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Clinical Assessment

  • Roberto Rabello Filho
  • Thiago Domingos Corrêa
Chapter

Abstract

The physiological rationale for monitoring peripheral perfusion is based on the concept that the cutaneous circulation is deprived of autoregulation. Clinical parameters easily obtained at bedside can access compensatory mechanisms induced by shock in early stages, since hypoperfusion might occur despite normal macrohemodynamic parameters.

The capillary refill time (CRT) shows conflicting results in the literature. There is no well-established relationship between CRT and global hemodynamics; however the association with worse clinical outcomes should not be overlooked.

Peripheral temperature and temperature gradients are objective and cheap and available parameters obtained without discomfort to the patients. They are markers highly correlated with cardiac index and competent indicators of severity in shock.

Cold extremities are associated with changes in laboratory tissue perfusion markers such as blood PH, central venous oxygen saturation, and blood lactate levels. Furthermore, other parameters derived from physical examination, such as skin mottling score (SMS), are independent predictors of mortality and, therefore their use in combination with other tissue perfusion monitoring tools should be encouraged.

Keywords

Microcirculation Physical examination Capillary refill Skin temperature Body temperature Critically ill Multiple organ failure Prognosis 

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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Roberto Rabello Filho
    • 1
  • Thiago Domingos Corrêa
    • 1
  1. 1.Department of Critical Care MedicineHospital Israelita Albert EinsteinSão PauloBrazil

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