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Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections.

Bourcier S, Pichereau C, Boelle PY, Nemlaghi S, Dubée V, Lejour G, Baudel JL, Galbois A, Lavillegrand JR, Bigé N, Tahiri J, Leblanc G, Maury E, Guidet B, Ait-Oufella H - Ann Intensive Care (2016)

Bottom Line: After initial resuscitation, toe-to-room temperature gradient was significantly lower in patients dead from MOF than in the survivors (-0.2 [-1.1; +1.3] °C vs +3.9 [+0.5; +7.2] °C, P < 0.001) and the difference in gradients increased during the first 24 h.Furthermore, toe-to-room temperature gradient was related to tissue perfusion parameters such as arterial lactate level (r = -0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee capillary refill time (r = -0.42, P < 0.0001) and mottling score (P = 0.001).Toe-to-room temperature gradient reflects tissue perfusion at the bedside and is a strong prognosis factor in critically ill patients with severe infections.

View Article: PubMed Central - PubMed

Affiliation: Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.

ABSTRACT

Background: Microcirculatory disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in severe sepsis and septic shock. As microcirculatory disorders have been identified as strong predictive factors of unfavourable outcome, there is a need to develop accurate parameters at the bedside to evaluate tissue perfusion. We evaluated whether different body temperature gradients could relate to sepsis severity and could predict outcome in critically ill patients with severe sepsis and septic shock.

Method: We conducted a prospective observational study in a tertiary teaching hospital in France. During a 10-month period, all consecutive adult patients with severe sepsis or septic shock who required ICU admission were included. Six hours after initial resuscitation (H6), we recorded the hemodynamic parameters and four temperature gradients: central-to-toe, central-to-knee, toe-to-room and knee-to-room.

Results: We evaluated 40 patients with severe sepsis (40/103, 39 %) and 63 patients with septic shock (63/103, 61 %). In patients with septic shock, central-to-toe temperature gradient was significantly higher (12.5 [9.2; 13.8] vs 6.9 [3.4; 12.0] °C, P < 0.001) and toe-to-room temperature gradient significantly lower (1.2 [-0.3; 5.2] vs 6.0 [0.6; 9.5] °C, P < 0.001) than in patients with severe sepsis. Overall ICU mortality rate due to multiple organ failure (MOF) was 21 %. After initial resuscitation, toe-to-room temperature gradient was significantly lower in patients dead from MOF than in the survivors (-0.2 [-1.1; +1.3] °C vs +3.9 [+0.5; +7.2] °C, P < 0.001) and the difference in gradients increased during the first 24 h. Furthermore, toe-to-room temperature gradient was related to tissue perfusion parameters such as arterial lactate level (r = -0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee capillary refill time (r = -0.42, P < 0.0001) and mottling score (P = 0.001).

Conclusions: Toe-to-room temperature gradient reflects tissue perfusion at the bedside and is a strong prognosis factor in critically ill patients with severe infections.

No MeSH data available.


Related in: MedlinePlus

Time course of toe-to-room temperature gradients of pooled severe sepsis/septic shock patients according to ICU outcome. Three groups, survivors, MOF deaths (multiple organ failure) and late deaths. **P < 0.01
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Fig2: Time course of toe-to-room temperature gradients of pooled severe sepsis/septic shock patients according to ICU outcome. Three groups, survivors, MOF deaths (multiple organ failure) and late deaths. **P < 0.01

Mentions: In the analysis of variance, the difference in toe-to-room gradient between the three groups was maintained over time, with a gradient decreasing by an average of 0.04 ± 0.05 °C/h in the deaths from MOF group but increasing by 0.08 ± 0.05 °C/h (P < 0.03) in the survivors (vs deaths from MOF, P = 0.001) (Fig. 2) and increasing by 0.06 ± 0.07 °C/h in the late deaths group (vs deaths from MOF, P = 0.006). The toe-to-room temperature gradient was predictive of death due to MOF at H6 with an area under the curve (AUC) of 0.76 [0.65; 0.86]. Predictive value increased over time, at H12 the AUC was 0.83 [0.71; 0.95] and at H24 it reached 0.84 [0.74; 0.94]. At H24, a threshold of toe-to-room temperature gradient of 1.75 °C was predictive of death from MOF with a sensitivity of 75 % (CI 95 %, 53; 98) and a specificity of 75 % (CI 95 %, 62; 85).Fig. 2


Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections.

Bourcier S, Pichereau C, Boelle PY, Nemlaghi S, Dubée V, Lejour G, Baudel JL, Galbois A, Lavillegrand JR, Bigé N, Tahiri J, Leblanc G, Maury E, Guidet B, Ait-Oufella H - Ann Intensive Care (2016)

Time course of toe-to-room temperature gradients of pooled severe sepsis/septic shock patients according to ICU outcome. Three groups, survivors, MOF deaths (multiple organ failure) and late deaths. **P < 0.01
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4940318&req=5

Fig2: Time course of toe-to-room temperature gradients of pooled severe sepsis/septic shock patients according to ICU outcome. Three groups, survivors, MOF deaths (multiple organ failure) and late deaths. **P < 0.01
Mentions: In the analysis of variance, the difference in toe-to-room gradient between the three groups was maintained over time, with a gradient decreasing by an average of 0.04 ± 0.05 °C/h in the deaths from MOF group but increasing by 0.08 ± 0.05 °C/h (P < 0.03) in the survivors (vs deaths from MOF, P = 0.001) (Fig. 2) and increasing by 0.06 ± 0.07 °C/h in the late deaths group (vs deaths from MOF, P = 0.006). The toe-to-room temperature gradient was predictive of death due to MOF at H6 with an area under the curve (AUC) of 0.76 [0.65; 0.86]. Predictive value increased over time, at H12 the AUC was 0.83 [0.71; 0.95] and at H24 it reached 0.84 [0.74; 0.94]. At H24, a threshold of toe-to-room temperature gradient of 1.75 °C was predictive of death from MOF with a sensitivity of 75 % (CI 95 %, 53; 98) and a specificity of 75 % (CI 95 %, 62; 85).Fig. 2

Bottom Line: After initial resuscitation, toe-to-room temperature gradient was significantly lower in patients dead from MOF than in the survivors (-0.2 [-1.1; +1.3] °C vs +3.9 [+0.5; +7.2] °C, P < 0.001) and the difference in gradients increased during the first 24 h.Furthermore, toe-to-room temperature gradient was related to tissue perfusion parameters such as arterial lactate level (r = -0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee capillary refill time (r = -0.42, P < 0.0001) and mottling score (P = 0.001).Toe-to-room temperature gradient reflects tissue perfusion at the bedside and is a strong prognosis factor in critically ill patients with severe infections.

View Article: PubMed Central - PubMed

Affiliation: Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.

ABSTRACT

Background: Microcirculatory disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in severe sepsis and septic shock. As microcirculatory disorders have been identified as strong predictive factors of unfavourable outcome, there is a need to develop accurate parameters at the bedside to evaluate tissue perfusion. We evaluated whether different body temperature gradients could relate to sepsis severity and could predict outcome in critically ill patients with severe sepsis and septic shock.

Method: We conducted a prospective observational study in a tertiary teaching hospital in France. During a 10-month period, all consecutive adult patients with severe sepsis or septic shock who required ICU admission were included. Six hours after initial resuscitation (H6), we recorded the hemodynamic parameters and four temperature gradients: central-to-toe, central-to-knee, toe-to-room and knee-to-room.

Results: We evaluated 40 patients with severe sepsis (40/103, 39 %) and 63 patients with septic shock (63/103, 61 %). In patients with septic shock, central-to-toe temperature gradient was significantly higher (12.5 [9.2; 13.8] vs 6.9 [3.4; 12.0] °C, P < 0.001) and toe-to-room temperature gradient significantly lower (1.2 [-0.3; 5.2] vs 6.0 [0.6; 9.5] °C, P < 0.001) than in patients with severe sepsis. Overall ICU mortality rate due to multiple organ failure (MOF) was 21 %. After initial resuscitation, toe-to-room temperature gradient was significantly lower in patients dead from MOF than in the survivors (-0.2 [-1.1; +1.3] °C vs +3.9 [+0.5; +7.2] °C, P < 0.001) and the difference in gradients increased during the first 24 h. Furthermore, toe-to-room temperature gradient was related to tissue perfusion parameters such as arterial lactate level (r = -0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee capillary refill time (r = -0.42, P < 0.0001) and mottling score (P = 0.001).

Conclusions: Toe-to-room temperature gradient reflects tissue perfusion at the bedside and is a strong prognosis factor in critically ill patients with severe infections.

No MeSH data available.


Related in: MedlinePlus