Assessment Of Peripheral Perfusion Research Articles

Towards the personalization of septic shock resuscitation: the fundamentals of ANDROMEDA-SHOCK-2 trial

Septic shock is a highly lethal and prevalent disease. Progressive circulatory dysfunction leads to tissue hypoperfusion and hypoxia, eventually evolving to multiorgan dysfunction and death. Prompt resuscitation may revert these pathogenic mechanisms, restoring oxygen delivery and organ function. High heterogeneity exists among the determinants of circulatory dysfunction in septic shock, and current algorithms provide a stepwise and standardized approach to conduct resuscitation.This review provides the pathophysiological and clinical rationale behind ANDROMEDA-SHOCK-2, an ongoing multicenter randomized controlled trial that aims to compare a personalized resuscitation strategy based on clinical phenotyping and peripheral perfusion assessment, versus standard of care, in early septic shock resuscitation.

Assessment of Peripheral Perfusion in Severe Acute Respiratory Syndrome Corona virus 2 (Sars-Cov-2) Infection: An Exploratory Analysis with Near-Infrared Spectroscopy

Assessment of Peripheral Perfusion in Severe Acute Respiratory Syndrome Corona virus 2 (Sars-Cov-2) Infection: An Exploratory Analysis with Near-Infrared Spectroscopy

Comparison of point-of-care peripheral perfusion assessment using pulse oximetry sensor with manual capillary refill time: clinical pilot study in the emergency department

BackgroundTraditional capillary refill time (CRT) is a manual measurement that is commonly used by clinicians to identify deterioration in peripheral perfusion status. Our study compared a novel method of measuring peripheral perfusion using an investigational device with standardized visual CRT and tested the clinical usefulness of this investigational device, using an existing pulse oximetry sensor, in an emergency department (ED) setting.Material and methodsAn ED attending physician quantitatively measured CRT using a chronometer (standardized visual CRT). The pulse oximetry sensor was attached to the same hand. Values obtained using the device are referred to as blood refill time (BRT). These techniques were compared in its numbers with the Bland-Altman plot and the predictability of patients’ admissions.ResultsThirty ED patients were recruited. Mean CRT of ED patients was 1.9 ± 0.8 s, and there was a strong correlation with BRT (r = 0.723, p < 0.001). The Bland-Altman plot showed a proportional bias pattern. The ED physician identified 3 patients with abnormal CRT (> 3 s). Area under the receiver operator characteristic curve (AUC) of BRT to predict whether or not CRT was greater than 3 s was 0.82 (95% CI, 0.58–1.00). Intra-rater reliability of BRT was 0.88 (95% CI, 0.79–0.94) and that of CRT was 0.92 (0.85–0.96). Twelve patients were admitted to the hospital. AUC to predict patients’ admissions was 0.67 (95% CI, 0.46–0.87) by BRT and 0.76 (0.58–0.94) by CRT.ConclusionsBRT by a pulse oximetry sensor was an objective measurement as useful as the standardized CRT measured by the trained examiner with a chronometer at the bedside.

Body surface and body core temperatures and their associations to haemodynamics: The BOSTON-I-study: Validation of a thermodilution catheter (PiCCO) to measure body core temperature and comparison of body surface temperatures to thermodilutionderived Cardiac Index.

Assessment of peripheral perfusion and comparison of surface and body core temperature (BST; BCT) are diagnostic cornerstones of critical care. Infrared non-contact thermometers facilitate the accurate measurement of BST. Additionally, a corrected measurement of BST on the forehead provides an estimate of BCT (BCT_Forehead). In clinical routine BCT is measured by ear thermometers (BCT_Ear). The PiCCO-device (PiCCO: Pulse contour analysis) provides thermodilution-derived Cardiac Index (CI_TD) using an arterial catheter with a thermistor tip in the distal aorta. Therefore, the PiCCO-catheter might be used for continuous BCT-measurement (BCT_PiCCO) in addition to intermittent CI-measurement. To the best of our knowledge, BCT_PiCCO has not been validated compared to standard techniques of BCT-measurement including measurement of urinary bladder temperature (BCT_Bladder). Therefore, we compared BCT_PiCCO to BCT_Ear and BCT_Bladder in 52 patients equipped with the PiCCO-device (Pulsion; Germany). Furthermore, this setting allowed to compare different BSTs and their differences to BCT with CI_TD. BCT_PiCCO, BCT_Ear (ThermoScan; Braun), BCT_Bladder (UROSID; ASID BONZ), BCT_Forehead and BSTs (Thermofocus; Tecnimed) were measured four times within 24h. BSTs were determined on the great toe, finger pad and forearm. Immediately afterwards TPTD was performed to obtain CI_TD. 32 (62%) male, 20 (38%) female patients; APACHE-II 23.8 ±8.3. Bland-Altman-analysis demonstrated low bias and percentage error (PE) values for the comparisons of BCT_PiCCO vs. BCT_Bladder (bias 0.05 ±0.27° Celsius; PE = 1.4%), BCT_PiCCO vs. BCT_Ear (bias 0.08 ±0.38° Celsius; PE = 2.0%) and BCT_Ear vs. BCT_Bladder (bias 0.04 ±0.42° Celsius; PE = 2.2). While BCT_PiCCO, BCT_Ear and BCT_Bladder can be considered interchangeable, Bland-Altman-analyses of BCT_Forehead vs. BCT_PiCCO (bias =-0.63 ±0.75° Celsius; PE = 3.9%) Celsisus, BCT_Ear (bias = -0.58 ±0.68° Celsius; PE = 3.6%) and BCT_Bladder (bias = -0.55 ±0.74° Celsius; PE = 3.9%) demonstrate a substantial underestimation of BCT by BCT_Forehead. BSTs and differences between BCT and BST (DCST) significantly correlated with CI_TD with r-values between 0.230 and 0.307 and p-values between 0.002 and p < 0.001. The strongest association with CI_TD was found for BST_forearm (r = 0.307; p < 0.001). In a multivariate analysis regarding CI_TD and including biometric data, BSTs and and their differences to core-temperatures (DCST), only higher temperatures on the forearm and the great toe, young age, low height and male gender were independently associated with CI_TD. The estimate of CI based on this model (CI_estimated) correlated with CI_TD (r = 0.594; p < 0.001). CI_estimated provided large ROC-areas under the curve (AUC) regarding the critical thresholds of CI_TD ≤ 2.5 L/min/m2 (AUC = 0.862) and CI_TD ≥ 5.0 L/min/m2 (AUC = 0.782). 1.) BCT_PiCCO, BCT_Ear and BCT_Bladder are interchangeable. 2.) BCT_Forehead significantly underestimates BCT by about 0.5° Celsius. 3.) All measured BSTs and DCSTs were significantly associated with CI_TD. 4.) CI_estimated is promising, in particular for the prediction of critical thresholds of CI.

Peripheral perfusion is correlated to metabolic perfusion parameters and microvascular reactivity but not with hepatosplanchnic or microcirculatory flow parameters in hyperdynamic septic shock

Peripheral perfusion assessment is increasingly being recognized as a potential surrogate of global perfusion parameters during septic shock resuscitation. Nevertheless, its correlation with other perfusion parameters is not well established. This study explores the relationship between peripheral perfusion parameters and macrohemodynamic, metabolic, hepatosplanchnic, and micro-circulatory-related parameters during hyperdynamic septic shock.

Evaluating Changes in Regional Tissue Perfusion Following Percutaneous Lower Extremity Revascularization Procedures With a Hyperspectral Image-Based Tissue Oxygenation Mapping System

This study established the feasibility of using applied imaging spectroscopy to replace or supplement existing adjuncts in the evaluation and follow-up of patients with chronic limb ischemia undergoing percutaneous revascularizations. This is an ongoing prospective investigation studying the use of a commercially available hyperspectral-imaging camera in patients undergoing endovascular procedures for chronic limb ischemia. Images of the dorsal surface of the foot were obtained across various wavelengths of light before and after intervention. Spectroscopic measures were used to assess capillary oxyhemoglobin, deoxyhemoglobin, and oxygen saturation values at each pixel in the image. The data are displayed as interactive digital color maps, demonstrating heterogeneous perfusion throughout the entire foot and allowing morphologic and quantitative analysis. Periprocedural changes were compared against existing noninvasive tests, such as ankle-brachial indices and the Rutherford classification. Revascularized patients were reimaged after the procedure and at 6 weeks, and 3, 6, and 12 months. Of 46 enrolled patients having lower extremity limbs amenable to endovascular treatment (Rutherford grades 1-3), 17 completed all preprocedure and postprocedure visits. For deoxyhemoglobin there was statistically significant overall decrease from visits 1-6 (P = .04), and between visit 6 and baseline (P = .02). For oxyhemoglobin and oxygen saturation, there was a clinically suggestive increase from visits 1-6, but neither the overall trend nor the difference between visit 6 and baseline were statistically significant. ABI did not prove to be a sensitive enough indicator to detect a change over the 1-year period (P = .97). Although our results lack adequate statistical power, they suggest that hyperspectral imaging may be a useful, noninvasive imaging modality to aid in the assessment of peripheral perfusion after percutaneous lower extremity revascularization procedures. We will continue to accrue patients to examine whether hyperspectral imaging can demonstrate clinically important and statistically significant findings of improved tissue oxygenation and decreased deoxygenation, and reliably replace ankle-brachial index to assess the success of lower extremity intervention for chronic limb ischemia.

Evaluating Changes in Regional Tissue Perfusion Following Percutaneous Lower Extremity Revascularization Procedures with a Hyperspectral Image-based Tissue Oxygenation Mapping System

To establish the feasibility of using applied imaging spectroscopy to replace or supplement existing adjuncts in the evaluation of patients with chronic limb ischemia undergoing percutaneous revascularizations. This is an ongoing prospective study of a commercially available hyperspectral imaging (HSI) camera, enrolling patients undergoing endovascular procedures for chronic limb ischemia. Images of the dorsal surface of the foot are obtained across various wavelengths of light before and after intervention. Spectroscopic data are used to measure capillary oxyhemoglobin, deoxyhemoglobin, and oxygen saturation (StO2) values. These data are displayed as interactive digital color maps, demonstrating heterogeneous perfusion throughout the entire foot and allowing morphologic and quantitative analysis. Periprocedural changes are compared against existing noninvasive tests. Revascularized patients are re-imaged at regular intervals for up to one year post-procedure. Of 25 enrolled patients having lower extremity limbs amenable to endovascular treatment (Rutherford grades 1-4), 15 subjects (17 limbs) completed their pre- and post-procedure visits. Of these, 11 subjects (13 limbs) also completed their six week and three month visits. All limbs demonstrated a post-procedural change in their HSI profile. There was a statistically significant increase in StO2 following revascularization that persists at three months (from 32% ± 2% to 41% ± 9%, P = .01). The increase corresponds with an increase in the ankle-brachial index (ABI), which also persists at three months (0.75 ± 0.06 to 0.94 ± 0.05, P = .02). The increase in StO2 predominantly resulted from 32% average decrease in Hb-Deoxy (60 ± 4 to 41 ± 4, P = .004). Total hemoglobin in tissue also decreased following treatment (90 ± 7 to 70 ± 6, P = .04). HSI is an effective noninvasive imaging modality in the assessment of peripheral perfusion after percutaneous lower extremity revascularization procedures. The ease of use, precision of regionally discrete data, and strong correlation with widely-accepted noninvasive measures such as ABI suggests that HSI will be a valuable addition to the vascular lab.