Abstract
IntroductionThe peripheral perfusion index (PI) is a noninvasive numerical value of peripheral perfusion, and the transcutaneous oxygen challenge test (OCT) is defined as the degree of transcutaneous partial pressure of oxygen (PtcO2) response to 1.0 FiO2. The value of noninvasive monitoring peripheral perfusion to predict outcome remains to be established in septic patients after resuscitation. Moreover, the prognostic value of PI has not been investigated in septic patients.MethodsForty-six septic patients, who were receiving PiCCO-Plus cardiac output monitoring, were included in the study group. Twenty stable postoperative patients were studied as a control group. All the patients inspired 1.0 of FiO2 for 10 minutes during the OCT. Global hemodynamic variables, traditional metabolic variables, PI and OCT related-variables were measured simultaneously at 24 hours after PiCCO catheter insertion. We obtained the 10min-OCT ((PtcO2 after 10 minutes on inspired 1.0 oxygen) - (baseline PtcO2)), and the oxygen challenge index ((10min-OCT)/(PaO2 on inspired 1.0 oxygen - baseline PaO2)) during the OCT.ResultsThe PI was significantly correlated with baseline PtcO2, 10min-OCT and oxygen challenge index (OCI) in all the patients. The control group had a higher baseline PtcO2, 10min-OCT and PI than the septic shock group. In the sepsis group, the macro hemodynamic parameters and ScvO2 showed no differences between survivors and nonsurvivors. The nonsurvivors had a significantly lower PI, 10min-OCT and OCI, and higher arterial lactate level. The PI, 10min-OCT and OCI predicted the ICU mortality with an accuracy that was similar to arterial lactate level. A PI <0.2 and a 10min-OCT <66mmHg were related to poor outcome after resuscitation.ConclusionsThe PI and OCT are predictive of mortality for septic patients after resuscitation. Further investigations are required to determine whether the correction of an impaired level of peripheral perfusion may improve the outcome of septic shock patients.
Highlights
The peripheral perfusion index (PI) is a noninvasive numerical value of peripheral perfusion, and the transcutaneous oxygen challenge test (OCT) is defined as the degree of transcutaneous partial pressure of oxygen (PtcO2) response to 1.0 fraction of inspired oxygen concentration (FiO2)
The PI, 10min-OCT and oxygen challenge index (OCI) predicted the intensive care unit (ICU) mortality with an accuracy that was similar to arterial lactate level, and the PI was significantly better than the difference between central venous and arterial
For predicting ICU mortality, a threshold of 10min-OCT at 66 mmHg was associated with a sensitivity of 65% and a specificity of 96.2%, and a cutoff of OCI at 0.55 was associated with a sensitivity of 60% and a specificity of 88.5%
Summary
The peripheral perfusion index (PI) is a noninvasive numerical value of peripheral perfusion, and the transcutaneous oxygen challenge test (OCT) is defined as the degree of transcutaneous partial pressure of oxygen (PtcO2) response to 1.0 FiO2. The value of noninvasive monitoring peripheral perfusion to predict outcome remains to be established in septic patients after resuscitation. Blood flow is diverted from the peripheral tissue to vital organs during circulation shock. Because thicker epidermal layers cause more discrepancy between PtcO2 and arterial pressure of oxygen (PaO2), PtcO2 and PtcCO2 have been used to represent tissue oxygenation and perfusion in critically ill adult patients [6,7,8]. Recent reports using the noninvasive PtcO2 have observed a relationship between low oxygen challenge test values to mortality and new organ failure [9,10]
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