Prognosis of Critically Ill Patients in the ED and Value of Perfusion Index Measurement: A Cross-Sectional Study

Oskay, Alten; Eray, Oktay; Dinc, Selcan Enver; Aydin, Alp; Eken, Cenker

doi:10.1016/j.ajem.2015.04.033

Cited by 28 publications

(17 citation statements)

References 9 publications

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“…10 , 11 Reduced peripheral perfusion has been associated with both morbidity and mortality in critically ill patients, patients with septic shock, and after acute or major elective surgery. 12 , 13 , 14 , 15 However, evaluation has only been made in relatively small cohorts of surgical patients and the association of intraoperative PPI with postoperative outcomes is inadequately described. Despite multidisciplinary efforts to improve perioperative care, 16 patients undergoing acute major abdominal or hip fracture surgery continue to demonstrate high rates of postoperative morbidity and mortality.…”

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confidence: 99%

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Agerskov¹,

Thusholdt²,

Sørensen³

et al. 2021

British Journal of Anaesthesia

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Background: We hypothesised that in acute high-risk surgical patients, a lower intraoperative peripheral perfusion index (PPI) would indicate a higher risk of postoperative complications and mortality. Methods: This retrospective observational study included 1338 acute high-risk surgical patients from November 2017 until October 2018 at two University Hospitals in Denmark. Intraoperative PPI was the primary exposure variable and the primary outcome was severe postoperative complications defined as a ClavieneDindo Class !III or death, within 30 days. Results: intraoperative PPI was associated with severe postoperative complications or death: odds ratio (OR) 1.12 (95% confidence interval [CI] 1.05e1.19; P<0.001), with an association of intraoperative mean PPI 0.5 and PPI 1.5 with the primary outcome: OR 1.79 (95% CI 1.09e2.91; P¼0.02) and OR 1.65 (95% CI 1.20e2.27; P¼0.002), respectively. Each 15-min increase in intraoperative time spend with low PPI was associated with the primary outcome (per 15 min with PPI 0.5: OR 1.11 (95% CI 1.05e1.17; P<0.001) and with PPI 1.5: OR 1.06 (95% CI 1.02e1.09; P¼0.002)). Thirty-day mortality in patients with PPI 0.5 was 19% vs 10% for PPI >0.5, P¼0.003. If PPI was 1.5, 30-day mortality was 16% vs 8% in patients with a PPI >1.5 (P<0.001). In contrast, intraoperative mean MAP 65 mm Hg was not significantly associated with severe postoperative complications or death (OR 1.21 [95% CI 0.92e1.58; P¼0.2]). Conclusions: Low intraoperative PPI was associated with severe postoperative complications or death in acute high-risk surgical patients. To guide intraoperative haemodynamic management, the PPI should be further investigated.

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confidence: 99%

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Agerskov¹,

Thusholdt²,

Sørensen³

et al. 2021

British Journal of Anaesthesia

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“…The authors showed that, only in the last day of hospitalization, the PI was able to stratify the death risk. And in the study conducted by Oskay et al, 44 the prognostic capacity of this index in the emergency department was analyzed in more than 700 patients. The researchers did not find any association between the PI and admission in the ICU and hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

Use of photoplethysmography to predict mortality in intensive care units

Kock¹,

Marques²

2018

VHRM

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PurposeThe aim of this study was to evaluate and compare the capacity to predict hemodynamic variables obtained with photoplethysmography (PPG) and Acute Physiology and Chronic Health Evaluation (APACHE II) in patients hospitalized in the intensive care unit (ICU).Materials and methodsA prospective cohort study was conducted in the adult ICU of Hospital Nossa Senhora da Conceição, located in Tubarão, Santa Catarina, Brazil. The data collected included the diagnosis for hospitalization, age, gender, clinical or surgical profile, PPG pulse curve signal, and APACHE II score in the first 24 hours. A bivariate and a multivariate logistic regressions were performed, with death as an outcome. A mortality model using artificial neural networks (ANNs) was proposed.ResultsA total of 190 individuals were evaluated. Most of them were males (6:5), with a median age of 67 (54–75) years, and the main reasons for hospitalization were cardiovascular and neurological causes; half of them were surgical cases. APACHE II median score was 14 (8–19), with a median length of stay of 6 (3–15) days, and 28.4% of the patients died. The following factors were associated with mortality: age (OR=1.023; 95% CI 1.001–1.044; P=0.039), clinical profile (OR=5.481; 95% CI 2.646–11.354; P<0.001), APACHE II (OR=1.168; 95% CI 1.106–1.234; P<0.001), heart rate in the first 24 hours (OR=1.020; 95% CI 1.001–1.039; P=0.036), and time between the systolic and diastolic peak (∆T) intervals obtained with PPG (OR=0.989; 95% CI 0.979–0.998; P=0.015). Compared with the accuracy (area under the receiver-operating characteristic curve) 0.780 of APACHE II (95% CI 0.711–0.849; P<0.001), the multivariate logistic model showed a larger area of 0.858 (95% CI 0.803–0.914; P<0.001). In the model using ANNs, the accuracy was 0.895 (95% CI 0.851–0.940; P<0.001).ConclusionThe mortality models using variables obtained with PPG, with the inclusion of epidemiological parameters, are very accurate and, if associated to APACHE II, improve prognostic accuracy. The use of ANN was even more accurate, indicating that this tool is important to help in the clinical judgment of the intensivist.

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“…Peripheral perfusion index is an early predictor of central hypovolemia [43]. In a prospective observational study in an emergency department, PPI was not significantly different between patients admitted to the hospital and patients discharged from the emergency department suggesting that it could not be used as a triage tool [44]. However, in critically ill patients, PPI is significantly lower in patients with a peripheral perfusion alteration (0.7 vs 2.3, p < 0.01) [21].…”

Section: Introductionmentioning

confidence: 99%

Narrative review: clinical assessment of peripheral tissue perfusion in septic shock

Hariri

Joffre

Leblanc

et al. 2019

Ann. Intensive Care

124

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Sepsis is one of the main reasons for intensive care unit admission and is responsible for high morbidity and mortality. The usual hemodynamic targets for resuscitation of patients with septic shock use macro-hemodynamic parameters (hearth rate, mean arterial pressure, central venous pressure). However, persistent alterations of microcirculatory blood flow despite restoration of macro-hemodynamic parameters can lead to organ failure. This dissociation between macro-and microcirculatory compartments brings a need to assess end organs tissue perfusion in patients with septic shock. Traditional markers of tissue perfusion may not be readily available (lactate) or may take time to assess (urine output). The skin, an easily accessible organ, allows clinicians to quickly evaluate the peripheral tissue perfusion with noninvasive bedside parameters such as the skin temperatures gradient, the capillary refill time, the extent of mottling and the peripheral perfusion index.

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Prognosis of Critically Ill Patients in the ED and Value of Perfusion Index Measurement: A Cross-Sectional Study

Cited by 28 publications

References 9 publications

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Association of the intraoperative peripheral perfusion index with postoperative morbidity and mortality in acute surgical patients: a retrospective observational multicentre cohort study

Use of photoplethysmography to predict mortality in intensive care units

Narrative review: clinical assessment of peripheral tissue perfusion in septic shock

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