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

Changes in peripheral perfusion relate to visceral organ perfusion in early septic shock: A pilot study

“…Similarly, improvement of capillary refill and skin mottling over time appears to parallel a decrease in visceral organ and renal vascular tone, respectively. This observation could for the first time provide an explanation for the published evidence on a strong relationship between clinical parameters of peripheral perfusion, arterial lactate, base deficit, organ function, and mortality [4][5][6][7][8][9][10][11][12][13].…”

“…In septic shock patients, Ait-Oufella et al [10] showed that the capillary refill time measured at 6 hours of resuscitation was related to lactate levels, organ dysfunction, and mortality. Second, early normalization of parameters of skin perfusion including the capillary refill time was associated with survival from septic shock [11] and has been suggested as an indicator to stop fluid resuscitation in septic shock [12,13]. So far, however, it remains unclear why patients with abnormal peripheral perfusion have increased morbidity and mortality.…”

Clinical assessment of peripheral circulation

“…However, at first day after surgery, CRT was significantly longer (CRT > 5.0 s) in patients who subsequently developed severe complications, and this difference persisted over time until the fourth day. In another recent study, Hernandez et al [20] reported that in a population of 41 critically ill patients with sepsisrelated circulatory dysfunction, 34 (85%) who were successfully resuscitated exhibited normal CRT (<5.0 s) within 6 h, even before normalization of lactate levels.…”

“…Many studies already showed that a CRT >5.0 s following initial haemodynamic optimization discriminated haemodynamically stable patients with more severe organ dysfunction and higher odds for worsening organ failure [20][21][22][23].…”

Actualización del bundle de reanimación inicial y monitorización integral de la perfusión tisular en la sepsis severa

“…58 desarrollaron un interesante estudio fisiológico en 50 pacientes críticos, con la finalidad de establecer si la evaluación subjetiva de la perfusión periférica pudiera identificar pacientes con mayor disfunción metabólica u orgánica. Los pacientes que presentaron alteración de la perfusión periférica tuvieron mayor incidencia de hiperlactatemia y más disfunciones orgánicas a las 48 h. Recientemente, nuestro grupo demostró que la pronta recuperación de la perfusión periférica evaluada clínicamente, en forma simple y no invasiva al lado de la cama del paciente, es un buen predictor de reanimación exitosa en pacientes con shock séptico 59 .…”