Role of Combining Peripheral with Sublingual Perfusion on Evaluating Microcirculation and Predicting Prognosis in Patients with Septic Shock

Pan, Pan; Liu, Dawei; Su, Longxiang; He, Huaiwu; Wang, Xiaoting; Yu, Chao

doi:10.4103/0366-6999.231524

Cited by 13 publications

(9 citation statements)

References 51 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, there remains to be a lack of effective monitoring and early warning when sepsis is early or has not occurred. Sublingual microcirculation monitoring in sepsis patients is used to predict risk stratification and evaluate prognosis, and may guide individualized sepsis treatment in the near future 24,[26][27][28][29] The application of Sidestream Dark Field and Incident Dark Field imaging techniques to analyze sublingual microcirculation and evaluate the degree of microcirculation lesions has been useful. 24 To date, most research on sublingual microcirculation in patients with confirmed sepsis focuses on the relevant treatment and prognosis analysis; research on the changes of sublingual microcirculation before sepsis is lacking.…”

Section: Discussionmentioning

confidence: 99%

Sublingual microcirculation and internal environment changes as early indications of sepsis: A prospective observational study

Yang

Teng

et al. 2023

Microcirculation

View full text Add to dashboard Cite

Objective This study aims to investigate the changes in microcirculation and internal environment before sepsis in patients with infectious diseases. Methods In this single‐center prospective observational study, all patients did not meet the diagnostic criteria of sepsis 3.0 at admission. Blood samples and sublingual microcirculation were collected at admission, 24 and 48 h after admission. Results A total of 101 patients completed this study. In total, 46 patients met the diagnostic criteria of sepsis 3.0 within 5 days after admission, while the remaining 55 patients did not. The platelet (PLT) was significantly lower in the sepsis patients (195.17 ± 63.89 vs. 242.02 ± 68.59, p = .01), Microvascular Flow Index (MFI) (2.45 ± 0.33 vs. 2.70 ± 0.18, p = .00) and Proportion of Perfused Vessels (PPV) (92.44 ± 4.45 vs. 95.88 ± 3.20, p = .00) were significantly lower, while Flow Heterogeneity Index (FHI) (0.32 ± 0.13 vs. 0.22 ± 0.10, p = .00) was significantly higher in the in the sepsis patients at admission. Decreased levels of MFI (p = .00, OR 0.02, 95% CI: 0.00, 0.15) and PLT (p = .00, OR 0.99, 95% CI: 0.98, 1.00) were independent risk factors for sepsis. Additionally, the 24 h PLT change rate (AUC 0.85, Cutoff −0.17, sensitivity 0.70, specificity 0.93, and Youden index 0.63) suggested a potential early warning effect for sepsis. Conclusion Changes in microcirculation disturbance and the internal environment occurred before sepsis. The MFI and PLT are independent risk factors for sepsis. Sublingual microcirculation and PLT deterioration can be used as early warning indicators before sepsis.

show abstract

Section: Discussionmentioning

confidence: 99%

Sublingual microcirculation and internal environment changes as early indications of sepsis: A prospective observational study

Yang

Teng

et al. 2023

Microcirculation

View full text Add to dashboard Cite

show abstract

“…9 PI has been shown to reflect changes in peripheral circulation perfusion and central hypovolemia, both of which are derived from photoelectric plethysmographic pulse oximetry signals. 10 Some studies have shown that PI can be used as a predictor of early adverse respiratory neonatal outcomes after elective cesarean delivery. 11 It has been suggested to be a reliable and early indicator of regional block success and is known to increase because of the effects of the autonomic blockade during spinal anesthesia.…”

Section: Discussionmentioning

confidence: 99%

“…12 In patients with septic shock, PI is related to 6 h lactate clearance. 10 Some studies have used an abnormal PI of <1.4 as a potential trigger to start treatment. In our study, we found that the cutoff value of the PI was <0.6 for predicting ICU mortality in patients with septic shock, resulting in a sensitivity of 77.1% and a specificity of 80%.…”

Section: Discussionmentioning

confidence: 99%

Effect of Norepinephrine on Peripheral Perfusion Index and Its Association With the Prognosis of Patients With Sepsis

Wang

Zhang

et al. 2023

J Intensive Care Med

View full text Add to dashboard Cite

Background: To evaluate whether the use of norepinephrine during the management of patients with sepsis affects the perfusion index (PI) and patient outcomes. Methods: We retrospectively studied patients with septic shock between January 2014 and December 2018 who had undergone Pulse index Continuous Cardiac Output-Plus cardiac output monitoring and received norepinephrine during the management. We collected data regarding basic clinical characteristics. Hemodynamic parameters, including lactate, PI, and norepinephrine dose at T0 and 24 h after Pulse index Continuous Cardiac Output catheterization (T24) were obtained. Results: The PI of the nonsurvivor group (n = 44) was significantly lower than that of the survivor group (n = 144) at T24, and the lactate level of the nonsurvivor group was significantly higher than that of the survivor group. The multiple logistic regression analysis suggested that the norepinephrine dose and PI were the most independent risk and protective factors, respectively, for intensive care unit mortality. The area under the curve for a poor prognosis was 0.847 (95% confidence interval, 0.782-0.912). The optimal cutoff value of the PI at T24 to predict intensive care unit mortality was 0.6, with a sensitivity of 77.1% and a specificity of 80%. Based on this optimal cutoff value, we divided patients into groups with PI ≥ 0.6 (n = 125) and PI < 0.6 (n = 59). The lactate level of the PI < 0.6 group was higher than that of the PI ≥ 0.6 group at T24. The PI < 0.6 group showed a significantly higher sublingual dose of norepinephrine indicators than the PI ≥ 0.6 group. The PI showed a strong negative correlation with norepinephrine dose (r = −0.344, P < .001) and lactate (r = −0.291, P < .001). Conclusions: A higher PI is a protective factor, and a higher dose of norepinephrine is a risk factor for the prognosis of critically ill patients with septic shock. A lower PI was associated with a higher dose of norepinephrine.

show abstract

“…Many studies demonstrated that the correction of the Macro did not restore the Micro in septic shock patients after early goal-directed resuscitation. [8,21–24] The disordered tissue perfusion is to some extent independent of global circulation in sepsis.…”

Section: Loss Of Resuscitation Coherence In Circulatory Shockmentioning

confidence: 99%

Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

Long

Liu

et al. 2019

Chinese Medical Journal

Self Cite

View full text Add to dashboard Cite

Objective: Poor tissue perfusion/cellular hypoxia may persist despite restoration of the macrocirculation (Macro). This article reviewed the literatures of coherence between hemodynamics and tissue perfusion in circulatory shock. Data sources: We retrieved information from the PubMed database up to January 2018 using various search terms or/and their combinations, including resuscitation, circulatory shock, septic shock, tissue perfusion, hemodynamic coherence, and microcirculation (Micro). Study selection: The data from peer-reviewed journals printed in English on the relationships of tissue perfusion, shock, and resuscitation were included. Results: A binary (coherence/incoherence, coupled/uncoupled, or associated/disassociated) mode is used to describe resuscitation coherence. The phenomenon of resuscitation incoherence (RI) has gained great attention. However, the RI concept requires a more practical, systematic, and comprehensive framework for use in clinical practice. Moreover, we introduce a conceptual framework of RI to evaluate the interrelationship of the Macro, Micro, and cell. The RI is divided into four types (Type 1: Macro-Micro incoherence + impaired cell; Type 2: Macro-Micro incoherence + normal cell; Type 3: Micro-Cell incoherence + normal Micro; and Type 4: both Macro-Micro and Micro-cell incoherence). Furthermore, we propose the concept of dynamic circulation-perfusion coupling to evaluate the relationship of circulation and tissue perfusion during circulatory shock. Conclusions: The concept of RI and dynamic circulation-perfusion coupling should be considered in the management of circulatory shock. Moreover, these concepts require further studies in clinical practice.

show abstract

Role of Combining Peripheral with Sublingual Perfusion on Evaluating Microcirculation and Predicting Prognosis in Patients with Septic Shock

Cited by 13 publications

References 51 publications

Sublingual microcirculation and internal environment changes as early indications of sepsis: A prospective observational study

Sublingual microcirculation and internal environment changes as early indications of sepsis: A prospective observational study

Effect of Norepinephrine on Peripheral Perfusion Index and Its Association With the Prognosis of Patients With Sepsis

Resuscitation incoherence and dynamic circulation-perfusion coupling in circulatory shock

Contact Info

Product

Resources

About