title: Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study.
abstract: OBJECTIVE
  Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.
  
  
  METHODS
  Patients with sepsis-related circulatory dysfunction were resuscitated according to a standard local algorithm. Perfusion assessment included serial determinations of metabolic (central venous O(2) saturation [Scvo(2)] and central venous to arterial Pco(2) gradient [P(cv-a)co(2)]) and peripheral perfusion parameters (CRT and Tc-toe, among others). Successful resuscitation was defined as a normal plasma lactate at 24 hours.
  
  
  RESULTS
  Forty-one patients were included. The presence of normal values for both CRT and Tc-toe considered together at 6 hours was independently associated with a successful resuscitation (P = .02), as compared with the behavior of metabolic parameters. Capillary refill time was the first parameter to be significantly normalized.
  
  
  CONCLUSIONS
  Early recovery of peripheral perfusion anticipates a successful resuscitation compared with traditional metabolic parameters in septic shock patients. Our findings support the inclusion of serial peripheral perfusion assessment in multimodal monitoring strategies for septic shock resuscitation.
authors.affiliation: Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile. glennguru@gmail.com
authors.forename: Glenn
authors.initials: G
authors.lastname: Hernandez
authors.forename: Cesar
authors.initials: C
authors.lastname: Pedreros
authors.forename: Enrique
authors.initials: E
authors.lastname: Veas
authors.forename: Alejandro
authors.initials: A
authors.lastname: Bruhn
authors.forename: Carlos
authors.initials: C
authors.lastname: Romero
authors.forename: Maximiliano
authors.initials: M
authors.lastname: Rovegno
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Neira
authors.forename: Sebastian
authors.initials: S
authors.lastname: Bravo
authors.forename: Ricardo
authors.initials: R
authors.lastname: Castro
authors.forename: Eduardo
authors.initials: E
authors.lastname: Kattan
authors.forename: Can
authors.initials: C
authors.lastname: Ince
mesh_terms: D000368:Aged; D002677:Chile; D005121:Extremities / Q000098:blood supply*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods*; D015999:Multivariate Analysis; D011446:Prospective Studies; D012039:Regional Blood Flow; D012772:Shock, Septic / Q000503:physiopathology* / Q000628:therapy; D012881:Skin Temperature; D014034:Toes / Q000098:blood supply
chemical_list: D019344:Lactic Acid