Narrative review: clinical assessment of peripheral tissue perfusion in septic shock

• Main Authors: Geoffroy Hariri, Jérémie Joffre, Guillaume Leblanc, Michael Bonsey, Jean-Remi Lavillegrand, Tomas Urbina, Bertrand Guidet, Eric Maury, Jan Bakker, Hafid Ait-Oufella
• Format: Article
• Language: English
• Published: SpringerOpen 2019-03-01
• Series: Annals of Intensive Care
• Subjects: Septic shock; Microcirculation; Capillary refill time; Temperatures gradient; Peripheral perfusion index; Mottling
• Online Access: http://link.springer.com/article/10.1186/s13613-019-0511-1

Abstract Sepsis is one of the main reasons for intensive care unit admission and is responsible for high morbidity and mortality. The usual hemodynamic targets for resuscitation of patients with septic shock use macro-hemodynamic parameters (hearth rate, mean arterial pressure, central venous pressure). However, persistent alterations of microcirculatory blood flow despite restoration of macro-hemodynamic parameters can lead to organ failure. This dissociation between macro- and microcirculatory compartments brings a need to assess end organs tissue perfusion in patients with septic shock. Traditional markers of tissue perfusion may not be readily available (lactate) or may take time to assess (urine output). The skin, an easily accessible organ, allows clinicians to quickly evaluate the peripheral tissue perfusion with noninvasive bedside parameters such as the skin temperatures gradient, the capillary refill time, the extent of mottling and the peripheral perfusion index.