Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study
Evolution of peripheral vs metabolic perfusion parameters during septic shock resuscitation. A clinical-physiologic study
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DOI：
10.1016/j.jcrc.2011.05.024
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发表时间：
2012-06-01
影响因子：
3.7
通讯作者：
Ince, Can
中科院分区：
文献类型：
--
作者：
Hernandez, Glenn;Pedreros, Cesar;Ince, Can
目的：感染性休克复苏期间的灌注评估是困难的，通常是复杂的测定。毛细血管再充盈时间（CRT）和中心-趾温差（Tc-toe）已被提出作为客观的可重复的参数来评价外周灌注。外周灌注参数与代谢灌注参数在感染性休克复苏中的比较演变尚未研究。我们进行了一项前瞻性的观察临床生理研究，以解决这个subject.Methods：脓毒症相关的循环功能障碍的患者进行复苏，根据一个标准的本地算法。灌注评估包括代谢（中心静脉O-2饱和度[ScvO（2）]和中心静脉至动脉PCO 2梯度[P（cv-a）CO2]）和外周灌注参数（CRT和Tc-toe等）的系列测定。复苏成功定义为24小时血乳酸正常。与代谢参数的行为相比，6小时时CRT和Tc-toe的正常值与成功复苏独立相关（P = .02）。毛细血管再充盈时间是第一个参数显着normalized.Conclusion：外周灌注早期恢复预期成功复苏相比，传统的代谢参数在感染性休克患者。我们的研究结果支持将连续外周灌注评估纳入脓毒性休克复苏的多模式监测策略中。(C)2012 Elsevier Inc. All rights reserved.
Purpose: Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.Methods: Patients with sepsis-related circulatory dysfunction were resuscitated according to a standard local algorithm. Perfusion assessment included serial determinations of metabolic (central venous O-2 saturation [ScvO(2)] and central venous to arterial PCO2 gradient [P(cv-a)CO2]) and peripheral perfusion parameters (CRT and Tc-toe, among others). Successful resuscitation was defined as a normal plasma lactate at 24 hours.Results: Forty-one patients were included. The presence of normal values for both CRT and Tc-toe considered together at 6 hours was independently associated with a successful resuscitation (P = .02), as compared with the behavior of metabolic parameters. Capillary refill time was the first parameter to be significantly normalized.Conclusion: Early recovery of peripheral perfusion anticipates a successful resuscitation compared with traditional metabolic parameters in septic shock patients. Our findings support the inclusion of serial peripheral perfusion assessment in multimodal monitoring strategies for septic shock resuscitation. (C) 2012 Elsevier Inc. All rights reserved.