title: Clinical assessment of peripheral circulation.
abstract: OBJECTIVE
  Monitoring of the peripheral circulation can be done noninvasively in contrast to the more traditional invasive systemic haemodynamic monitoring in the intensive care unit. Physical examination of peripheral circulation based on clinical assessment has been well emphasized for its convenience, accessibility, and relation to the prognosis of patients with circulatory shock. The purpose of this article is to highlight the main findings according to recent literature into the clinical applications of the peripheral perfusion assessment in patient management.
  
  
  RESULTS
  Clinical assessment of peripheral circulation includes physical examination by inspecting the skin for pallor or mottling, and measuring capillary refill time on finger or knee. Studies have addressed the capillary refill time assessment in adults and its relation to normal range, body site, effect of skin temperature, and its reliability among examiners. These are easily applicable methods in many circumstances, and it has been used for predicting unfavourable outcomes in critically ill adult patients. Current studies are ongoing to determine the effects of different interventions on the clinical parameters of peripheral circulation in critically ill patients during shock resuscitation.
  
  
  CONCLUSIONS
  The feasibility and reproducibility of the clinical assessment of peripheral circulation are substantial, and reliance on capillary refill time, skin temperature, and mottling score must be emphasized and exploited. Incorporating therapeutic strategies into resuscitation protocols that aim at normalizing these peripheral circulation parameters are being developed to investigate the impact of peripheral perfusion-targeted resuscitation in the survival of critically ill patients.
authors.affiliation: Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lima
authors.forename: Jan
authors.initials: J
authors.lastname: Bakker
mesh_terms: D000328:Adult; D002196:Capillaries / Q000502:physiology*; D016638:Critical Illness; D006439:Hemodynamics; D006801:Humans; D008991:Monitoring, Physiologic / Q000379:methods; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology*; D012769:Shock / Q000175:diagnosis* / Q000503:physiopathology