Remote Ischemic Postconditioning in Septic Shock

Remote Ischemic Postconditioning in Septic Shock

Septic shock is a leading cause of death worldwide despite intensive research efforts. Only a few interventions have been proven to be effective in improving patient-centered outcomes. Recent clinical trials have reported the safety and efficacy of remote ischemic postconditioning (RIPOST) in a variety of pathologies, including myocardial infarction, cardiac surgery, and stroke. While RIPOST was mainly tested in pathologies with low mortality rates, several follow-up studies of large randomized clinical trials in acute myocardial infarction and in patients undergoing coronary artery bypass surgery have reported significant decreases (> 50%) in long-term mortality. Experimental studies and proof-of-concept clinical trials have also suggested the potential benefits of RIPOST on mortality in sepsis and septic shock. The present protocol aims to test whether this non-invasive, widely available, inexpensive, and innovative intervention can improve survival in septic shock.

Inclusion Criteria:

• Age ≥ 18 years
• Hospitalized in intensive care unit for less than 24 hours
• Septic shock (Sepsis-3 definition) evolving for less than 18 hours
• Preliminary written informed consent obtained from the patient or his/her close relative, or use of the emergency procedure in accordance with local regulations

Exclusion Criteria:

• Contraindication of the use of a brachial pressure cuff on both arms
• Cardiac arrest
• Pregnancy or breast feeding
• Participation in another interventional study
• Lack of French national health insurance coverage
• Patient with any legal protection measure