Prediction of Shock by Peripheral Perfusion Index
- 11 Downloads
To detect occurrence of clinical shock and impending shock by monitoring Peripheral Perfusion Index (PI).
In this study, 100 children aged 1 mo to 12 y of age who needed hemodynamic monitoring were included and categorized into five age groups. Demographic data, nutritional status, vital parameters, perfusion index and laboratory parameters were recorded. Hemodynamic monitoring was done for 48 h. In total, 65 and 35 children were admitted with and without features of shock respectively. Nine hundred thirty six hemodynamic measurements were taken and analyzed. Correlation between perfusion index, blood pressures and clinically assessed shock were done.
Clinical shock can be reasonably detected when perfusion index value is less than 1.15 in children less than 3 y of age, less than 1.25 in 3 to 10 y of age and less than 1.55 in 10 to 12 y of age. These values had high sensitivity and low false positivity in detecting clinically assessed shock in that particular age group. PI had good correlation with pulse pressure and systolic blood pressure in all age groups and weak correlation with mean arterial blood pressure and diastolic blood pressure. A 57% reduction in PI value from the baseline value may predict impending shock in children.
Perfusion index can be used as a non-invasive, continuous parameter to monitor peripheral perfusion in children and to detect impending shock.
KeywordsPerfusion index Clinical shock Pulse oxymeter
PS and RMG have collectively done this study with full guidance of BM in MGM Government Hospital, KAPV Govt. Medical College, Thiruchirapalli, Tamil Nadu. RMG analyzed the data and prepared the article. BM will act as guarantor for this paper.
Compliance with Ethical Standards
Conflict of Interest
- 1.Turner DA, Cheifetz IM. Shock. In: Kliemgman RM, editor. Nelson Textbook of Pediatrics. First South Asia edition. India: Elsevier; 2016. p. 516–23.Google Scholar
- 2.Engle WD. Definition of normal blood pressure range. The elusive target. In: Kleinman CS, Seri I, editors. Hemodynamics and Cardiology. Neonatology Questions and Controversies. Philadelphia: Elsevier Health Sciences; 2008. p. 39–65.Google Scholar
- 3.Zaritsky AL, Nadkarni VM, Hickey RW, et al. Recognition of respiratory failure and shock. In: Chameides L, editor. Textbook of Pediatric Advanced Life Support. Dallas: American Heart Association; 2012. p. 97–8.Google Scholar
- 4.Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents. Published by the National High Blood Pressure Education Program Working Group on High Blood Pressure in Children and Adolescents. 2004. Available at: https://www.nhlbi.nih.gov/health-topics/fourth-report-on-diagnosis-evaluation-treatment-high-blood-pressure-in-children-and-adolescents. Accessed on 10 Aug 2004.
- 5.Lande MB. Systemic hypertension: measurements of BP in children. In: Kliemgman RM, editor. Nelson Textbook of Pediatrics, First South Asia edition. India: Elsevier; 2016. p. 2295.Google Scholar
- 6.The Concept, Implementation and Use of Masimo SET. Technical Bulletin 2. Available at: http://www.masimo.com/siteassets/us/documents/pdf/lab3474c.pdf. Accessed on 25 Jan 2008.
- 7.Clinical Applications of Perfusion Index. White paper. 2007. Available at: http://www.masimo.co.uk/siteassets/uk/documents/pdf/clinical-evidence/whitepapers/lab3410f_whitepapers_perfusion_index.pdf. Accessed on 21 Sep 2007.
- 8.Atef HM, Fattah SA, Gaffer ME, Al Rahman AA. Perfusion index versus non-invasive hemodynamic parameters during insertion of i-gel, classic laryngeal mask airway and endotracheal tube. Indian J Anaesth. 2013;57:156–62.Google Scholar
- 9.Levrat Q, Petitpas F, Bouche G, Debaene B, Minoz O. Usefulness of pulse oximetry using the SET technology in critically ill adult patients. Ann Fr Anesth Reanim. 2009;28:640–4.Google Scholar
- 10.Allen J. Photoplethysmography and its application in clinical physiological measurement. Physiol Meas. 2007;28:R1–39.Google Scholar
- 11.Lima AP, Beelen P, Bakker J. Utilization of peripheral perfusion index derived from pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30:1210–3.Google Scholar
- 12.Zdolsek J, Li Y, Hahn RG. Detection of dehydration by using volume kinetics. Anesth Analg. 2012;115:814–22.Google Scholar
- 13.Yamada T, Hagiwara C, Tsuchiya M, Asada A. The usefulness of perfusion index to access the vasocontrictive response to tracheal intubation during remifentanil anesthesia. Anesth Analg. 2010;110:S-1–S-491.Google Scholar
- 16.Ridling DA, Kroon L. Comparing three methods of assessing peripheral perfusion in critically ill children. Pediatr Nurs. 2009;35:11–5, 42.Google Scholar
- 17.Nishimura T, Nakae A, Shibata M, Mashimo T, Fujino Y. Age-related and sex-related changes in perfusion index in response to noxious electrical stimulation in healthy subjects. J Pain Res. 2014;7:91–7.Google Scholar