Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods
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ORIGINAL RESEARCH
Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods Roberto Rabello Filho1 · Renato Carneiro de Freitas Chaves1,2 · Murillo Santucci Cesar Assunção1 · Ary Serpa Neto1,3 · Flavia Manfredi De Freitas1 · Maria Laura Romagnoli1 · Eliézer Silva1 · Bernardo Lattanzio4 · Arnaldo Dubin4,5 · Thiago Domingos Corrêa1 Received: 22 August 2019 / Accepted: 13 November 2019 © The Author(s) 2019
Abstract Microvascular dysfunction has been associated with adverse outcomes in critically ill patients, and the current concept of hemodynamic incoherence has gained attention. Our objective was to perform a comprehensive analysis of microcirculatory perfusion parameters and to investigate the best variables that could discriminate patients with and without circulatory shock during early intensive care unit (ICU) admission. This prospective observational study comprised a sample of 40 adult patients with and without circulatory shock (n = 20, each) admitted to the ICU within 24 h. Peripheral clinical [capillary refill time (CRT), peripheral perfusion index (PPI), skin-temperature gradient (Tskin-diff)] and laboratory [arterial lactate and base excess (BE)] perfusion parameters, in addition to near-infrared spectroscopy (NIRS)-derived variables were simultaneously assessed. While lactate, BE, CRT, PPI and Tskin-diff did not differ significantly between the groups, shock patients had lower baseline tissue oxygen saturation (StO2) [81 (76–83) % vs. 86 (76–90) %, p = 0.044], lower StO2min [50 (47–57) % vs. 55 (53–65) %, p = 0.038] and lower S tO2max [87 (80–92) % vs. 93 (90–95) %, p = 0.017] than patients without shock. Additionally, dynamic NIRS variables [recovery time (r = 0.56, p = 0.010), descending slope (r = − 0.44, p = 0.05) and ascending slope (r = − 0.54, p = 0.014)] and not static variable [baseline S tO2 (r = − 0.24, p = 0.28)] exhibited a significant correlation with the administered dose of norepinephrine. In our study with critically ill patients assessed within the first twenty-four hours of ICU admission, among the perfusion parameters, only NIRS-derived parameters could discriminate patients with and without shock. Keywords Critical care · Shock · Hemodynamics · Microcirculation · Oxygen consumption · Near-infrared spectroscopy Abbreviations BE Base excess CI Cardiac index CRT Capillary refill time CVP Central venous pressure HR Heart rate ICU Intensive care unit (ICU) IQR Interquartile range Roberto Rabello Filho and Renato Carneiro de Freitas Chaves have contributed equally to this study. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10877-019-00423-8) contains supplementary material, which is available to authorized users. * Roberto Rabello Filho [email protected]
MAP Mean arterial pressure NIRS Near-infrared spectroscopy PaCO2 Partial pressure of arterial carbon dioxide PaO2 Partial pressure of arterial oxygen PPI Peripheral perfusion index SAPS Simp
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