Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients

Abstract

Background: Pediatric shock has a high mortality rate because many of the early clinical signs are subtle and have poor sensitivity and specificity. Pediatric shock was categorized either: compensated with normal blood pressure, poor skin perfusion (CRT >2 s, mottled, cool peripheries, peripheral cyanosis), weak peripheral pulse, age specific tachycardia, tachypnoea, and oliguria or decompensated with hypotension (SBP < 70 þ (2Â age in years) mm Hg and decreased mental status. The perfusion index is a non-invasive method for assessing peripheral perfusion and may be a useful marker for identifying shock early in pediatric patients. Objective: This prospective cohort study (November 2019 to August 2020) evaluated whether the perfusion index, lactate, and/or lactate clearance could predict mortality among pediatric shock patients. Methods: Fifty children (68% male) with shock underwent assessments at presentation to the emergency room to evaluate their heart rate, blood pressure, capillary refill time, central venous pressure, perfusion index, cardiac index, systemic vascular resistance, central venous oxygen saturation, and lactate clearance. Results: The perfusion index range was 0.03 to 2.2 and 0.18 as the cut-off for mortality prediction providing 74% sensitivity and 78% specificity. The serum lactate concentration range was 0 to 16 mmol/L and >5.7 mmol/L as the cut-off for mortality prediction provided 70% sensitivity and 96% specificity at presentation to the emergency room. The lactate clearance range was 3% to 75% and >10% as the cut-off for survival prediction after resuscitation and at 6 h later. Conclusion: Perfusion index (PI), lactate, and lactate clearance provided comparable sensitivity and specificity for predicting outcomes among pediatric patients with shock Therefore, we suggest that the PI is an inexpensive, rapid, and non-invasive tool that can be used to predict illness severity and mortality in busy pediatric intensive care units and emergency departments. This tool may guide better patient triage and an earlier diagnosis of shock in this setting.

Blood pressure and flow in pediatric anesthesia: An educational review

“…Normal values in healthy normal babies of both sexes have been established 26,27 . Furthermore, PPI has also been found to correlate to lactate levels and lactate clearance in pediatric shock patients 28 . Thus, this technique appears potentially useful since it does not need any further electrodes or probes, and the value is possible to get from the already applied pulse oximeter probe.…”

“…Promising data regarding the use of PPI have recently been reported also in children 26–28 . Normal values in healthy normal babies of both sexes have been established 26,27 .…”

“…Promising data regarding the use of PPI have recently been reported also in children. [26][27][28] Normal values in healthy normal babies of both sexes have been established. 26,27 Furthermore, PPI has also been found to correlate to lactate levels and lactate clearance in pediatric shock patients.…”

“…26,27 Furthermore, PPI has also been found to correlate to lactate levels and lactate clearance in pediatric shock patients. 28 Thus, this technique appears potentially useful since it does not need any further electrodes or probes, and the value is possible to get from the already applied pulse oximeter probe. The method is, however, dependent on the pulse oximetry reading and, therefore, potentially vulnerable to many of the limitations associated with the underlying monitoring method.…”

What's New in Shock, December 2021?

“…In this study comparing latest generation ultrasound technology to change in central venous pressure with modification of intrathoracic pressure, the authors identified changes in central venous pressure as the only parameter providing at least modest fluid responsiveness prediction. In contrast to the evaluation of vascular bed predictors just discussed, tissue perfusion parameters and clearance of lactate were assessed in a pediatric patient group by Bazaraa et al (8) from Cairo University. This team studied a Perfusion Index using signal extraction technology based on a pulse oximetry to noninvasively monitor perfusion status.…”