Multimodal Assessment of Peripheral Perfusion for the Early Diagnosis of Sepsis in Critically Ill Patients (MAP-SEPS): A Protocol for an Observational Study

IntroductionSepsis-induced organ failure is caused by a dysregulated host response characterized by mitochondrial and microcirculatory abnormalities. Early detection of perfusion deficits is critical to preventing progression to shock and organ failure. While capillary refill time (CRT) and other single-parameter assessments are used, a comprehensive, multimodal evaluation of peripheral perfusion has not yet been applied in clinical settings. The purpose of the MAP-SEPS trial is to ascertain whether such a multimodal approach can enhance early identification of sepsis and organ dysfunction in critically ill ICU patients. Methods and analysisMAP-SEPS is a prospective observational study enrolling a minimum of 50 adult ICU patients without sepsis on admission. Patients will be monitored over 72 hours using a multimodal protocol that includes clinical (CRT, skin temperature, mottling score, urine output), biochemical (lactate, ScvO{square}, Pv- aCO{square}, arterial/interstitial glucose), and near-infrared spectroscopy assessments. Standardized macrohemodynamic monitoring and echocardiography will be performed, along with advanced calculations of venous return dynamics, cardiac efficiency, and arterial/venous resistance. Data will be collected at predefined intervals and analyzed using mixed-effects linear regression models. The primary objective is to assess the predictive value of these hemodynamic and perfusion parameters for early detection of sepsis and organ failure. Secondary outcomes include ICU and hospital length of stay, mechanical ventilation duration, and mortality at 28 and 90 days. Ethics and disseminationThe study has been approved by the Ethics Committee of the General Hospital Tzaneio and complies with the Declaration of Helsinki. Peer-reviewed papers, conference presentations, and clinical seminars will all be used to disseminate the findings, contributing to better bedside evaluation techniques for septic patients.