1
|
Dewachter P, Mouton-Faivre C, Dimby SF, Vicaut E, Beloucif S. Association Between Early Patient Characteristics and IgE-Mediated Allergy in the Perioperative Setting. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1202-1214.e3. [PMID: 38378094 DOI: 10.1016/j.jaip.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 01/24/2024] [Accepted: 02/08/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND Early recognition of perioperative anaphylaxis, a life-threatening, usually IgE-mediated, immediate hypersensitivity, is essential, but bedside diagnosis is not always straightforward because clinical presentation may vary. OBJECTIVES To describe early characteristics of perioperative immediate hypersensitivity, with special attention to cutaneous phenotypes, and identify risk factors for IgE-mediated allergy. METHODS We retrospectively analyzed data from adults with suspected perioperative immediate hypersensitivity who were investigated in two academic medical centers. Multivariable logistic regression was conducted to evaluate associations among patient, clinical, and paraclinical characteristics and IgE-mediated allergy. RESULTS Of 145 enrolled patients, 99 (68.3%) and 46 (31.7%) were respectively categorized in the IgE-mediated allergy and non-allergy groups. Cutaneous vasoconstriction phenotype (pallor, piloerection, thelerethism, and sweating with or without cyanosis) occurring within minutes (or even 1 minute) of drug exposure was strongly associated with IgE-mediated allergy (adjusted odds ratio [aOR] = 28.02; 95% CI, 4.41-305.18). IgE-mediated allergy was always life-threatening in this setting. Other early factors associated with allergy were low end-tidal carbon dioxide 25 mm Hg or less (aOR = 5.45; 95% CI, 2.39-26.45), low mean arterial pressure 60 mm Hg or less (aOR = 3.82; 95% CI, 1.28-17.31), and early cutaneous vasodilation (erythema, urticaria, and/or angioedema) (aOR = 2.78; 95% CI, 0.73-20.54). Late cutaneous vasodilation after restoration of hemodynamics corroborated the diagnosis of allergy (aOR = 23.67; 95% CI, 4.94-205.09). The best-fit model including three readily available variables (cutaneous phenotype involving the three modalities [reference lack of cutaneous signs], low mean arterial pressure, and low end-tidal carbon dioxide) had an area under the curve of 0.91. CONCLUSIONS Cutaneous vasoconstriction phenotype is associated with the strongest risk of life-threatening allergy and thus may be regarded as pathognomonic of perioperative IgE-mediated anaphylaxis.
Collapse
Affiliation(s)
- Pascale Dewachter
- Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Seine-Saint-Denis and Sorbonne Paris Nord University, Bobigny, France.
| | | | - Solohaja Faniaha Dimby
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, University Hospitals Saint-Louis, Lariboisière and Fernand-Widal and Paris-Cité University, Paris, France
| | - Eric Vicaut
- Clinical Research Unit, Assistance Publique-Hôpitaux de Paris, University Hospitals Saint-Louis, Lariboisière and Fernand-Widal and Paris-Cité University, Paris, France
| | - Sadek Beloucif
- Department of Anesthesiology and Intensive Care, Assistance Publique-Hôpitaux de Paris, University Hospitals Paris Seine-Saint-Denis and Sorbonne Paris Nord University, Bobigny, France
| |
Collapse
|
2
|
On the use of indexes derived from photoplethysmographic (PPG) signals for postoperative pain assessment: A narrative review. Biomed Signal Process Control 2023. [DOI: 10.1016/j.bspc.2022.104335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
3
|
Vats V, Nagori A, Singh P, Dutt R, Bandhey H, Wason M, Lodha R, Sethi T. Early Prediction of Hemodynamic Shock in Pediatric Intensive Care Units With Deep Learning on Thermal Videos. Front Physiol 2022; 13:862411. [PMID: 35923238 PMCID: PMC9340772 DOI: 10.3389/fphys.2022.862411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 06/07/2022] [Indexed: 11/13/2022] Open
Abstract
Shock is one of the major killers in intensive care units, and early interventions can potentially reverse it. In this study, we advance a noncontact thermal imaging modality for continuous monitoring of hemodynamic shock working on 1,03,936 frames from 406 videos recorded longitudinally upon 22 pediatric patients. Deep learning was used to preprocess and extract the Center-to-Peripheral Difference (CPD) in temperature values from the videos. This time-series data along with the heart rate was finally analyzed using Long-Short Term Memory models to predict the shock status up to the next 6 h. Our models achieved the best area under the receiver operating characteristic curve of 0.81 ± 0.06 and area under the precision-recall curve of 0.78 ± 0.05 at 5 h, providing sufficient time to stabilize the patient. Our approach, thus, provides a reliable shock prediction using an automated decision pipeline that can provide better care and save lives.
Collapse
Affiliation(s)
- Vanshika Vats
- Indraprastha Institute of Information Technology, Delhi, India
| | - Aditya Nagori
- Indraprastha Institute of Information Technology, Delhi, India
- CSIR-Institute of Genomics and Integrative Biology, New Delhi, India
- Academy of Scientific and Innovative Research (AcSIR), Ghaziabad, India
| | - Pradeep Singh
- Indraprastha Institute of Information Technology, Delhi, India
| | - Raman Dutt
- Computer Science and Engineering, Shiv Nadar University, Greater Noida, India
| | - Harsh Bandhey
- Indraprastha Institute of Information Technology, Delhi, India
| | - Mahika Wason
- Indraprastha Institute of Information Technology, Delhi, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Tavpritesh Sethi
- Indraprastha Institute of Information Technology, Delhi, India
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
- *Correspondence: Tavpritesh Sethi,
| |
Collapse
|
4
|
Magnin M, Amson H, Vacheron CH, Thiollière F, Piriou V, Junot S, Bonnet Garin JM, Allaouchiche B. Associations between peripheral perfusion disorders, mean arterial pressure and dose of norepinephrine administrated in the early phase of septic shock. Clin Exp Pharmacol Physiol 2021; 48:1327-1335. [PMID: 34133795 DOI: 10.1111/1440-1681.13540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 09/11/2020] [Accepted: 06/14/2021] [Indexed: 11/27/2022]
Abstract
The aim of the study was to explore the correlations between peripheral perfusion, mean arterial pressure and the dose-rate of norepinephrine (NE) infused for the treatment of septic shock. The study is retrospective analysis of data acquired prospectively on 57 patients during the first 24 hours after the occurrence of the shock. Clinical and haemodynamic characteristics, skin perfusion parameters (capillary refill time [CRT], mottling score and temperature gradients) and the dose rate of NE infusion were collected. Negative correlations between mean arterial pressure (MAP) and temperature gradients (core-to-toe: P = .03, core-to-index: P = .04) were found and abnormal CRT was associated with lower MAP (P = .02). The dose rate of NE was negatively correlated with temperature gradients (core-to-toe: P = .02, core-to-index: P = .01, forearm-to-index: P = .008) in the overall population. In patients receiving NE for at least 12 hours, the NE dose rate positively was correlated with the mottling score (P = .006), temperature gradients (core-to-toe: P = .04, forearm-to-index: P = .02, core-to-index: P = .005) and CRT (P = .001). The dose of NE administrated was associated with 14-days mortality (odds ration [OR] = 1.21 [1.06-1.38], P = .006) and with 28-days mortality (OR = 1.17 [1.01-1.36], P = 0.04). In conclusion, the study described the presence of correlations between peripheral perfusion and MAP and between peripheral perfusion and the dose rate of NE infusion.
Collapse
Affiliation(s)
- Mathieu Magnin
- University of Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis (Pulmonary and circulatory disorders in sepsis), VetAgro Sup, Marcy l'Etoile, France.,Physiology, University of Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Harry Amson
- Intensive care unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, Pierre-Bénite, France.,PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS UMR 5308, Université Claude Bernard Lyon 1, Lyon, France.,Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Charles-Hervé Vacheron
- Intensive care unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, Pierre-Bénite, France.,PHE3ID, Centre International de Recherche en Infectiologie, Institut National de la Santé et de la Recherche Médicale U1111, CNRS UMR 5308, Université Claude Bernard Lyon 1, Lyon, France.,Service de Biostatistique - Bioinformatique, Pôle Santé Publique, Hospices Civils de Lyon, Lyon, France
| | - Fabrice Thiollière
- Intensive care unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, Pierre-Bénite, France
| | - Vincent Piriou
- Intensive care unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, Pierre-Bénite, France
| | - Stéphane Junot
- University of Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis (Pulmonary and circulatory disorders in sepsis), VetAgro Sup, Marcy l'Etoile, France.,Anesthesiology, University of Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Jeanne-Marie Bonnet Garin
- University of Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis (Pulmonary and circulatory disorders in sepsis), VetAgro Sup, Marcy l'Etoile, France.,Physiology, University of Lyon, VetAgro Sup, Marcy l'Etoile, France
| | - Bernard Allaouchiche
- University of Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis (Pulmonary and circulatory disorders in sepsis), VetAgro Sup, Marcy l'Etoile, France.,Intensive care unit, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, University of Lyon, Pierre-Bénite, France
| |
Collapse
|
5
|
Chalifoux NV, Spielvogel CF, Stefanovski D, Silverstein DC. Standardized capillary refill time and relation to clinical parameters in hospitalized dogs. J Vet Emerg Crit Care (San Antonio) 2021; 31:585-594. [PMID: 34181819 DOI: 10.1111/vec.13088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 11/03/2019] [Accepted: 12/07/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the relationship between various physical and clinicopathologic parameters and the capillary refill time (CRT) using a standard method; to evaluate the influence of emergency room (ER) versus ICU hospital location on CRT; and to identify latent subgroups among the CRT distribution. DESIGN Prospective, observational study. SETTING University teaching hospital. ANIMALS Client-owned dogs in the ER (n = 40) and ICU (n = 71). INTERVENTIONS The CRT was defined as the duration required for the oral mucosa of the upper lip to return to its original color after blanching for 4 seconds. The CRT was recorded in seconds to the 10ths place by a single observer using an automated recording device. MEASUREMENTS AND MAIN RESULTS Median CRT for all dogs was 1.1 seconds (ER, 1.2 s; ICU, 1.1 s; P = 1.000). The CRT was significantly associated with rectal temperature (P = 0.004), systolic blood pressure (P = 0.028), body weight (P = 0.031), mucous membrane color (P = 0.007), skin turgor (P = 0.039), and acute patient physiologic and laboratory evaluation mentation score (P = 0.019) for all dogs. The CRT was related to a greater number of variables in the ER than in the ICU patient population. In general, the total population of dogs had CRTs belonging to 1 of 2 groups: either ≤1.2 or ≥1.7 seconds. A statistically significant association was found between body weight CRT ≥1.3 seconds (P = 0.02). CONCLUSIONS A CRT following blanching for 4 seconds may provide insight into the hydration status and hemodynamic stability of canine patients. Further research into its clinical application is warranted.
Collapse
Affiliation(s)
- Nolan V Chalifoux
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Carl F Spielvogel
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Darko Stefanovski
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| | - Deborah C Silverstein
- Department of Clinical Sciences and Advanced Medicine, University of Pennsylvania School of Veterinary Medicine, Philadelphia, Pennsylvania, USA
| |
Collapse
|
6
|
Assessment of ocular blood flow in continuous-flow ventricular assist device by laser speckle flowgraphy. J Artif Organs 2021; 24:419-424. [PMID: 33825101 DOI: 10.1007/s10047-021-01265-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 03/25/2021] [Indexed: 12/16/2022]
Abstract
Although the influence of continuous-flow left ventricular assist device (CF-LVAD) support on peripheral circulation has been widely discussed, its monitoring modalities are limited. The aim of this study was to assess the peripheral circulation using the laser speckle flowgraph (LSFG) which can quantitatively measure the ocular blood flow. We implanted a centrifugal CF-LVAD (EVAHEART®; Sun Medical Technology Research Corporation, Nagano, Japan) in five adult goats (body weight 44.5 ± 2.9 kg) under general anesthesia. The waveform of the central retinal artery using the mean blur rate (MBR) for ocular blood velocity and fluctuations as a parameter of pulsatility were obtained before LVAD implantation and after LVAD full-bypass support. The MBR waveform and LSFG fluctuation data were compared with the waveform and pulsatility index of the external carotid artery using an ultrasonic flow meter to evaluate circulatory patterns at different levels. The MBR waveform pattern of the central retinal artery was pulsatile before LVAD implantation and less pulsatile under LVAD full bypass. The fluctuation was 14.7 ± 1.86 before LVAD implantation and 3.85 ± 0.61 under LVAD full bypass (p < 0.01), respectively. The fluctuations of LSFG showed a strong correlation with the pulsatility index of the external carotid artery meaning that similar changes in circulatory pattern were observed at two different levels. Measuring the ocular blood flow using LSFG has potential utility for the assessment of the status of the peripheral circulation and its pulsatility during CF-LVAD.
Collapse
|
7
|
Dietrich M, Marx S, von der Forst M, Bruckner T, Schmitt FCF, Fiedler MO, Nickel F, Studier-Fischer A, Müller-Stich BP, Hackert T, Brenner T, Weigand MA, Uhle F, Schmidt K. Bedside hyperspectral imaging indicates a microcirculatory sepsis pattern - an observational study. Microvasc Res 2021; 136:104164. [PMID: 33831406 DOI: 10.1016/j.mvr.2021.104164] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/28/2021] [Accepted: 03/28/2021] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Microcirculatory alterations are key mechanisms in sepsis pathophysiology leading to tissue hypoxia, edema formation, and organ dysfunction. Hyperspectral imaging (HSI) is an emerging imaging technology that uses tissue-light interactions to evaluate biochemical tissue characteristics including tissue oxygenation, hemoglobin content and water content. Currently, clinical data for HSI technologies in critical ill patients are still limited. METHODS AND ANALYSIS TIVITA® Tissue System was used to measure Tissue oxygenation (StO2), Tissue Hemoglobin Index (THI), Near Infrared Perfusion Index (NPI) and Tissue Water Index (TWI) in 25 healthy volunteers and 25 septic patients. HSI measurement sites were the palm, the fingertip, and a suprapatellar knee area. Septic patients were evaluated on admission to the ICU (E), 6 h afterwards (E+6) and three times a day (t3-t9) within a total observation period of 72 h. Primary outcome was the correlation of HSI results with daily SOFA-scores. RESULTS Serial HSI at the three measurement sites in healthy volunteers showed a low mean variance expressing high retest reliability. HSI at E demonstrated significantly lower StO2 and NPI as well as higher TWI at the palm and fingertip in septic patients compared to healthy volunteers. StO2 and TWI showed corresponding results at the suprapatellar knee area. In septic patients, palm and fingertip THI identified survivors (E-t4) and revealed predictivity for 28-day mortality (E). Fingertip StO2 and THI correlated to SOFA-score on day 2. TWI was consistently increased in relation to the TWI range of healthy controls during the observation time. Palm TWI correlated positively with SOFA scores on day 3. DISCUSSION HSI results in septic patients point to a distinctive microcirculatory pattern indicative of reduced skin oxygenation and perfusion quality combined with increased blood pooling and tissue water content. THI might possess risk-stratification properties and TWI could allow tissue edema evaluation in critically ill patients. CONCLUSION HSI technologies could open new perspectives in microcirculatory monitoring by visualizing oxygenation and perfusion quality combined with tissue water content in critically ill patients - a prerequisite for future tissue perfusion guided therapy concepts in intensive care medicine.
Collapse
Affiliation(s)
- M Dietrich
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - S Marx
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M von der Forst
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - F C F Schmitt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - M O Fiedler
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Nickel
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - A Studier-Fischer
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - B P Müller-Stich
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Hackert
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - T Brenner
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - M A Weigand
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - F Uhle
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany
| | - K Schmidt
- Department of Anesthesiology, Heidelberg University Hospital, Heidelberg, Germany; Department of Anesthesiology and Intensive Care Medicine, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
| |
Collapse
|
8
|
Rasmussen PS, Aasvang EK, Olsen RM, Haahr‐Raunkjaer C, Elvekjaer M, Sørensen HBD, Meyhoff CS. Continuous peripheral perfusion index in patients admitted to hospital wards - An observational study. Acta Anaesthesiol Scand 2021; 65:257-265. [PMID: 32959371 DOI: 10.1111/aas.13711] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Revised: 08/25/2020] [Accepted: 09/09/2020] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Risk patients admitted to hospital wards may quickly develop haemodynamic deterioration and early recognition has high priority to allow preventive intervention. The peripheral perfusion index (PPI) may be an indicator of circulatory distress by assessing peripheral perfusion non-invasively from photoplethysmography. We aimed to describe the characteristics of PPI in hospitalized patients since this is not well-studied. MATERIALS AND METHODS Patients admitted due to either acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or after major abdominal cancer surgery were included in this study. Patients were monitored continuously up to 96 hours with a pulse oximeter. Comparisons between median PPI each day, time of day and admission type were described with mean difference (MD) and were analysed using Wilcoxon rank sum test and related to morbidity and mortality. RESULTS PPI data from 291 patients were recorded for a total of 9279 hours. Median PPI fell from 1.4 (inter quartile range, IQR 0.9-2.3) on day 1 to 1.0 (IQR 0.6-1.6) on day 4. Significant differences occurred between PPI day vs evening (MD = 0.18, 95% CI 0.16-0.20, P = .028), day vs night (MD = 0.56, 95% CI 0.49-0.62, P < .0001) and evening vs night (MD = 0.38, 95% CI 0.33-0.42, P = .002). No significant difference in median PPI between AECOPD and surgical patients was found (MD = 0.15, 95% CI -0.08-0.38, P = .62). CONCLUSION Lower PPI during daytime vs evening and night-time were seen for both populations. The highest frequency of serious adverse events and mortality was seen among patients with low median PPI. The clinical impact of PPI monitoring needs further confirmation.
Collapse
Affiliation(s)
- Patrick S. Rasmussen
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital, Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Eske K. Aasvang
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases Rigshospitalet, University of Copenhagen Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - Rasmus M. Olsen
- Biomedical Engineering, Department of Health Technology Technical University of Denmark Kgs. Lyngby Denmark
| | - Camilla Haahr‐Raunkjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital, Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Mikkel Elvekjaer
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital, Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Anaesthesiology, Centre for Cancer and Organ Diseases Rigshospitalet, University of Copenhagen Copenhagen Denmark
| | - Helge B. D. Sørensen
- Biomedical Engineering, Department of Health Technology Technical University of Denmark Kgs. Lyngby Denmark
| | - Christian S. Meyhoff
- Department of Anaesthesia and Intensive Care, Bispebjerg and Frederiksberg Hospital University of Copenhagen Copenhagen Denmark
- Copenhagen Center for Translational Research Copenhagen University Hospital, Bispebjerg and Frederiksberg Copenhagen Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| |
Collapse
|
9
|
Falotico JM, Shinozaki K, Saeki K, Becker LB. Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status. Front Med (Lausanne) 2020; 7:614326. [PMID: 33365323 PMCID: PMC7750533 DOI: 10.3389/fmed.2020.614326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. By monitoring peripheral perfusion status, clinicians can promptly initiate life-saving therapy and reduce the likelihood of shock-associated death. Historically, abnormal perfusion has been indicated by the observation of pale, cold, and clammy skin with increased capillary refill time. The utility of these assessments has been debated given that clinicians may vary in their clinical interpretation of body temperature and refill time. Considering these constraints, current sepsis bundles suggest the need to revise resuscitation guidelines. New technologies have been developed to calculate capillary refill time in the hopes of identifying a new gold standard for clinical care. These devices measure either light reflected at the surface of the fingertip (reflected light), or light transmitted through the inside of the fingertip (transmitted light). These new technologies may enable clinicians to monitor peripheral perfusion status more accurately and may increase the potential for ubiquitous hemodynamic monitoring across different clinical settings. This review will summarize the different methods available for peripheral perfusion monitoring and will discuss the advantages and disadvantages of each approach.
Collapse
Affiliation(s)
- Julianne M Falotico
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, United States
| | - Koichiro Shinozaki
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, United States.,The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Nihon Kohden Innovation Center, Cambridge, MA, United States
| | - Lance B Becker
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, United States.,The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| |
Collapse
|
10
|
Amson H, Vacheron CH, Thiolliere F, Piriou V, Magnin M, Allaouchiche B. Core-to-skin temperature gradient measured by thermography predicts day-8 mortality in septic shock: A prospective observational study. J Crit Care 2020; 60:294-299. [DOI: 10.1016/j.jcrc.2020.08.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/15/2020] [Accepted: 08/22/2020] [Indexed: 10/23/2022]
|
11
|
Abstract
PURPOSE OF REVIEW Currently, the treatment of patients with shock is focused on the clinical symptoms of shock. In the early phase, this is usually limited to heart rate, blood pressure, lactate levels and urine output. However, as the ultimate goal of resuscitation is the improvement in microcirculatory perfusion the question is whether these currently used signs of shock and the improvement in these signs actually correspond to the changes in the microcirculation. RECENT FINDINGS Recent studies have shown that during the development of shock the deterioration in the macrocirculatory parameters are followed by the deterioration of microcirculatory perfusion. However, in many cases the restoration of adequate macrocirculatory parameters is frequently not associated with improvement in microcirculatory perfusion. This relates not only to the cause of shock, where there are some differences between different forms of shock, but also to the type of treatment. SUMMARY The improvement in macrohemodynamics during the resuscitation is not consistently followed by subsequent changes in the microcirculation. This may result in both over-resuscitation and under-resuscitation leading to increased morbidity and mortality. In this article the principles of coherence and the monitoring of the microcirculation are reviewed.
Collapse
|
12
|
Schaefer JD, Reminga CL, Reineke EL, Drobatz KJ. Evaluation of the rectal-interdigital temperature gradient as a diagnostic marker of shock in dogs. J Vet Emerg Crit Care (San Antonio) 2020; 30:670-676. [PMID: 32965089 DOI: 10.1111/vec.12992] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 12/23/2018] [Accepted: 01/28/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the difference in the rectal-interdigital temperature gradient (RITG) between dogs that were presented to an emergency room with clinical signs of shock compared to those without signs of shock, and if this gradient can be used as a diagnostic marker for shock. DESIGN Prospective, single center, observational study conducted from 2014 to 2015. SETTING University veterinary teaching hospital. ANIMALS Twenty dogs with a clinical diagnosis of shock and 60 dogs without a clinical diagnosis of shock (controls). MEASUREMENTS AND MAIN RESULTS Upon presentation to the emergency room and prior to intervention, measurements of rectal temperature, interdigital temperature, ambient temperature, systemic markers of perfusion (capillary refill time [CRT], heart rate [HR], respiratory rate [RR], Doppler blood pressure [DBP], and venous plasma lactate concentration), and venous blood gas analytes were recorded. Dogs were initially determined to be in shock by the attending clinician, and post hoc inclusion criteria were applied. Shock was defined as abnormalities in ≥3 of the 6 following criteria: HR > 120/min, RR > 40/min, CRT > 2 seconds, rectal temperature <37.8°C (100.0°F), venous plasma lactate concentration >2.5 mmol/L, or DBP < 90 mm Hg. Animals with circulatory shock had a significantly increased RITG. An increased RITG was also correlated with individual perfusion parameters including prolonged CRT (ρ = .353, P = 0.0013), tachycardia (ρ = .3485, P = 0.0015), decreased DBP (ρ = -0.6162, P = 0.0003), and shock index (ρ = 0.6168, P = 0.0003). Receiver operator curve analysis indicated a RITG cutoff point of 11.6°F had 90% specificity for the diagnosis of shock (area under the curve = 0.7604). CONCLUSIONS The RITG in this study was associated with a diagnosis of shock and therefore may serve as a diagnostic marker of circulatory shock. Future studies with larger sample sizes to validate the use of temperature gradients and other peripheral perfusion abnormalities as diagnostic and monitoring tools are warranted.
Collapse
Affiliation(s)
- Jonathan D Schaefer
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Christin L Reminga
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Erica L Reineke
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kenneth J Drobatz
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| |
Collapse
|
13
|
Endo Y, Miyasho T, Imahase H, Kawamura Y, Sakamoto Y, Yamashita K. Use of perfusion index to detect hemodynamic changes in endotoxemic pigs. J Vet Emerg Crit Care (San Antonio) 2020; 30:534-542. [PMID: 32652875 DOI: 10.1111/vec.12985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 12/23/2018] [Accepted: 01/30/2019] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The perfusion index (PI) derived from plethysmographic signals provides a noninvasive indication of peripheral perfusion. This study aimed to investigate changes in PI and other hemodynamic variables in pigs subjected to endotoxemia. DESIGN Prospective experimental study. SETTING University teaching hospital. ANIMALS Twelve healthy pigs weighing a mean (± standard deviation [SD]) of 31.7 ± 2.0 kg. INTERVENTIONS Pigs were divided into control and endotoxin groups (n = 6 each). Endotoxemia was induced by IV infusion of lipopolysaccharide. Heart rate, mean arterial pressure, cardiac index (CI), central venous pressure, systemic vascular resistance index (SVRI), extravascular lung water index (ELWI), Global end-diastolic volume (GEDV) index, and pulmonary permeability index were measured using a transpulmonary thermodilution monitor in all pigs. PI was measured using a pulse oximeter probe attached to the tail. Pao2 , Paco2 , and plasma lactate concentration were measured by blood gas analysis. Measurements were taken at baseline (T0 ). Saline or lipopolysaccharide was then administered for 30 min to all pigs (control or endotoxemia group, respectively), and each parameter was measured every 30 min up to 270 min. Data were analyzed by analysis of variance and Student's t-tests. MEASUREMENTS AND MAIN RESULTS There were no significant changes in any variables in the control group, but CI, SVRI, PI, ELWI, blood lactate concentration, and Pao2 changed significantly from baseline in the endotoxin group (P < 0.001, P = 0.0048, P < 0.001, P = 0.0064, P < 0.001, and P = 0.0220, respectively). In the endotoxin group, mean (± SD) %PI increased from T0 to 154 ± 34% at T60 (P = .001) and 135 ± 50% at T90 (P =0 .004), which mirrored significant changes in %CI and %SVRI. CONCLUSION The PI may be useful to detect changes in CI and SVRI.
Collapse
Affiliation(s)
- Yusuke Endo
- Departments of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Taku Miyasho
- Departments of Veterinary Science, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Hisashi Imahase
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Yoshio Kawamura
- Department of Veterinary Pathobiology, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| | - Yuichiro Sakamoto
- Department of Emergency and Critical Care Medicine, Faculty of Medicine, Saga University, Saga, Japan
| | - Kazuto Yamashita
- Departments of Small Animal Clinical Sciences, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Japan
| |
Collapse
|
14
|
Bakker J, Hernandez G. Can Peripheral Skin Perfusion Be Used to Assess Organ Perfusion and Guide Resuscitation Interventions? Front Med (Lausanne) 2020; 7:291. [PMID: 32656220 PMCID: PMC7324549 DOI: 10.3389/fmed.2020.00291] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/22/2020] [Indexed: 11/17/2022] Open
Abstract
Although the definition of septic shock is straightforward, the physiological response to inadequate hemodynamics in patients with septic shock is variable. Therefore, the clinical recognition is limited not only by the patient's response but also by the clinical parameters we can use at the bedside. In this short overview we will argue that the state of the peripheral perfusion can help to identify and to treat patients with septic shock.
Collapse
Affiliation(s)
- Jan Bakker
- Department of Pulmonary and Critical Care, Bellevue Hospital, NYU Langone, New York, NY, United States.,Division of Pulmonary and Critical Care Medicine, Columbia University Medical Center, New York, NY, United States.,Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, Netherlands.,Pontificia Universidad Católica de Chile, Department of Intensive Care, Santiago, Chile
| | - Glenn Hernandez
- Pontificia Universidad Católica de Chile, Department of Intensive Care, Santiago, Chile
| |
Collapse
|
15
|
Shi X, Xu M, Yu X, Lu Y. Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study. BMC Anesthesiol 2020; 20:153. [PMID: 32552781 PMCID: PMC7301460 DOI: 10.1186/s12871-020-01072-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background Peripheral perfusion index (PPI) is an indicator reflecting perfusion. Patients undergoing long time surgeries are more prone to hypoperfusion and increased lactate. Few studies focusing on investigating the association between PPI and surgical patients’ prognoses. We performed this study to find it out. Methods From January 2019 to September 2019, we retrospected all surgical patients who were transferred to ICU, Xinyang Central hospital, Henan province, China. Inclusive criteria: age ≥ 18 years old; surgical length ≥ 120 min. Exclusive criteria: died in ICU; discharging against medical advice; existing diseases affecting blood flow of upper limbs, for example, vascular thrombus in arms; severe liver dysfunction. We defined “prolonged ICU stay” as patients with their length of ICU stay longer than 48 h. According to the definition, patients were divided into two groups: “prolonged group” (PG) and “non-prolong group” (nPG). Baseline characteristics, surgical and therapeutic information, ICU LOS, SOFA and APACHE II were collected. Besides we gathered data of following parameters at 3 time points (T0: ICU admission; T1: 6 h after admission; T2: 12 h after admission): mean artery pressure (MAP), lactate, heart rate (HR), PPI and body temperature. Data were compared between the 2 groups. Multivariable binary logistic regression and ROC (receiver operating characteristic) curves were performed to find the association between perfusion indictors and ICU LOS. Results Eventually, 168 patients were included, 65 in PG and 103 in nPG. Compared to nPG, patients in PG had higher blood lactate and lower PPI. PPI showed significant difference between two groups earlier than lactate (T0 vs T1). The value of PPI at two time points was lower in PG than nPG(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001). Increased lactateT1(OR 3.216; 95% CI 1.253–8.254, P = 0.015) and decreased PPIT1 (OR 0.070; 95% CI 0.016–0.307, P < 0.001) were independently associated with prolonged ICU stay. The area under ROC of the PPIT1 for predicting ICU stay> 48 h was 0.772, and the cutoff value for PPIT1 was 1.35, with 83.3% sensitivity and 73.8% specificity. Conclusions PPI and blood lactate at T1(6 h after ICU admission) are associated with ICU LOS in surgical patient. Compared to lactate, PPI indicates hypoperfusion earlier and more accurate in predicting prolonged ICU stay.
Collapse
Affiliation(s)
- Xinge Shi
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China
| | - Ming Xu
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China
| | - Xu Yu
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China
| | - Yibin Lu
- Department of Critical Care Medicine, Xinyang Central Hospital, No.1, Siyi Road, Xinyang, 464000, Henan Province, China.
| |
Collapse
|
16
|
Association Between Doppler Snuffbox Resistive Index and Tissue Perfusion in Septic Patients. Shock 2020; 54:723-730. [PMID: 32941387 DOI: 10.1097/shk.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Peripheral vascular disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in septic shock. The Doppler snuffbox resistive index (SBRI) can be an accurate parameter to evaluate the status of peripheral vasculature at the bedside. We evaluated whether the SBRI is related to lactate levels or the peripheral perfusion index (PI) and its ability to predict lactate clearance in septic patients. METHODS We conducted a prospective observational study in a tertiary general and teaching hospital in China. From July 2019 to December 2019, all consecutive adult patients with septic shock who required intensive care unit admission were included. At the same time, 20 stable postoperative patients were studied as a control group. We recorded the hemodynamic parameters, including the SBRI and PI, which were measured simultaneously after patient recruitment. RESULTS We evaluated 44 patients with septic shock in the study group and 20 stable postoperative patients in the control group. Patients with septic shock had higher Sequential Organ Failure Assessment scores, procalcitonin levels, cardiac index (CI) and lactate levels than patients in the control group. The SBRI was correlated with the PI and lactate level. The CI was not correlated with lactate level in the patients examined. Based on lactate clearance in the first 6 h, the septic shock patients were divided into two groups: one with lactate clearance ≥20% (n = 28) and the other with lactate clearance <20% (n = 16). The CI was not significantly different between the two groups. The SBRI of the lactate clearance <20% group was higher than that of the lactate clearance ≥20% group and the control group. The PI of the lactate clearance <20% group was lower than that of the lactate clearance ≥20% group and the control group. The SBRI cutoff value for predicting 6-h lactate clearance after resuscitation was ≥1.09, with a sensitivity of 68.8% and a specificity of 85.7%. The PI cutoff value for predicting 6-h lactate clearance after resuscitation was ≤0.99, with a sensitivity of 64.3% and a specificity of 81.2%. The SBRI was significantly better than the PI for predicting 6-h lactate clearance after resuscitation (area under the curve: 0.805 vs. 0.703, P < 0.05). CONCLUSIONS The Doppler SBRI is correlated with tissue perfusion parameters in critically ill patients. An abnormal SBRI may be better than the PI for predicting poor lactate clearance in septic patients. Further investigations are required to determine whether correcting an abnormal SBRI and PI may improve the success rate of septic shock resuscitation.
Collapse
|
17
|
Magnin M, Junot S, Cardinali M, Ayoub JY, Paquet C, Louzier V, Garin JMB, Allaouchiche B. Use of infrared thermography to detect early alterations of peripheral perfusion: evaluation in a porcine model. BIOMEDICAL OPTICS EXPRESS 2020; 11:2431-2446. [PMID: 32499935 PMCID: PMC7249846 DOI: 10.1364/boe.387481] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 03/10/2020] [Accepted: 03/18/2020] [Indexed: 05/08/2023]
Abstract
This study aimed to evaluate the variations of infrared thermography according to rapid hemodynamic changes, by measuring the peripheral skin temperature in a porcine model. Eight healthy piglets were anesthetized and exposed to different levels of arterial pressure. Thermography was performed on the left forelimb to measure carpus and elbow skin temperature and their associated gradient with the core temperature. Changes in skin temperature in response to variations of blood pressure were observed. A negative correlation between arterial pressure and temperature gradients between peripheral and core temperature and a negative correlation between cardiac index and these temperature gradients were observed. Thermography may serve as a tool to detect early changes in peripheral perfusion.
Collapse
Affiliation(s)
- Mathieu Magnin
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, Vetagro Sup, Campus Vétérinaire de Lyon, Unité de Physiologie, Pharmacodynamie et Thérapeutique, F-69280 Marcy l’Etoile, France
| | - Stephane Junot
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, Anesthésiologie, F-69280 Marcy l’Etoile, France
| | - Martina Cardinali
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, VetAgro Sup, Campus Vétérinaire de Lyon, Anesthésiologie, F-69280 Marcy l’Etoile, France
| | - Jean Yves Ayoub
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, Vetagro Sup, Campus Vétérinaire de Lyon, Unité de Physiologie, Pharmacodynamie et Thérapeutique, F-69280 Marcy l’Etoile, France
| | - Christian Paquet
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, Vetagro Sup, Campus Vétérinaire de Lyon, Unité de Physiologie, Pharmacodynamie et Thérapeutique, F-69280 Marcy l’Etoile, France
| | - Vanessa Louzier
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, Vetagro Sup, Campus Vétérinaire de Lyon, Unité de Physiologie, Pharmacodynamie et Thérapeutique, F-69280 Marcy l’Etoile, France
| | - Jeanne Marie Bonnet Garin
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, Vetagro Sup, Campus Vétérinaire de Lyon, Unité de Physiologie, Pharmacodynamie et Thérapeutique, F-69280 Marcy l’Etoile, France
| | - Bernard Allaouchiche
- Université de Lyon, APCSe Agressions Pulmonaires et Circulatoires dans le Sepsis, VetAgro Sup, F-69280 Marcy l’Etoile, France
- Université de Lyon, Hospices Civils de Lyon, Centre Hospitalier Lyon Sud, Réanimation Médicale, Unité APCSE, Pierre-Bénite, France
| |
Collapse
|
18
|
Increase of Perfusion Index During Vascular Occlusion Test is Paradoxically Associated With Higher Mortality in Septic Shock After Fluid Resuscitation: A Prospective Study. Shock 2019; 51:605-612. [DOI: 10.1097/shk.0000000000001217] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
19
|
Mathew J, Bada Shekarappa C, Padubidri Nanyam Rao S. Correlation between Perfusion Index and CRIB Score in Sick Neonates Admitted to a Tertiary Center. J Trop Pediatr 2019; 65:84-89. [PMID: 29684189 DOI: 10.1093/tropej/fmy016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE The study was to determine the correlation of Perfusion Index (PI) and Clinical Risk Index for Babies (CRIB) score, in assessing the severity of illness in sick neonates. METHODS This was a cross-sectional study conducted at a tertiary care Neonatal Intensive Care Unit (NICU). All eligible neonates, both term and preterm, admitted to the high-dependency unit of the NICU were included, after parental consent. Relevant details of history and examination were collected with a structured proforma. Severity of illness was assessed using CRIB score within 12 h of admission. PI was recorded within 24 h of admission, and babies were examined for the presence or absence of shock and their outcome was documented. The correlation coefficient between PI and CRIB score was derived. RESULTS A total of 200 eligible newborns were enrolled. The mean gestational age of the neonates was 34 weeks. The median [interquartile range (IQR)] CRIB score was 1.00 (0.00, 3.00), and PI was 1.400 (0.93, 2.30). The Spearman's rank correlation coefficient between PI and CRIB score was -0.41 with p value <0.05. The median PI of neonates with CRIB score ≤5, 6-10 and >10 was 1.50, 0.74, 0.67, respectively (p value <0.0001). The median (IQR) PI of babies with shock and without shock was 0.63 (0.43, 0.84) and 1.58 (1.19, 2.41), respectively, with p value <0.001. CONCLUSION PI has a negative correlation with CRIB score and can be used to assess the severity of illness in sick neonates.
Collapse
Affiliation(s)
- Jisha Mathew
- Department of Neonatology, St. John's Medical College and Hospital, Bangalore, India
| | | | | |
Collapse
|
20
|
Soares FB, Pereira-Neto GB, Rabelo RC. Assessment of plasma lactate and core-peripheral temperature gradient in association with stages of naturally occurring myxomatous mitral valve disease in dogs. J Vet Emerg Crit Care (San Antonio) 2018; 28:532-540. [PMID: 30294857 DOI: 10.1111/vec.12771] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/13/2017] [Accepted: 04/17/2017] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate plasma lactate concentrations and core-peripheral temperature gradients as perfusion parameters in dogs with heart failure caused by myxomatous mitral valve disease (MMVD) and to determine whether the above perfusion parameters are correlated with disease stages. DESIGN Prospective observational study. SETTING University teaching hospital. ANIMALS After excluding 129 dogs because of exclusion criteria, 7 dogs with heart failure classified as stage B2 and 10 dogs classified as stage C according to the American Heart Association (AHA)/American College of Cardiology (ACC) were included in the study. Six dogs without MMVD were evaluated as the control group. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Among the evaluated parameters, the plasma lactate concentrations were increased in stage C (median 3.70 mmol/L [33.3 mg/dL], interquartile range (IQR) 0.72 mmol/L [6.5 mg/dL]) compared with those in the control (median 2.80 mmol/L [25.2 mg/dL], IQR 0.8 mmol/L [7.2 mg/dL]; P = 0.024) and stage B2 groups (median 2.70 mmol/L [24.3 mg/dL], IQR 1.8 mmol/L [16.2 mg/dL]; P = 0.045). Significant differences were not observed in the core-peripheral temperature gradients among the control, stage B2, and stage C dogs. CONCLUSIONS Dogs with structural heart disease as a result of MMVD may have occult tissue hypoperfusion in stage C that is demonstrated by hyperlactatemia.
Collapse
Affiliation(s)
- Felipe B Soares
- Veterinary Hospital of the Faculty of Agronomy and Veterinary Medicine, University of Brasilia, Brasília, Brazil.,Northern Sector of Clubs, Darcy Ribeiro Universitary Campus, Brasília, Brazil
| | - Gláucia B Pereira-Neto
- Veterinary Hospital of the Faculty of Agronomy and Veterinary Medicine, University of Brasilia, Brasília, Brazil.,Northern Sector of Clubs, Darcy Ribeiro Universitary Campus, Brasília, Brazil
| | | |
Collapse
|
21
|
Teixeira LG, Martins LR, Schimites PI, de Oliveira RB, Bonella J, Campos RV, Mangini LT, Gasparotto JC, Soares AV. Peripheral perfusion index does not accurately reflect hypoperfusion in healthy dogs undergoing elective ovariohysterectomy. Vet J 2018; 240:27-30. [PMID: 30268329 DOI: 10.1016/j.tvjl.2018.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Revised: 08/28/2018] [Accepted: 09/02/2018] [Indexed: 11/18/2022]
Abstract
This study evaluated the variability of the peripheral perfusion index (PI) in 22 anaesthetised female dogs undergoing elective ovariohysterectomy and examined the relationship between peripheral PI and heart rate, blood pressure, blood pH, end tidal CO2 (EtCO2), O2 saturation (SpO2), core-peripheral temperature gradient (ΔTc-p), partial pressure of CO2 (PCO2), and concentrations of glucose, cortisol, lactate and bicarbonate (HCO3-). Blood pH, lactate and glucose concentrations were determined 15, 30, 45min into the ovariohysterectomy procedure and after extubation. Cortisol concentrations were assessed before anaesthesia and after extubation. Other variables were recorded at every 5min throughout the ovariohysterectomy procedure. Hyperglycaemia was observed in 59% of bitches during surgery, but serum cortisol concentrations remained unchanged. Most measures of perfusion (ΔTc-p, pH, PCO2, EtCO2, SpO2) and heart rate remained unchanged throughout anaesthesia and did not correlate with peripheral PI. Mean arterial pressure increased during the ovariohysterectomy procedure, while peripheral PI decreased, resulting in negative correlations between these variables at 30 and 45min. Lactate concentrations decreased from baseline to the time of measurement post-extubation. Peripheral PI gradually decreased during the ovariohysterectomy procedure, probably reflecting vasoconstriction induced by nociceptive stimuli. Using lactate concentrations as the reference standard for peripheral perfusion, low peripheral PI in healthy bitches undergoing ovariohysterectomy might not represent peripheral hypoperfusion.
Collapse
Affiliation(s)
- L G Teixeira
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil.
| | - L R Martins
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - P I Schimites
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - R B de Oliveira
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - J Bonella
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - R V Campos
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - L T Mangini
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - J C Gasparotto
- Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| | - A V Soares
- Graduate Programme of Veterinary Medicine, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil; Department of Small Animal Clinics, Centre of Rural Science, Federal University of Santa Maria (UFSM), Avenida Roraima n° 1000/97, 97195-000 Santa Maria, Rio Grande do Sul State, Brazil
| |
Collapse
|
22
|
Pan P, Liu DW, Su LX, He HW, Wang XT, Yu C. Role of Combining Peripheral with Sublingual Perfusion on Evaluating Microcirculation and Predicting Prognosis in Patients with Septic Shock. Chin Med J (Engl) 2018; 131:1158-1166. [PMID: 29722335 PMCID: PMC5956766 DOI: 10.4103/0366-6999.231524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Measurement of general microcirculation remains difficult in septic shock patients. The peripheral perfusion index (PI) and sublingual microcirculation monitoring are thought to be possible methods. This study was performed to determine whether assessing microcirculation by PI and a new parameter, proportion of perfusion vessel change rate (ΔPPV) from sublingual microcirculation monitoring, can be associated with patients' outcome. Methods: A prospective observational study was carried out, including 74 patients with septic shock in a mixed intensive care unit. Systemic hemodynamic variables were obtained at T0 and 6 h after (T6). PI and sublingual microcirculation indicators were obtained using a bedside monitor and a sidestream dark-field device, respectively. The t-test, analysis of variance, Mann-Whitney U-test, Kruskal-Wallis test, receiver operating characteristic curve analysis with the Hanley-McNeil test, survival curves using the Kaplan-Meier method, and the log-rank (Mantel-Cox) test were used to statistical analysis. Results: Systemic hemodynamics and microcirculation data were obtained and analyzed. Patients were divided into two groups based on whether the first 6 h lactate clearance (LC) was ≥20%; PI and ΔPPV were lower at T6 in the LC <20% group compared with LC ≥20% (PI: 1.52 [0.89, 1.98] vs. 0.79 [0.44, 1,81], Z = −2.514, P = 0.012; ΔPPV: 5.9 ± 15.2 vs. 17.9 ± 20.0, t = −2.914, P = 0.005). The cutoff values of PI and ΔPPV were 1.41% and 12.1%, respectively. The cutoff value of the combined indicators was 1.379 according to logistic regression. Area under the curve demonstrated 0.709 (P < 0.05), and the sensitivity and specificity of using combined indicators were 0.622 and 0.757, respectively. Based on the PI and ΔPPV cutoff, all the participants were divided into the following groups: (1) high PI and high ΔPPV group, (2) high PI and low ΔPPV group, (3) low PI and high ΔPPV group, and (4) low PI and low ΔPPV group. The highest Sequential Organ Failure Assessment score (14.5 ± 2.9) was in the low PI and low ΔPPV group (F = 13.7, P < 0.001). Post hoc tests showed significant differences in 28-day survival rates among these four groups (log rank [Mantel-Cox], 20.931; P < 0.05). Conclusion: PI and ΔPPV in septic shock patients are related to 6 h LC, and combining these two parameters to assess microcirculation can predict organ dysfunction and 28-day mortality in patients with septic shock.
Collapse
Affiliation(s)
- Pan Pan
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Da-Wei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Long-Xiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Huai-Wu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Xiao-Ting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| | - Chao Yu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100730, China
| |
Collapse
|
23
|
Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG, Altiparmak F, Suren M. The effect of patient positions on perfusion index. BMC Anesthesiol 2018; 18:111. [PMID: 30115011 PMCID: PMC6097320 DOI: 10.1186/s12871-018-0571-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 08/01/2018] [Indexed: 12/17/2022] Open
Abstract
Background The optimal position for surgery is one in which the patient is provided the best possible surgical intervention and put at minimum risk. Different surgical positions may cause changes in tissue perfusion. This study investigates the relationship between surgical patient positions and perfusion index. Methods A sample of 61 healthy individuals with no peripheral circulatory disorders, chronic diseases, or anemia was included in this study. Participants held six different positions: supine, prone, 45-degree sitting-supine, 45-degree supine with legs lifted, Trendelenburg (45-degrees head down), and reverse Trendelenburg (45-degrees head up). Perfusion index values were then measured and recorded after individuals held their positions for five minutes. Results Participants’ perfusion index values were affected by different body positions (p < 0.05). Perfusion index was lowest in the sitting position (4.5 ± 2.5) and highest in individuals with Trendelenburg position (7.8 ± 3.8). Conclusion Different body positions can cause changes in tissue perfusion. This should be considered in patient follow-up along with the perfusion index.
Collapse
Affiliation(s)
- Hakan Tapar
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey.
| | - Serkan Karaman
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey
| | - Serkan Dogru
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey
| | - Tugba Karaman
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey
| | - Aynur Sahin
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey
| | | | - Fatih Altiparmak
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey
| | - Mustafa Suren
- Department of Anesthesiology and Reanimation, Gaziosmanpasa University, Faculty of Medicine, 60100, Tokat, Turkey
| |
Collapse
|
24
|
Bridges E, McNeill M, Munro N. Research in Review: Driving Critical Care Practice Change. Am J Crit Care 2016; 25:76-84. [PMID: 26724298 DOI: 10.4037/ajcc2016564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
During the past year, studies were published that will lead to practice change, address challenges at the bedside, and introduce new care strategies. This article summarizes some of this important work and considers it in the context of previous research and practice. Examples of research-based practice changes include the performance and assessment of septic shock resuscitation, and the integration of tourniquets and massive transfusions in civilian trauma. Care challenges addressed include ethical considerations in light of the Ebola epidemic, infection prevention associated with chlorhexidine bathing, bedside alarm management, evidence to enhance moral courage, and interventions to mitigate thirst in critically ill patients. Research that portends future care includes a discussion of fecal microbiota transplant for patients with refractory infection with refractory infection with Clostridium difficile.
Collapse
Affiliation(s)
- Elizabeth Bridges
- Elizabeth Bridges is a clinical nurse researcher and associate professor at the University of Washington Medical Center/School of Nursing, Seattle, Washington. Margaret McNeill is a clinical nurse specialist, perianesthesia, Department of Professional and Clinical Development, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is senior acute care nurse practitioner, Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Margaret McNeill
- Elizabeth Bridges is a clinical nurse researcher and associate professor at the University of Washington Medical Center/School of Nursing, Seattle, Washington. Margaret McNeill is a clinical nurse specialist, perianesthesia, Department of Professional and Clinical Development, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is senior acute care nurse practitioner, Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| | - Nancy Munro
- Elizabeth Bridges is a clinical nurse researcher and associate professor at the University of Washington Medical Center/School of Nursing, Seattle, Washington. Margaret McNeill is a clinical nurse specialist, perianesthesia, Department of Professional and Clinical Development, Frederick Regional Health System, Frederick, Maryland. Nancy Munro is senior acute care nurse practitioner, Critical Care Medicine Department, National Institutes of Health, Bethesda, Maryland
| |
Collapse
|
25
|
He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2015; 19:330. [PMID: 26369784 PMCID: PMC4568576 DOI: 10.1186/s13054-015-1057-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/04/2015] [Accepted: 08/30/2015] [Indexed: 01/09/2023]
Abstract
Introduction We investigated whether combining the peripheral perfusion index (PI) and central venous oxygen saturation(ScvO2) would identify subsets of patients for assessing the tissue perfusion and predicting outcome during the resuscitation in critically ill patients. Methods A total of 202 patients with central venous catheters for resuscitation were enrolled in this prospective observational study. The arterial, central venous blood gas and the PI were measured simultaneously at the enrollment (T0) and 8 h (T8) after early resuscitation. Based on the distribution of the PI in healthy population, a cutoff of PI ≥1.4 was defined as a normal PI. Moreover, the critical value of PI was defined as the best cutoff value related to the mortality in the study population. The PI impairment stratification is defined as follows: a normal PI(≥1.4), mild PI impairment (critical value < PI < 1.4) and critical PI impairment (PI ≤ critical value). Results The PI at T8 was with the greatest AUC for prediction the 30-day mortality and PI is an independent risk factor for 30-day mortality. Moreover, a cutoff of PI < 0.6 is related to poor outcomes following resuscitation. So, based on cutoffs of ScvO2 (70 %) and critical PI (0.6) at T8, we assigned the patients to four categories: group 1 (PI ≤ 0.6 on ScvO2 < 70 %), group 2 (PI ≤ 0.6 on ScvO2 ≥ 70 %), group 3 (PI > 0.6 on ScvO2 < 70 %), and group 4 (PI > 0.6 on ScvO2 ≥ 70 %). The combination of low ScvO2(<70 %) and PI(≤0.6) was associated with the lowest survival rates at 30 days [log rank (Mantel–Cox) = 87.518, p < 0.0001]. The sub-group patients who had high ScvO2(>80 %) at T8 were with low mortality and high PI. Moreover, the normal PI (≥1.4) did not show a better outcome than mild impaired PI (0.6-1.4) patients who had a normalized ScvO2(>70 %) after resuscitation. The PI was correlated with the lactate, P(v-a)CO2, and ScvO2 in all the measurements (n = 404). These relationships are strengthened with abnormal PI (PI < 1.4) but not with normal PI (PI ≥ 1.4). Conclusion Complementing ScvO2 assessment with PI can better identify endpoints of resuscitation and adverse outcomes. Pursuing a normalized PI (≥1.4) may not result in better outcomes for a mild impaired PI after ScvO2 is normalized. Electronic supplementary material The online version of this article (doi:10.1186/s13054-015-1057-8) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Huaiwu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 1 shuaifuyuan, Dongcheng District, 100730, Beijing, China.
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 1 shuaifuyuan, Dongcheng District, 100730, Beijing, China.
| | - Dawei Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 1 shuaifuyuan, Dongcheng District, 100730, Beijing, China.
| | - Xiaoting Wang
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 1 shuaifuyuan, Dongcheng District, 100730, Beijing, China.
| | - Xiang Zhou
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Science, 1 shuaifuyuan, Dongcheng District, 100730, Beijing, China.
| |
Collapse
|
26
|
van Genderen ME, Engels N, van der Valk RJP, Lima A, Klijn E, Bakker J, van Bommel J. Early peripheral perfusion-guided fluid therapy in patients with septic shock. Am J Respir Crit Care Med 2015; 191:477-80. [PMID: 25679107 DOI: 10.1164/rccm.201408-1575le] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
27
|
Abay TY, Kyriacou PA. Reflectance Photoplethysmography as Noninvasive Monitoring of Tissue Blood Perfusion. IEEE Trans Biomed Eng 2015; 62:2187-95. [PMID: 25838515 DOI: 10.1109/tbme.2015.2417863] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In the last decades, photoplethysmography (PPG) has been used as a noninvasive technique for monitoring arterial oxygen saturation by pulse oximetry (PO), whereas near-infrared spectroscopy (NIRS) has been employed for monitoring tissue blood perfusion. While NIRS offers more parameters to evaluate oxygen delivery and consumption in deep tissues, PO only assesses the state of oxygen delivery. For a broader assessment of blood perfusion, this paper explores the utilization of dual-wavelength PPG by using the pulsatile (ac) and continuous (dc) PPG for the estimation of arterial oxygen saturation (SpO2) by conventional PO. Additionally, the Beer-Lambert law is applied to the dc components only for the estimation of changes in deoxyhemoglobin (HHb), oxyhemoglobin (HbO2), and total hemoglobin (tHb) as in NIRS. The system was evaluated on the forearm of 21 healthy volunteers during induction of venous occlusion (VO) and total occlusion (TO). A reflectance PPG probe and NIRS sensor were applied above the brachioradialis, PO sensors were applied on the fingers, and all the signals were acquired simultaneously. While NIRS and forearm SpO2 indicated VO, SpO2 from the finger did not exhibit any significant drop from baseline. During TO, all the indexes indicated the change in blood perfusion. HHb, HbO2, and tHb changes estimated by PPG presented high correlation with the same parameters obtained by NIRS during VO (r(2) = 0.960, r(2) = 0.821, and r(2) = 0.974, respectively) and during TO (r(2) = 0.988, r(2) = 0.940, and r(2) = 0.938, respectively). The system demonstrated the ability to extract valuable information from PPG signals for a broader assessment of tissue blood perfusion.
Collapse
|
28
|
Huang HS, Chu CL, Tsai CT, Wu CK, Lai LP, Yeh HM. Perfusion index derived from a pulse oximeter can detect changes in peripheral microcirculation during uretero-renal-scopy stone manipulation (URS-SM). PLoS One 2014; 9:e115743. [PMID: 25542000 PMCID: PMC4277408 DOI: 10.1371/journal.pone.0115743] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Accepted: 12/01/2014] [Indexed: 11/19/2022] Open
Abstract
Background The objective of this study was to test the effect of removal of a ureteral obstruction (renal calculus) from anesthetized patients on the perfusion index (PI), as measured by a pulse oximeter, and on the estimated glomerular filtration rate (eGFR). Patients and Methods This prospective study enrolled 113 patients with unilateral ureteral obstructions (kidney stones) who were scheduled for ureteroscopy (URS) laser lithotripsy. One urologist graded patient hydronephrosis before surgery. A pulse oximeter was affixed to each patient's index finger ipsilateral to the intravenous catheter, and a non-invasive blood pressure cuff was placed on the contralateral side. Ipsilateral double J stents and Foley catheters were inserted and left indwelling for 24 h. PI and mean arterial pressure (MAP) were determined at baseline, 5 min after anesthesia, and 10 min after surgery; eGFR was determined at admission, 1 day after surgery, and 14 days after surgery. Results Patients with different grades of hydronephrosis had similar age, eGFR, PI, mean arterial pressure (MAP), and heart rate (HR). PI increased significantly in each hydronephrosis group after ureteral stone disintegration. None of the groups had significant post-URS changes in eGFR, although eGFR increased in the grade I hydronephrosis group after 14 days. The percent change of PI correlates significantly with the percent change of MAP, but not with that of eGFR. Conclusion Our results demonstrate that release of a ureteral obstruction leads to a concurrent increase of PI during anesthesia. Measurement of PI may be a valuable tool to monitor the successful release of ureteral obstructions and changes of microcirculation during surgery. There were also increases in eGFR after 14 days, but not immediately after surgery.
Collapse
Affiliation(s)
- Ho-Shiang Huang
- Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Lin Chu
- Institute of Biomedical Engineering National Taiwan University, Taipei, Taiwan
- Department of Anesthesiology, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan
| | - Chia-Ti Tsai
- Division of Cardiology, Department of Cardiology, National Taiwan University Hospital, Taipei and Yun-Lin, Taiwan
- * E-mail: (HMY); (CTT)
| | - Cho-Kai Wu
- Division of Cardiology, Department of Cardiology, National Taiwan University Hospital, Taipei and Yun-Lin, Taiwan
| | - Ling-Ping Lai
- Division of Cardiology, Department of Cardiology, National Taiwan University Hospital, Taipei and Yun-Lin, Taiwan
| | - Huei-Ming Yeh
- Department of Anesthesiology, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail: (HMY); (CTT)
| |
Collapse
|
29
|
Dembek KA, Hurcombe SD, Frazer ML, Morresey PR, Toribio RE. Development of a likelihood of survival scoring system for hospitalized equine neonates using generalized boosted regression modeling. PLoS One 2014; 9:e109212. [PMID: 25295600 PMCID: PMC4189956 DOI: 10.1371/journal.pone.0109212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 08/29/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Medical management of critically ill equine neonates (foals) can be expensive and labor intensive. Predicting the odds of foal survival using clinical information could facilitate the decision-making process for owners and clinicians. Numerous prognostic indicators and mathematical models to predict outcome in foals have been published; however, a validated scoring method to predict survival in sick foals has not been reported. The goal of this study was to develop and validate a scoring system that can be used by clinicians to predict likelihood of survival of equine neonates based on clinical data obtained on admission. METHODS AND RESULTS Data from 339 hospitalized foals of less than four days of age admitted to three equine hospitals were included to develop the model. Thirty seven variables including historical information, physical examination and laboratory findings were analyzed by generalized boosted regression modeling (GBM) to determine which ones would be included in the survival score. Of these, six variables were retained in the final model. The weight for each variable was calculated using a generalized linear model and the probability of survival for each total score was determined. The highest (7) and the lowest (0) scores represented 97% and 3% probability of survival, respectively. Accuracy of this survival score was validated in a prospective study on data from 283 hospitalized foals from the same three hospitals. Sensitivity, specificity, positive and negative predictive values for the survival score in the prospective population were 96%, 71%, 91%, and 85%, respectively. CONCLUSIONS The survival score developed in our study was validated in a large number of foals with a wide range of diseases and can be easily implemented using data available in most equine hospitals. GBM was a useful tool to develop the survival score. Further evaluations of this scoring system in field conditions are needed.
Collapse
Affiliation(s)
- Katarzyna A. Dembek
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Samuel D. Hurcombe
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
| | - Michele L. Frazer
- Hagyard Equine Medical Institute, Lexington, Kentucky, United States of America
| | - Peter R. Morresey
- Rood and Riddle Equine Hospital, Lexington, Kentucky, United States of America
| | - Ramiro E. Toribio
- College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, United States of America
- * E-mail:
| |
Collapse
|
30
|
Cheng YY, Lin SJS, Chang CH, Lin CJ, Tsai CC, Su YC. Cool extremities, a diagnostic sign recorded in Shang Han Lun, still good prognosis index for septic patients in today's medical intensive care unit. Chin J Integr Med 2014. [PMID: 25253547 DOI: 10.1007/s11655-014-1840-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2013] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To evaluate and compare the predictive value of the physical signs mentioned by ZHANG Zhong-jing in Treatise on Cold Damaged Diseases (Shang Han Lun), together with other clinically determined diagnostic scores and laboratory values in modern medicine on 28-day mortality in septic patients. METHODS Three-year prospective observation was conducted in medical intensive care unit in two local community hospitals. In all, 126 patients with severe sepsis and/or septic shock were consecutively enrolled. Ten diagnostic signs (lack of fever, lethargy, delirium, clammy skin, mottled skin, edematous limbs, cool extremities, threadlike pulse, tachycardia, and abdominal distension), acute physiology and chronic health evaluation (APACHE) II, cardiovascular component (CV score) in multiple organ dysfunction syndrome (MODS) score and blood sampled for cytokine measurement, including tumor necrosis factor α (TNF-α), interleukin (IL)-6, IL-8, IL-10 and IL-18, were collected within 24 h after admission. Main outcome was 28-day mortality; independent predictors were determined by multivariate logistic regression analysis. RESULTS Significant correlation between lack of fever, cool extremities, abdominal distension, plasma IL-10 level and mortality emerged. Areas under the receiver operating characteristic curves for cool extremities (0.73, 95% confidence interval: 0.64-0.82, P<0.01) and IL-10 (0.74, 95% confidence interval: 0.66-0.83, P<0.01) indicated comparable discrimination between survivors and non-survivors. CONCLUSIONS Assessment of cool extremities in septic patients, which showed comparable discriminant ability as IL-10, proves prognostic value of diagnostic signs recorded in Treatise on Cold Damaged Diseases, and may provide a quicker, easily-observed, and non-invasive predictor of sepsis mortality.
Collapse
Affiliation(s)
- Yung-Yen Cheng
- Department of Internal Medicine, Nantou Hospital, Department of Health, Executive Yuan, Nantou, Taiwan, 54044, China
| | | | | | | | | | | |
Collapse
|
31
|
van Genderen ME, Paauwe J, de Jonge J, van der Valk RJP, Lima A, Bakker J, van Bommel J. Clinical assessment of peripheral perfusion to predict postoperative complications after major abdominal surgery early: a prospective observational study in adults. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:R114. [PMID: 24894892 PMCID: PMC4229808 DOI: 10.1186/cc13905] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/16/2014] [Indexed: 01/05/2023]
Abstract
INTRODUCTION Altered peripheral perfusion is strongly associated with poor outcome in critically ill patients. We wanted to determine whether repeated assessments of peripheral perfusion during the days following surgery could help to early identify patients that are more likely to develop postoperative complications. METHODS Haemodynamic measurements and peripheral perfusion parameters were collected one day prior to surgery, directly after surgery (D0) and on the first (D1), second (D2) and third (D3) postoperative days. Peripheral perfusion assessment consisted of capillary refill time (CRT), peripheral perfusion index (PPI) and forearm-to-fingertip skin temperature gradient (T(skin-diff)). Generalized linear mixed models were used to predict severe complications within ten days after surgery based on Clavien-Dindo classification. RESULTS We prospectively followed 137 consecutive patients, from among whom 111 were included in the analysis. Severe complications were observed in 19 patients (17.0%). Postoperatively, peripheral perfusion parameters were significantly altered in patients who subsequently developed severe complications compared to those who did not, and these parameters persisted over time. CRT was altered at D0, and PPI and T(skin-diff) were altered on D1 and D2, respectively. Among the different peripheral perfusion parameters, the diagnostic accuracy in predicting severe postoperative complications was highest for CRT on D2 (area under the receiver operating characteristic curve = 0.91 (95% confidence interval (CI) = 0.83 to 0.92)) with a sensitivity of 0.79 (95% CI = 0.54 to 0.94) and a specificity of 0.93 (95% CI = 0.86 to 0.97). Generalized mixed-model analysis demonstrated that abnormal peripheral perfusion on D2 and D3 was an independent predictor of severe postoperative complications (D2 odds ratio (OR) = 8.4, 95% CI = 2.7 to 25.9; D2 OR = 6.4, 95% CI = 2.1 to 19.6). CONCLUSIONS In a group of patients assessed following major abdominal surgery, peripheral perfusion alterations were associated with the development of severe complications independently of systemic haemodynamics. Further research is needed to confirm these findings and to explore in more detail the effects of peripheral perfusion-targeted resuscitation following major abdominal surgery.
Collapse
|
32
|
Microvascular perfusion as a target for fluid resuscitation in experimental circulatory shock. Crit Care Med 2014; 42:e96-e105. [PMID: 24158169 DOI: 10.1097/ccm.0b013e3182a63fbf] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To study regional perfusion during experimental endotoxemic and obstructive shock and compare the effect of initial cardiac output-targeted fluid resuscitation with optimal cardiac output-targeted resuscitation on different peripheral tissues. DESIGN Controlled experimental study. SETTING University-affiliated research laboratory. SUBJECTS Fourteen fasted anesthetized mechanically ventilated domestic pigs. INTERVENTIONS Domestic pigs were randomly assigned to the endotoxemic (n = 7) or obstructive shock (n = 7) model. Central and regional perfusion parameters were obtained at baseline, during greater than or equal to 50% reduction of cardiac output (T1), after initial resuscitation to baseline (T2), and after optimization of cardiac output (T3). MEASUREMENTS AND MAIN RESULTS Regional perfusion was assessed in the sublingual, intestinal, and muscle vascular beds at the different time points and included visualization of the microcirculation, measurement of tissue oxygenation, and indirect assessments of peripheral skin perfusion. Hypodynamic shock (T1) simultaneously decreased all regional perfusion variables in both models. In the obstructive model, these variables returned to baseline levels at T2 and remained in this range after T3, similar to cardiac output. In the endotoxemic model, however, the different regional perfusion variables were only normalized at T3 associated with the hyperdynamic state at this point. The magnitude of changes over time between the different vascular beds was similar in both models, but the endotoxemic model displayed greater heterogeneity between tissues. CONCLUSIONS This study demonstrates that the relationship between the systemic and regional perfusion is dependent on the underlying cause of circulatory shock. Further research will have to demonstrate whether different microvascular perfusion variables can be used as additional resuscitation endpoints.
Collapse
|
33
|
Huang B, Sun K, Zhu Z, Zhou C, Wu Y, Zhang F, Yan M. Oximetry-derived perfusion index as an early indicator of CT-guided thoracic sympathetic blockade in palmar hyperhidrosis. Clin Radiol 2013; 68:1227-32. [DOI: 10.1016/j.crad.2013.07.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Revised: 06/19/2013] [Accepted: 07/01/2013] [Indexed: 12/20/2022]
|