Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods

Roberto Rabello Filho, Renato Carneiro de Freitas Chaves, Murillo Santucci Cesar Assunção, Ary Serpa Neto, Flavia Manfredi De Freitas, Maria Laura Romagnoli, Eliézer Silva, Bernardo Lattanzio, Arnaldo Dubin, Thiago Domingos Corrêa

Research output: Contribution to journalArticleResearchpeer-review

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 StO2max [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 StO2 (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.

Original languageEnglish
Number of pages10
JournalJournal of Clinical Monitoring and Computing
DOIs
Publication statusAccepted/In press - Nov 2019
Externally publishedYes

Keywords

  • Critical care
  • Hemodynamics
  • Microcirculation
  • Near-infrared spectroscopy
  • Oxygen consumption
  • Shock

Cite this

Filho, R. R., de Freitas Chaves, R. C., Assunção, M. S. C., Neto, A. S., De Freitas, F. M., Romagnoli, M. L., Silva, E., Lattanzio, B., Dubin, A., & Corrêa, T. D. (Accepted/In press). Assessment of the peripheral microcirculation in patients with and without shock: a pilot study on different methods. Journal of Clinical Monitoring and Computing. https://doi.org/10.1007/s10877-019-00423-8