Rasmy Islam, Mohamed Hossam, Nabil Nashwa, Abdalah Sabah, Hasanin Ahmed, Eladawy Akram, Ahmed Mai, Mukhtar Ahmed
Anesthetic Department, Faculty of Medicine, Cairo University, Giza, Egypt.
Shock. 2015 Dec;44(6):554-9. doi: 10.1097/SHK.0000000000000481.
We evaluated the ability of perfusion index (PI) to predict vasopressor requirement during early resuscitation in patients with severe sepsis. All consecutive patients with clinically suspected severe sepsis as defined by the criteria of the American College of Chest Physicians/Society of Critical Care Medicine Consensus Conference were included. Perfusion variables included PI, arterial lactate level, central venous oxygen saturation, and the difference between central venous carbon dioxide and arterial carbon dioxide pressures, and were recorded before resuscitation and 6 h thereafter. We enrolled 36 patients with severe sepsis. Twenty-one patients required vasopressors, whereas 15 did not. The cut-off of the PI value for predicting vasopressor requirement was ≤0.3. This cut-off value had a sensitivity of 100% and a specificity of 93%; the area under the curve was 0.96 (95% confidence interval 0.8-0.99, P < 0.0001). The cut-off of the arterial lactate level for predicting vasopressor requirement was ≥1.8 mg dL. This cut-off value had a sensitivity of 82% and a specificity of 80%; the area under the curve was 0.84 (95% confidence interval 0.68-0.94, P < 0.0001). Other perfusion variables failed to predict vasopressor requirement in patients with severe sepsis. We concluded that PI and arterial lactate level are good predictors of vasopressor requirement during early resuscitation in patients with severe sepsis. Further studies are warranted to investigate whether monitoring PI during resuscitation improves the outcome of patients with septic shock.
我们评估了灌注指数（PI）预测严重脓毒症患者早期复苏期间血管升压药需求的能力。纳入了所有符合美国胸科医师学会/危重病医学会共识会议标准、临床上疑似严重脓毒症的连续患者。灌注变量包括PI、动脉血乳酸水平、中心静脉血氧饱和度以及中心静脉二氧化碳与动脉二氧化碳压力之差，在复苏前及复苏后6小时记录这些变量。我们纳入了36例严重脓毒症患者。21例患者需要血管升压药，而15例患者不需要。预测血管升压药需求的PI值临界值为≤0.3。该临界值的敏感性为100%，特异性为93%；曲线下面积为0.96（95%置信区间0.8 - 0.99，P<0.0001）。预测血管升压药需求的动脉血乳酸水平临界值为≥1.8 mg/dL。该临界值的敏感性为82%，特异性为80%；曲线下面积为0.84（95%置信区间0.68 - 0.94，P<0.0001）。其他灌注变量未能预测严重脓毒症患者的血管升压药需求。我们得出结论，PI和动脉血乳酸水平是严重脓毒症患者早期复苏期间血管升压药需求的良好预测指标。有必要进行进一步研究以调查复苏期间监测PI是否能改善感染性休克患者的预后。
