROMEDA-PEGASUS with 3150 recruited pts in 4 continents. We hope it provides a strong epidemiological support for considering pulse pressure to take initial decisions during septic shock resuscitation. Coming soon by the ANDROMEDA Network

Just out of the oven! Acute hemodynamic tests to determine the status of macro-to-microcirculatory coupling in septic shock. More and more validating data. In ANDROMEDA-SHOCK-2 great success in normalizing CRT with various tests (summarized in the text)! The way to personalize!!