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As microcirculatory dysfunction is associated with adverse outcomes and objective bedside monitoring remains limited, hyperspectral imaging (HSI) has emerged as a promising noninvasive method to assess tissue oxygenation. This study investigated the association between load of vasoactive medication and microcirculatory impairment using HSI in critically ill patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In this secondary analysis of the prospective HySpec-ICU study, 502 surgical ICU patients were included. HSI measurements of the hand were performed on the day of admission to determine tissue oxygenation (StO\u2082) and other HSI variables. Multivariable linear regression and mediation analysis were employed to investigate the association between Norepinephrine Equivalent (NEE) and StO\u2082 and its impact on serum lactate levels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Higher NEE was independently associated with significantly lower StO\u2082 (B\u2009=\u2009\u2212\u20090.0931, \u03b2=\u22120.193,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), while MAP showed no significant correlation with StO\u2082. Patients in the highest NEE quartile (&gt;\u20090.28) exhibited the lowest StO\u2082 and the highest 30-day mortality (41.8%). StO\u2082 partially mediated the relationship between vasopressor load and arterial lactate. StO\u2082 generally improved after shock reversal defined as NEE\u2009\u2264\u20090.05, lactate\u2009&lt;\u20092mmol\/l, MAP\u2009\u2265\u200965mmHg for at least 24\u00a0h (+\u20095.8%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>High vasopressor requirements are associated with impaired microcirculatory oxygenation of the hand regardless of systemic blood pressure. HSI provides an objective bedside tool to monitor these alterations, potentially identifying patients with persistent microcirculatory shock who require intensified therapy beyond macrohemodynamic targets.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s13054-026-06110-w","type":"journal-article","created":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T12:42:46Z","timestamp":1780058566000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["High vasopressor doses are associated with decreased tissue oxygenation in critically ill patients: a secondary analysis of a prospective cohort"],"prefix":"10.1186","volume":"30","author":[{"given":"Patrick","family":"Rehn","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharina","family":"H\u00f6lzl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Seidlitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayca","family":"von Garrel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"H\u00f6lle","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maik","family":"von der Forst","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander","family":"Studier-Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mascha","family":"Fiedler-Kalenka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dania","family":"Fischer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felix CF","family":"Schmitt","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christoph","family":"Lichtenstern","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Markus Alexander","family":"Weigand","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena","family":"Maier-Hein","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Dietrich","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephan","family":"Katzenschlager","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,5,29]]},"reference":[{"key":"6110_CR1","doi-asserted-by":"publisher","first-page":"1825","DOI":"10.1097\/01.CCM.0000138558.16257.3F","volume":"32","author":"Y Sakr","year":"2004","unstructured":"Sakr Y, Dubois M-J, de Backer D, Creteur J, Vincent J-L. 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The protocol was approved by the Ethics Committee of the Medical Faculty of Heidelberg University, Germany (study reference number: S-288\/2022, Chairperson Prof. Dr. med. Dr. h.c. Thomas Strowitzki) on April 24th 2022 and registered with the German Clinical Trials Register (study identifier: DRKS00029709; date of registration: 22th August 2022) prior to the commencement of recruitment. Individual patient consent was deferred by the ethics committee, as HSI was performed as part of the routine care during the study time.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"277"}}