Associação entre perfusão periférica, microcirculação e mortalidade em sepse: uma revisão sistemática

Santos, Danillo Menezes dos; Quintans, Jullyana S. S.; Quintans‐Júnior, Lucindo J.; Santana‐Filho, Valter Joviniano; Cunha, Cristiane Martins; Menezes, Igor Alexandre Côrtes de; Santos, Márcio Roberto Viana dos

doi:10.1016/j.bjan.2019.09.007

Cited by 7 publications

(5 citation statements)

References 50 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Curiously, contradicting our results, a study by Brunauer et al (2016) showed positive correlations between skin perfusion and visceral organ vascular tone, including the kidney, even though the anatomic-physiological differences cited [35]. It could also be argued that dynamic circulatory changes attributed to sepsis lead to the different time-related clinical significance of peripheral perfusion values [36]. Early stages of sepsis are characterized by a hemodynamic coherence between macro and microcirculation.…”

Section: Plos Onecontrasting

confidence: 91%

“…In fact, a critical study found no significant correlation between skin and sublingual perfusion in patients with sepsis, corroborating this hypothesis [43]. Thus, it is plausible to admit that the microvascular damage in different tissues may not have the same pathophysiological meaning despite its similarity from a clinical point of view (predictive value for estimating mortality) [36].…”

Section: Plos Onementioning

confidence: 89%

“…Several robust human studies have been shown that the predictive value of persistent peripheral hypoperfusion occurs regardless of the correction of systemic hemodynamic [36].…”

Section: Plos Onementioning

confidence: 99%

See 2 more Smart Citations

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

et al. 2020

View full text Add to dashboard Cite

Microcirculatory disorders have been consistently linked to the pathophysiology of sepsis. One of the major organs affected is the kidneys, resulting in sepsis-associated acute kidney injury (SA-AKI) that correlates considerably with mortality. However, the potential role of clinical assessment of peripheral perfusion as a possible tool for SA-AKI management has not been established. To address this gap, the purpose of this study was to investigate the prevalence of peripheral hypoperfusion in SA-AKI, its association with mortality, and fluid balance. This observational cohort study enrolled consecutive septic patients in the Intensive Care Unit. After fluid resuscitation, peripheral perfusion was evaluated using the capillary filling time (CRT) and peripheral perfusion index (PI) techniques. The AKI was defined based on both serum creatinine and urine output criteria. One hundred and forty-one patients were included, 28 (19%) in the non-SA-AKI group, and 113 (81%) in the SA-AKI group. The study revealed higher peripheral hypoperfusion rates in the SA-AKI group using the CRT (OR 3.6; 95% CI 1.35-9.55; p < 0.05). However, this result lost significance after multivariate adjustment. Perfusion abnormalities in the SA-AKI group diagnosed by both CRT (RR 1.96; 95% CI 1.25-3.08) and PI (RR 1.98; 95% CI 1.37-2.86) methods were associated to higher rates of 28-day mortality (p < 0.01). The PI's temporal analysis showed a high predictive value for death over the first 72 h (p < 0.01). A weak correlation between PI values and the fluid balance was found over the first 24 h (r =-0.20; p < 0.05). In conclusion, peripheral perfusion was not different intrinsically between patients with or without SA-AKI. The presence of peripheral hypoperfusion in the SA-AKI group has appeared to be a prognostic marker for mortality. This evaluation maintained its predictive value over the first 72 hours. The fluid balance possibly negatively influences peripheral perfusion in the SA-AKI.

show abstract

Section: Plos Onecontrasting

confidence: 91%

Section: Plos Onementioning

confidence: 89%

See 1 more Smart Citation

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Among the microcirculatory disorders in sepsis, several studies have demonstrated the relevance of peripheral hypoperfusion to mortality [ 5 , 17 ]. However, the role of vascular hyporesponsiveness in the resulting hypoperfusion is less known.…”

Section: Discussionmentioning

confidence: 99%

“…Persistent microcirculatory disturbances commonly occur in sepsis even after the normalization of macro-hemodynamics [3,4]. A recent review confirmed the association with mortality even when evaluated in different tissues such as skin, sublingual, and muscle [5]. Among the mechanisms involved, great emphasis has recently been given to vascular hyporesponsiveness and endothelial dysfunction [6,7].…”

Section: Introductionmentioning

confidence: 94%

Peripheral ischemic reserve in sepsis and septic shock as a new bedside prognostic enrichment tool: A Brazilian cohort study

et al. 2023

View full text Add to dashboard Cite

Microvascular dysfunctions are associated with poor prognosis in sepsis. However, the potential role of clinical assessment of peripheral ischemic microvascular reserve (PIMR), a parameter that characterizes the variation of peripheral perfusion index (PPI) after brief ischemia of the upper arm, as a tool to detect sepsis-induced microvascular dysfunction and for prognostic enrichment has not been established. To address this gap, this study investigated the association of high PIMR with mortality over time in patients with sepsis and its subgroups (with and without shock) and peripheral perfusion (capillary-refill time). This observational cohort study enrolled consecutive septic patients in four Intensive-care units. After fluid resuscitation, PIMR was evaluated using the oximetry-derived PPI and post-occlusive reactive hyperemia for two consecutive days in septic patients. Two hundred and twenty-six patients were included—117 (52%) in the low PIMR group and 109 (48%) in the high PIMR group. The study revealed differences in mortality between groups on the first day, which was higher in the high PIMR group (RR 1.25; 95% CI 1.00–1.55; p = 0.04) and maintained its prognostic significance after multivariate adjustment. Subsequently, this analysis was made for sepsis subgroups and showed significant differences in mortality only for the septic-shock subgroup, with was higher in the high PIMR group (RR 2.14; 95% CI 1.49–3.08; p = 0.01). The temporal ΔPPI peak values (%) analyses did not demonstrate maintenance of the predictive value over the first 48 h in either group (p > 0.05). A moderate positive correlation (r = 0.41) between ΔPPI peak (%) and capillary-refill time (s) was found within the first 24 hours of diagnosis (p < 0.001). In conclusion, detecting a high PIMR within 24 h appears to be a prognostic marker for mortality in sepsis. Furthermore, its potential as a prognostic enrichment tool seems to occur mainly in septic shock.

show abstract

Peripheral perfusion index in well newborns at 6 to 72 h of life at different altitudes: a multi-center study in China

Hua

Niu

Xuan³

et al. 2022

Eur J Pediatr

View full text Add to dashboard Cite

The purpose of this study is to obtain the reference range of peripheral perfusion index (PPI) of asymptomatic well newborns at 6 to 72 h of life at different altitudes. A population-based prospective cohort study was conducted in cities at different altitudes in China. Asymptomatic well newborns were enrolled consecutively from six hospitals with an altitude of 4 to 4200 m between February 1, 2020, and April 15, 2021. PPI was measured at 6, 12, 24, 48, and 72 h after birth on the right hand (pre-ductal) and either foot (post-ductal) using a Masimo SET Radical-7 oximeter. Fiftieth percentile reference curves of the pre- and post-ductal PPI values at 6–72 h after birth were generated using the Lambda Mu Sigma method. Linear mixed-effects regression was performed to determine the influence of different altitude levels on PPI values over different measurement time points. A total of 4257 asymptomatic well newborns were recruited for analysis. The median and quartile pre- and post-ductal PPI values at 6–72 h of life at different altitudes were 1.70 (1.20, 2.60) and 1.70 (1.10, 2.70) for all infants, 1.30 (1.10, 1.90) and 1.10 (0.88, 1.80) for infants at low altitude, 1.40 (1.00, 2.00) and 1.30 (0.99, 2.00) at mild altitudes, 1.90 (1.30, 2.50) and 1.80 (1.20, 2.70) at moderate altitudes, 1.80 (1.40, 3.50) and 2.20 (1.60, 4.30) for high altitudes, 3.20 (2.70, 3.70), and 3.10 (2.10, 3.30) for higher altitudes, respectively. Overall, both pre- and post-ductal PPI increased with altitude. The 50th percentile curves of pre- and post-ductal PPI values in well newborns at mild, low, moderate, and high altitudes were relatively similar, while the difference between the PPI curves of infants at higher altitudes and other altitudes was significantly different. Conclusions: With the increase of altitude, pre- and post-ductal PPI of newborns increases. Our study obtained the PPI reference values of asymptomatic well newborns at 6 to 72 h after birth at different altitudes from 4 to ≥ 4000 m. What is Known:• Monitoring hemodynamics is very important to neonates. As an accurate and reliable hemodynamic monitoring index, PPI can detect irreversible damage caused by insufficient tissue perfusion and oxygenation early, directly, noninvasively, and continuously. What is New:• Our study obtained the PPI reference values of asymptomatic well newborns at 6 to 72 h after birth at different altitudes from 4 to ≥ 4000 m. With the increase of altitude, pre- and post-ductal PPI of newborns increase with statistical significance. Therefore, the values and disease thresholds of PPI for asymptomatic neonates should be modified according to altitudes.

show abstract

Associação entre perfusão periférica, microcirculação e mortalidade em sepse: uma revisão sistemática

Cited by 7 publications

References 50 publications

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Monitoring peripheral perfusion in sepsis associated acute kidney injury: Analysis of mortality

Peripheral ischemic reserve in sepsis and septic shock as a new bedside prognostic enrichment tool: A Brazilian cohort study

Peripheral perfusion index in well newborns at 6 to 72 h of life at different altitudes: a multi-center study in China

Contact Info

Product

Resources

About