title: Alteration of skin perfusion in mottling area during septic shock.
abstract: BACKGROUND
  Mottling score has been reported to be a strong predictive factor during septic shock. However, the pathophysiology of mottling remains unclear.
  
  
  METHODS
  In patients admitted in ICU for septic shock, we measured on the same area the mean skin perfusion by laser Doppler, the mottling score, and variations of both indices between T1 (6 hours after vasopressors were started) and T2 (24 hours later).
  
  
  RESULTS
  Fourteen patients were included, SAPS II was 56 [37-71] and SOFA score at T1 was 10 [7-12]. The mean skin surface area analyzed was 4108 ± 740 mm2; 1184 ± 141 measurements were performed over each defined skin surface area. Skin perfusion was significantly different according to mottling score and decreased from 37 [31-42] perfusion units (PUs) for a mottling score of [0-1] to 22 [20-32] PUs for a mottling score of [2-3] and 23 [16-28] for a score of [4-5] (Kruskal-Wallis test, P = 0.05). We analyzed skin perfusion changes during resuscitation in each patient and together with mottling score variations between T1 and T2 using a Wilcoxon signed-rank test. Among the 14 patients included, mottling score increased (worsened) in 5 patients, decreased (improved) in 5 patients, and remained stable in 4 patients. Baseline skin perfusion at T1 was arbitrarily scored 100%. Mean skin perfusion significantly decreased in all the patients whose mottling score worsened from 100% baseline to 63.2 ± 10.7% (P = 0.001), mean skin perfusion significantly increased in all patients whose mottling score improved from 100% baseline to 172.6 ± 46.8% (P = 0.001), and remained stable in patients whose mottling score did not change (100.5 ± 6.8%, P = 0.95).
  
  
  CONCLUSIONS
  We have shown that mottling score variations and skin perfusion changes during septic shock resuscitation were correlated, providing additional evidence that mottling reflects skin hypoperfusion.
authors.affiliation: Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184 rue du Faubourg Saint-Antoine, Cedex 12, Paris 75571, France. hafid.aitoufella@sat.aphp.fr.
authors.forename: Hafid
authors.initials: H
authors.lastname: Ait-Oufella
authors.forename: Simon
authors.initials: S
authors.lastname: Bourcier
authors.forename: Mikael
authors.initials: M
authors.lastname: Alves
authors.forename: Arnaud
authors.initials: A
authors.lastname: Galbois
authors.forename: Jean-Luc
authors.initials: JL
authors.lastname: Baudel
authors.forename: Dimitri
authors.initials: D
authors.lastname: Margetis
authors.forename: Naike
authors.initials: N
authors.lastname: Bige
authors.forename: Georges
authors.initials: G
authors.lastname: Offenstadt
authors.forename: Eric
authors.initials: E
authors.lastname: Maury
authors.forename: Bertrand
authors.initials: B
authors.lastname: Guidet
references.citation: Br J Clin Pharmacol. 2005 May;59(5):511-9
references.pmid: 15842548
references.citation: Crit Care Med. 2003 Apr;31(4):1250-6
references.pmid: 12682500
references.citation: Ind Health. 2007 Apr;45(2):309-17
references.pmid: 17485876
references.citation: Crit Care Med. 2003 Apr;31(4 Suppl):S221-30
references.pmid: 12682444
references.citation: Intensive Care Med. 2010 Aug;36(8):1286-98
references.pmid: 20443110
references.citation: Crit Care. 2005;9 Suppl 4:S13-9
references.pmid: 16168069
references.citation: Intensive Care Med. 2012 Jun;38(6):976-83
references.pmid: 22527071
references.citation: Ann Surg. 1956 May;143(5):600-7
references.pmid: 13314533
references.citation: Crit Care. 2005;9 Suppl 4:S9-12
references.pmid: 16168075
references.citation: Am J Respir Crit Care Med. 2002 Jul 1;166(1):98-104
references.pmid: 12091178
references.citation: Crit Care Med. 2008 Jan;36(1):296-327
references.pmid: 18158437
references.citation: JAMA. 1993 Dec 22-29;270(24):2957-63
references.pmid: 8254858
references.citation: Intensive Care Med. 2007 Sep;33(9):1549-56
references.pmid: 17572876
references.citation: Intensive Care Med. 2011 May;37(5):801-7
references.pmid: 21373821
references.citation: Intensive Care Med. 2012 Apr;38(4):606-11
references.pmid: 22349421
references.citation: Intensive Care Med. 1999 Jul;25(7):686-96
references.pmid: 10470572
references.citation: Curr Opin Crit Care. 2009 Jun;15(3):261-5
references.pmid: 19346939