All authors: Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium.
Crit Care Med. 2020 Apr;48(4):443-450. doi: 10.1097/CCM.0000000000004177.
Skin blood flow is rapidly altered during circulatory shock and may remain altered despite apparent systemic hemodynamic stabilization. We evaluated whether changes in skin blood flow during circulatory shock were related to survival.
Prospective study.
Thirty-five-bed medical-surgical university hospital department of intensive care.
Twenty healthy volunteers and 70 patients with circulatory shock (< 12 hr duration), defined as the need for vasopressors to maintain mean arterial pressure greater than or equal to 65 mm Hg and signs of altered tissue perfusion.
We assessed skin blood flow using skin laser Doppler on the fingertip for 3 minutes at basal temperature (SBFBT) and at 37°C (SBF37) (thermal challenge test) once in volunteers and at the time of inclusion and after 6, 24, 48, 72, and 96 hours in patients with shock. Capillary refill time and peripheral perfusion index were measured at the same time points on the contralateral hand.
The thermal challenge response (ΔSBF/ΔT) was calculated using the following formula: (SBF37-SBFBT)/(37-basal temperature). Area under the receiver operating characteristic curves were calculated to evaluate variables predictive of ICU mortality. At inclusion, skin blood flow and ΔSBF/ΔT were lower in patients than in volunteers. Baseline skin blood flow (31 [17-113] vs 16 [9-32] arbitrary perfusion units; p = 0.01) and ΔSBF/ΔT (4.3 [1.7-10.9] vs 0.9 [0.4-2.9] arbitrary perfusion unit/s) were greater in survivors than in nonsurvivors. Capillary refill time was shorter in survivors than in nonsurvivors; peripheral perfusion index was similar in the two groups. ΔSBF/ΔT (area under the receiver operating characteristic curve 0.94 [0.88-0.99]) and SBFBT (area under the receiver operating characteristic curve 0.83 [0.73-0.93]) had the best predictive value for ICU mortality with cutoff values less than or equal to 1.25 arbitrary perfusion unit/°C (sensitivity 88%, specificity 89%) and less than or equal to 21 arbitrary perfusion unit (sensitivity 84%, specificity 81%), respectively.
Alterations in fingertip skin blood flow can be evaluated using a laser Doppler thermal challenge technique in patients with circulatory shock and are directly related to outcome. These novel monitoring techniques could potentially be used to guide resuscitation.
在循环休克期间，皮肤血流会迅速改变，尽管全身血流动力学似乎稳定，但血流仍可能持续改变。我们评估了循环休克期间皮肤血流的变化与存活率的关系。
前瞻性研究。
35 张病床的内科-外科大学附属医院重症监护病房。
20 名健康志愿者和 70 名循环休克患者（<12 小时），定义为需要升压药维持平均动脉压大于或等于 65mmHg 和组织灌注改变的迹象。
我们使用指尖激光多普勒在基础体温（SBFBT）和 37°C（SBF37）下（热挑战测试）评估皮肤血流 3 分钟，志愿者进行一次，休克患者在纳入时以及 6、24、48、72 和 96 小时时进行。同时在对侧手上测量毛细血管再充盈时间和外周灌注指数。
使用以下公式计算热挑战反应（ΔSBF/ΔT）：（SBF37-SBFBT）/（37-基础体温）。计算受试者工作特征曲线下面积以评估预测 ICU 死亡率的变量。纳入时，患者的皮肤血流和ΔSBF/ΔT 低于志愿者。存活者的基线皮肤血流（31 [17-113] 与 16 [9-32] 任意灌注单位；p=0.01）和ΔSBF/ΔT（4.3 [1.7-10.9] 与 0.9 [0.4-2.9] 任意灌注单位/s）大于非存活者。存活者的毛细血管再充盈时间短于非存活者；两组的外周灌注指数相似。ΔSBF/ΔT（受试者工作特征曲线下面积 0.94 [0.88-0.99]）和 SBFBT（受试者工作特征曲线下面积 0.83 [0.73-0.93]）对 ICU 死亡率具有最佳预测价值，截取值小于或等于 1.25 任意灌注单位/°C（灵敏度 88%，特异性 89%）和小于或等于 21 任意灌注单位（灵敏度 84%，特异性 81%）。
使用激光多普勒热挑战技术可以评估循环休克患者指尖皮肤血流的改变，并且与结果直接相关。这些新的监测技术可能可用于指导复苏。
