The Circulation

  • Martin W. DünserEmail author
  • Daniel Dankl
  • Sirak Petros
  • Mervyn Mer


Adequate systemic perfusion is the endpoint of shock resuscitation and the therapeutic goal in all critically ill patients. In view of this, it is important to remember that it is not the numbers on a monitor (e.g. arterial blood pressure, cardiac output) but mostly clinical signs which determine whether systemic blood flow is adequate or not. The skin, mental state, kidneys and the general appearance are readily available bedside indicators to assess the adequacy of systemic perfusion.

Supplementary material


  1. 1.
    Joly HR, Weil MH (1969) Temperature of the great toe as an indication of the severity of shock. Circulation 39:131–138CrossRefPubMedGoogle Scholar
  2. 2.
    Ait-Oufella H, Bige N, Boelle PY, Pichereau C, Alves M, Bertinchamp R, Baudel JL, Galbois A, Maury E, Guidet B (2014) Capillary refill time exploration during septic shock. Intensive Care Med 40:958–964CrossRefPubMedGoogle Scholar
  3. 3.
    Thygesen K, Alpert JS, White HD (2007) Universal definition of myocardial infarction. Eur Heart J 28:2525–2538CrossRefPubMedGoogle Scholar
  4. 4.
    Canto JG, Rogers WJ, Goldberg RJ, Peterson ED, Wenger NK, Vaccarino V, Kiefe CI, Frederick PD, Sopko G, Zheng ZJ, NRMI Investigators (2012) Association of age and sex with myocardial infarction symptom presentation and in-hospital mortality. JAMA 307:813–822PubMedPubMedCentralGoogle Scholar
  5. 5.
    Fanaroff AC, Rymer JA, Goldstein SA, Simel DL, Newby LK (2015) Does this patient with chest pain have acute coronary syndrome? The rational clinical examination systematic review. JAMA 314:1955–1965CrossRefPubMedGoogle Scholar
  6. 6.
    Rutherford RB, Baker JD, Ernst C, Johnston KW, Porter JM, Ahn S, Jones DN (1997) Recommended standards for reports dealing with lower extremity ischaemia: revised version. J Vasc Surg 26:517–538CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Martin W. Dünser
    • 1
    Email author
  • Daniel Dankl
    • 2
  • Sirak Petros
    • 3
  • Mervyn Mer
    • 4
  1. 1.Department of Anesthesiology and Intensive Care MedicineKepler University Hospital, Johannes Kepler University LinzLinzAustria
  2. 2.Department of Anesthesiology, Perioperative Medicine and General Intensive CareSalzburg University Hospital and Paracelsus Private Medical UniversitySalzburgAustria
  3. 3.Medical Intensive Care Unit and Centre of Haemostaseology, University Hospital LeipzigLeipzigGermany
  4. 4.Divisions of Critical Care and Pulmonology, Department of MedicineCharlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences University of the WitwatersrandJohannesburgSouth Africa

Personalised recommendations