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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

Relationship between toe-to-room temperature gradient and hemodynamic parameters in a pooled analysis of patient with severe sepsis and septic shock at H6; a arterial lactate level, b urinary output, c cardiac index, d knee capillary refill time, e norepinephrine dose and f mottling score. ***P < 0.001
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Fig3: Relationship between toe-to-room temperature gradient and hemodynamic parameters in a pooled analysis of patient with severe sepsis and septic shock at H6; a arterial lactate level, b urinary output, c cardiac index, d knee capillary refill time, e norepinephrine dose and f mottling score. ***P < 0.001

Mentions: We also analysed correlations between toe-to-room temperature gradient and other hemodynamic variables both measured at H6 after initial resuscitation (Fig. 3) in a pooled analysis of patients with severe sepsis and patients with septic shock. The toe-to-room temperature gradient did not correlate with cardiac index but correlated weakly with vasopressor doses (r = −0.20, P = 0.05). In contrast, we observed a significant relationship between toe-to-room temperature gradient and tissue perfusion variables such as arterial lactate level (r = −0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee CRT (r = −0.42, P < 0.0001) and mottling score (P = 0.001) (Fig. 2). When analysing only patients with septic shock, we found the same correlation between toe-to-room temperature gradient and arterial lactate level, urine output, knee CRT and mottling score. However, the correlation between toe-to-room temperature gradient and vasopressor doses was not significant (data not shown).Fig. 3


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)

Relationship between toe-to-room temperature gradient and hemodynamic parameters in a pooled analysis of patient with severe sepsis and septic shock at H6; a arterial lactate level, b urinary output, c cardiac index, d knee capillary refill time, e norepinephrine dose and f mottling score. ***P < 0.001
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig3: Relationship between toe-to-room temperature gradient and hemodynamic parameters in a pooled analysis of patient with severe sepsis and septic shock at H6; a arterial lactate level, b urinary output, c cardiac index, d knee capillary refill time, e norepinephrine dose and f mottling score. ***P < 0.001
Mentions: We also analysed correlations between toe-to-room temperature gradient and other hemodynamic variables both measured at H6 after initial resuscitation (Fig. 3) in a pooled analysis of patients with severe sepsis and patients with septic shock. The toe-to-room temperature gradient did not correlate with cardiac index but correlated weakly with vasopressor doses (r = −0.20, P = 0.05). In contrast, we observed a significant relationship between toe-to-room temperature gradient and tissue perfusion variables such as arterial lactate level (r = −0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee CRT (r = −0.42, P < 0.0001) and mottling score (P = 0.001) (Fig. 2). When analysing only patients with septic shock, we found the same correlation between toe-to-room temperature gradient and arterial lactate level, urine output, knee CRT and mottling score. However, the correlation between toe-to-room temperature gradient and vasopressor doses was not significant (data not shown).Fig. 3

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