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.
Highlights
Hemodynamic instability creates an imbalance between oxygen delivery and consumption and is an important contributor to organ failure [1]
The authors reported that peripheral perfusion–targeted resuscitation was associated with less organ dysfunction compared to lactate-targeted resuscitation [mean sequential organ failure assessment (SOFA) score 5.6 vs. 6.6]
It is important to acknowledge that our review does not discuss all of the available technologies that may be used to evaluate peripheral perfusion status, such as laser doppler flowmetry (LDF), infrared thermography [73], and PulseCam technology [74]
Summary
Hemodynamic instability creates an imbalance between oxygen delivery and consumption and is an important contributor to organ failure [1]. Hemodynamic monitoring is crucial to identify inadequate tissue perfusion in order to prevent organ dysfunction and death [2] Both global and peripheral biomarkers of tissue perfusion are used clinically as proxies for hemodynamic status. Shock is the clinical manifestation of acute circulatory failure It is characterized by signs of tissue hypoperfusion [8] and leads to impairments in cellular oxygen delivery [9, 10]. New technologies have been developed to calculate CRT 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). The available techniques will be grouped according to their mechanism of monitoring perfusion status, including reflected light, transmitted light, and temperature Within these categories, the techniques will be further delineated as either subjective or objective methods of monitoring. This review provides a novel schema for classifying the available methods of monitoring peripheral perfusion (Table 1)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
