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Disparity between skin perfusion and sublingual microcirculatory alterations in severe sepsis and septic shock: a prospective observational study.

Boerma EC, Kuiper MA, Kingma WP, Egbers PH, Gerritsen RT, Ince C - Intensive Care Med (2008)

Bottom Line: Also no significant correlation between temperature gradient/microvascular flow index and systemic hemodynamic parameters could be demonstrated.During the early phase of resuscitated severe sepsis and septic shock there appears to be no correlation between sublingual microcirculatory alterations and the central-to-toe temperature difference.This finding adds to the concept of a dispersive nature of blood flow under conditions of sepsis between microcirculatory and systemic hemodynamics.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care, Medical Center Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands. e.boerma@chello.nl

ABSTRACT

Objective: Measurement of central-to-toe temperature difference has been advocated as an index of severity of shock and as a guide for circulatory therapy in critically ill patients. However, septic shock, in contrast to other forms of shock, is associated with a distributive malfunction resulting in a disparity between vascular compartments. Although this disparity has been established between systemic and microcirculatory parameters, it is unclear whether such disparity exists between skin perfusion and microcirculation. To test this hypothesis of disparity, we simultaneously measured parameters of the two vascular compartments, in the early phase of sepsis.

Design: Prospective observational study in patients with severe sepsis/septic shock in the first 6 h of ICU admission. Simultaneous measurements of central-to-toe temperature difference and sublingual microcirculatory orthogonal polarization spectral imaging, together with parameters of systemic hemodynamics.

Setting: 22 bed mixed-ICU in a tertiary teaching hospital.

Patients: 35 consecutive patients in a 12-month period.

Measurements and results: In 35 septic patients and a median APACHE II score of 20, no correlation between central-to-toe temperature gradient and microvascular flow index was observed (r (s) = -0.08, p =0.65). Also no significant correlation between temperature gradient/microvascular flow index and systemic hemodynamic parameters could be demonstrated.

Conclusions: During the early phase of resuscitated severe sepsis and septic shock there appears to be no correlation between sublingual microcirculatory alterations and the central-to-toe temperature difference. This finding adds to the concept of a dispersive nature of blood flow under conditions of sepsis between microcirculatory and systemic hemodynamics.

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Related in: MedlinePlus

Scatter of microvascular flow index (MFI) of small vessels (< 20 μm) in the sublingual region vs. the central-to-toe temperature gradient (ΔT); open symbols, severe sepsis; filled symbols, septic shock. Spearman's rank correlation −0.08, p = 0.65
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Fig1: Scatter of microvascular flow index (MFI) of small vessels (< 20 μm) in the sublingual region vs. the central-to-toe temperature gradient (ΔT); open symbols, severe sepsis; filled symbols, septic shock. Spearman's rank correlation −0.08, p = 0.65

Mentions: Primary outcome of the study, the relation between MFI and ΔT, appeared to be absent; nonparametric rank correlation (rs) was −0.08 (p = 0.65, Fig. 1). After subgroup analysis rs in severe sepsis was −0.04 (n = 16, p = 0.87) and in septic shock −0.23 (n = 19, p = 0.35). Secondary outcome was the relationship between MFI and ΔT, on the one hand, and systemic hemodynamic parameters and parameters of morbidity/mortality on the other. Correlation coefficients between MFI/ΔT and macro-hemodynamic parameters such as heart rate (HR), CI, MAP, CVP, lactate, and use of inotropic and vasopressors agents or parameters of morbidity (APACHE II and SOFA) were all statistically nonsignificant (Table 2). There was no difference between median MFI/ΔT of survivors and nonsurvivors (2.42 and 2.42; 3.3 and 3, respectively).Fig. 1


Disparity between skin perfusion and sublingual microcirculatory alterations in severe sepsis and septic shock: a prospective observational study.

Boerma EC, Kuiper MA, Kingma WP, Egbers PH, Gerritsen RT, Ince C - Intensive Care Med (2008)

Scatter of microvascular flow index (MFI) of small vessels (< 20 μm) in the sublingual region vs. the central-to-toe temperature gradient (ΔT); open symbols, severe sepsis; filled symbols, septic shock. Spearman's rank correlation −0.08, p = 0.65
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC2480600&req=5

Fig1: Scatter of microvascular flow index (MFI) of small vessels (< 20 μm) in the sublingual region vs. the central-to-toe temperature gradient (ΔT); open symbols, severe sepsis; filled symbols, septic shock. Spearman's rank correlation −0.08, p = 0.65
Mentions: Primary outcome of the study, the relation between MFI and ΔT, appeared to be absent; nonparametric rank correlation (rs) was −0.08 (p = 0.65, Fig. 1). After subgroup analysis rs in severe sepsis was −0.04 (n = 16, p = 0.87) and in septic shock −0.23 (n = 19, p = 0.35). Secondary outcome was the relationship between MFI and ΔT, on the one hand, and systemic hemodynamic parameters and parameters of morbidity/mortality on the other. Correlation coefficients between MFI/ΔT and macro-hemodynamic parameters such as heart rate (HR), CI, MAP, CVP, lactate, and use of inotropic and vasopressors agents or parameters of morbidity (APACHE II and SOFA) were all statistically nonsignificant (Table 2). There was no difference between median MFI/ΔT of survivors and nonsurvivors (2.42 and 2.42; 3.3 and 3, respectively).Fig. 1

Bottom Line: Also no significant correlation between temperature gradient/microvascular flow index and systemic hemodynamic parameters could be demonstrated.During the early phase of resuscitated severe sepsis and septic shock there appears to be no correlation between sublingual microcirculatory alterations and the central-to-toe temperature difference.This finding adds to the concept of a dispersive nature of blood flow under conditions of sepsis between microcirculatory and systemic hemodynamics.

View Article: PubMed Central - PubMed

Affiliation: Department of Intensive Care, Medical Center Leeuwarden, P.O. Box 888, 8901 BR, Leeuwarden, The Netherlands. e.boerma@chello.nl

ABSTRACT

Objective: Measurement of central-to-toe temperature difference has been advocated as an index of severity of shock and as a guide for circulatory therapy in critically ill patients. However, septic shock, in contrast to other forms of shock, is associated with a distributive malfunction resulting in a disparity between vascular compartments. Although this disparity has been established between systemic and microcirculatory parameters, it is unclear whether such disparity exists between skin perfusion and microcirculation. To test this hypothesis of disparity, we simultaneously measured parameters of the two vascular compartments, in the early phase of sepsis.

Design: Prospective observational study in patients with severe sepsis/septic shock in the first 6 h of ICU admission. Simultaneous measurements of central-to-toe temperature difference and sublingual microcirculatory orthogonal polarization spectral imaging, together with parameters of systemic hemodynamics.

Setting: 22 bed mixed-ICU in a tertiary teaching hospital.

Patients: 35 consecutive patients in a 12-month period.

Measurements and results: In 35 septic patients and a median APACHE II score of 20, no correlation between central-to-toe temperature gradient and microvascular flow index was observed (r (s) = -0.08, p =0.65). Also no significant correlation between temperature gradient/microvascular flow index and systemic hemodynamic parameters could be demonstrated.

Conclusions: During the early phase of resuscitated severe sepsis and septic shock there appears to be no correlation between sublingual microcirculatory alterations and the central-to-toe temperature difference. This finding adds to the concept of a dispersive nature of blood flow under conditions of sepsis between microcirculatory and systemic hemodynamics.

Show MeSH
Related in: MedlinePlus