title: Disparity between skin perfusion and sublingual microcirculatory alterations in severe sepsis and septic shock: a prospective observational study.
abstract: OBJECTIVE
  Measurement of central-to-toe temperature difference has been advocated as an index of severity of shock and as a guide for circulatory therapy in critically ill patients. However, septic shock, in contrast to other forms of shock, is associated with a distributive malfunction resulting in a disparity between vascular compartments. Although this disparity has been established between systemic and microcirculatory parameters, it is unclear whether such disparity exists between skin perfusion and microcirculation. To test this hypothesis of disparity, we simultaneously measured parameters of the two vascular compartments, in the early phase of sepsis.
  
  
  METHODS
  Prospective observational study in patients with severe sepsis/septic shock in the first 6 h of ICU admission. Simultaneous measurements of central-to-toe temperature difference and sublingual microcirculatory orthogonal polarization spectral imaging, together with parameters of systemic hemodynamics.
  
  
  METHODS
  22 bed mixed-ICU in a tertiary teaching hospital.
  
  
  METHODS
  35 consecutive patients in a 12-month period.
  
  
  RESULTS
  In 35 septic patients and a median APACHE II score of 20, no correlation between central-to-toe temperature gradient and microvascular flow index was observed (r (s) = -0.08, p =0.65). Also no significant correlation between temperature gradient/microvascular flow index and systemic hemodynamic parameters could be demonstrated.
  
  
  CONCLUSIONS
  During the early phase of resuscitated severe sepsis and septic shock there appears to be no correlation between sublingual microcirculatory alterations and the central-to-toe temperature difference. This finding adds to the concept of a dispersive nature of blood flow under conditions of sepsis between microcirculatory and systemic hemodynamics.
authors.affiliation: Department of Intensive Care, Medical Center Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands. e.boerma@chello.nl
authors.forename: E Christiaan
authors.initials: EC
authors.lastname: Boerma
authors.forename: Michael A
authors.initials: MA
authors.lastname: Kuiper
authors.forename: W Peter
authors.initials: WP
authors.lastname: Kingma
authors.forename: Peter H
authors.initials: PH
authors.lastname: Egbers
authors.forename: Rik T
authors.initials: RT
authors.lastname: Gerritsen
authors.forename: Can
authors.initials: C
authors.lastname: Ince
mesh_terms: D018806:APACHE; D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D009060:Mouth Floor / Q000098:blood supply; D011446:Prospective Studies; D018805:Sepsis / Q000145:classification / Q000503:physiopathology; D012772:Shock, Septic / Q000145:classification / Q000503:physiopathology*