Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study

Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution o...

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Vydáno v:	Journal of critical care Ročník 27; číslo 3; s. 283 - 288
Hlavní autoři:	Hernandez, Glenn, Pedreros, Cesar, Veas, Enrique, Bruhn, Alejandro, Romero, Carlos, Rovegno, Maximiliano, Neira, Rodolfo, Bravo, Sebastian, Castro, Ricardo, Kattan, Eduardo, Ince, Can
Médium:	Journal Article
Jazyk:	angličtina
Vydáno:	United States Elsevier Inc 01.06.2012 Elsevier Limited
Témata:	Aged Catheters Chile Critical Care Extremities - blood supply Female Fluid Therapy Heart rate Humans Lactate Lactic Acid - blood Male Microcirculation Middle Aged Monitoring, Physiologic - methods Multivariate Analysis Peripheral perfusion Prospective Studies Regional Blood Flow Resuscitation Sepsis Septic shock Shock, Septic - physiopathology Shock, Septic - therapy Skin Temperature Studies Toes - blood supply Veins & arteries Chile Septic shock Peripheral perfusion Lactate Resuscitation
ISSN:	0883-9441, 1557-8615, 1557-8615
On-line přístup:	Získat plný text
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Popis
Shrnutí:	Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject. Patients with sepsis-related circulatory dysfunction were resuscitated according to a standard local algorithm. Perfusion assessment included serial determinations of metabolic (central venous O2 saturation [Scvo2] and central venous to arterial Pco2 gradient [P(cv-a)co2]) and peripheral perfusion parameters (CRT and Tc-toe, among others). Successful resuscitation was defined as a normal plasma lactate at 24 hours. Forty-one patients were included. The presence of normal values for both CRT and Tc-toe considered together at 6 hours was independently associated with a successful resuscitation (P = .02), as compared with the behavior of metabolic parameters. Capillary refill time was the first parameter to be significantly normalized. Early recovery of peripheral perfusion anticipates a successful resuscitation compared with traditional metabolic parameters in septic shock patients. Our findings support the inclusion of serial peripheral perfusion assessment in multimodal monitoring strategies for septic shock resuscitation.
Bibliografie:	ObjectType-Article-2 SourceType-Scholarly Journals-1 content type line 14 ObjectType-Undefined-1 ObjectType-Feature-3 ObjectType-Article-1 ObjectType-Feature-2 content type line 23
ISSN:	0883-9441 1557-8615 1557-8615
DOI:	10.1016/j.jcrc.2011.05.024