Departamento de Medicina Intensiva, Pontificia Universidad Católica de Chile, Marcoleta 367, Santiago, Chile.
J Crit Care. 2012 Jun;27(3):283-8. doi: 10.1016/j.jcrc.2011.05.024. Epub 2011 Jul 27.
Perfusion assessment during septic shock resuscitation is difficult and usually complex determinations. Capillary refill time (CRT) and central-to-toe temperature difference (Tc-toe) have been proposed as objective reproducible parameters to evaluate peripheral perfusion. The comparative evolution of peripheral vs metabolic perfusion parameters in septic shock resuscitation has not been studied. We conducted a prospective observational clinical-physiologic study to address this subject.
Patients with sepsis-related circulatory dysfunction were resuscitated according to a standard local algorithm. Perfusion assessment included serial determinations of metabolic (central venous O(2) saturation [Scvo(2)] and central venous to arterial Pco(2) gradient [P(cv-a)co(2)]) and peripheral perfusion parameters (CRT and Tc-toe, among others). Successful resuscitation was defined as a normal plasma lactate at 24 hours.
Forty-one patients were included. The presence of normal values for both CRT and Tc-toe considered together at 6 hours was independently associated with a successful resuscitation (P = .02), as compared with the behavior of metabolic parameters. Capillary refill time was the first parameter to be significantly normalized.
Early recovery of peripheral perfusion anticipates a successful resuscitation compared with traditional metabolic parameters in septic shock patients. Our findings support the inclusion of serial peripheral perfusion assessment in multimodal monitoring strategies for septic shock resuscitation.
脓毒性休克复苏期间的灌注评估较为困难且通常较为复杂。毛细血管再充盈时间（CRT）和中心-趾温差（Tc-toe）已被提议作为评估外周灌注的客观可重复参数。外周与代谢性灌注参数在脓毒性休克复苏中的比较演变尚未得到研究。我们进行了一项前瞻性观察性临床生理学研究来解决这个问题。
根据标准的局部算法对伴有脓毒症相关循环功能障碍的患者进行复苏。灌注评估包括代谢（中心静脉血氧饱和度[Scvo2]和中心静脉-动脉 Pco2 梯度[P（cv-a）co2]）和外周灌注参数（CRT 和 Tc-toe 等）的连续测定。成功复苏定义为 24 小时内正常的血浆乳酸水平。
共纳入 41 例患者。6 小时时 CRT 和 Tc-toe 两者的正常值同时存在与成功复苏独立相关（P=0.02），与代谢参数的行为相比。CRT 是第一个显著恢复正常的参数。
与传统代谢参数相比，外周灌注的早期恢复预示着脓毒性休克患者的复苏成功。我们的研究结果支持在脓毒性休克复苏的多模式监测策略中纳入连续的外周灌注评估。
