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Clinical Assessment

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Monitoring Tissue Perfusion in Shock

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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.

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Authors and Affiliations

  1. Department of Critical Care Medicine, Hospital Israelita Albert Einstein, São Paulo, Brazil

    Roberto Rabello Filho & Thiago Domingos Corrêa

Authors
  1. Roberto Rabello Filho
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  2. Thiago Domingos Corrêa
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Correspondence to Roberto Rabello Filho .

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Editors and Affiliations

  1. Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands

    Alexandre Augusto Pinto Lima

  2. Medical School Hospital of the Albert Einstein, Sao Paulo, Brazil

    Eliézer Silva

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Filho, R.R., Corrêa, T.D. (2018). Clinical Assessment. In: Pinto Lima, A., Silva, E. (eds) Monitoring Tissue Perfusion in Shock. Springer, Cham. https://doi.org/10.1007/978-3-319-43130-7_10

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  • DOI: https://doi.org/10.1007/978-3-319-43130-7_10

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-43128-4

  • Online ISBN: 978-3-319-43130-7

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