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Prospective longitudinal observational study of the macro and micro haemodynamic responses to septic shock in the renal and systemic circulations: a protocol for the MICROSHOCK – RENAL study
  1. Jim Watchorn1,2,
  2. Dean Huang3,
  3. Philip Hopkins1,4,
  4. Kate Bramham1,
  5. Sam Hutchings1,5
  1. 1 School of Immunology and Microbial Sciences, King's College London, London, UK
  2. 2 Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
  3. 3 Department of Radiology, Kings College Hospital, London, UK
  4. 4 Critical Care, Kings College Hospital, London, UK
  5. 5 Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
  1. Correspondence to Dr Jim Watchorn; j.watchorn{at}


Introduction Septic acute kidney injury (AKI) is the most common complication of septic shock and increases mortality. A large body of experimental data suggests alterations in renal perfusion occur, but this is yet to be fully assessed in humans. The aim of the current study is to observe the macro and microcirculations in both the systemic and renal circulations in a cohort of patients with early septic shock.

Methods and analysis Single-centre, prospective, longitudinal, observational study of 50 patients with septic shock. Renal microcirculatory assessment will be performed with contrast-enhanced ultrasound, the sublingual microcirculation assessed with incident dark field microscopy and transthoracic echocardiography used to assess global flow. Patients will be enrolled as soon as possible after admission to the intensive care unit and then at +24,+48 and +96 hours. Blood samples of circulatory and renal biomarkers will be collected. Sample groups will be defined by the presence or absence of AKI and then subclassified by the severity (Kidney Disease Improving Global Outcomes (KDIGO) criteria), variables will be compared within and between groups over time.

Ethics and dissemination Research Ethics Committee (REC) approval has been granted for this study by Yorkshire and the Humber, Leeds West Research Ethics Committee (18/YH/0371) and due to the nature of the patients enrolled with septic shock, capacity for informed consent is likely to be lacking. Therefore, a personal consultee (friend or relative) will be consulted or a nominated consultee (clinician) in their absence. After capacity is regained, consent will then be sought from the patient in accordance with the Mental Capacity Act, UK (2005). This consent process has been approved following REC review. Results will be published in a relevant peer-reviewed journal and presented at academic meetings.

  • microcirculation
  • acute renal failure
  • septic shock
  • contrast enhanced ultrasound
  • dark field microscopy

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  • Contributors JW coauthored the manuscript, is undertaking the investigation and has contributed to the concept. DH is responsible for the radiological input to the study both in concept, writing and training of the investigator(s). KB contributed to the renal aspects of this study, advised on concept and editing of the manuscript. PH contributed to the concept of the study and its evaluation, editing of the manuscript and strategic support. SH is the principal investigator for this study. His involvement includes but is not limited to its design and concept, coauthorship of the manuscript and responsibility for the final editing.

  • Funding The study is sponsored by King's College Hospital NHS Foundation Trust. The study is funded by the Medical Directorate of the Defence Medical Services, part of the UK Ministry of Defence.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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