Peripheral perfusion index predicting prolonged ICU stay earlier and better than lactate in surgical patients: an observational study

Abstract

Background: Peripheral perfusion index (PPI) is an indicator reflecting perfusion. Patients undergoing long time surgeries are more prone to hypoperfusion and increased lactate. Few studies focusing on investigating the association between PPI and surgical patients' prognoses. We performed this study to find it out. Methods: From January 2019 to September 2019, we retrospected all surgical patients who were transferred to ICU, Xinyang Central hospital, Henan province, China. Inclusive criteria: age ≥ 18 years old; surgical length ≥ 120 min. Exclusive criteria: died in ICU; discharging against medical advice; existing diseases affecting blood flow of upper limbs, for example, vascular thrombus in arms; severe liver dysfunction. We defined "prolonged ICU stay" as patients with their length of ICU stay longer than 48 h. According to the definition, patients were divided into two groups: "prolonged group" (PG) and "non-prolong group" (nPG). Baseline characteristics, surgical and therapeutic information, ICU LOS, SOFA and APACHE II were collected. Besides we gathered data of following parameters at 3 time points (T0: ICU admission; T1: 6 h after admission; T2: 12 h after admission): mean artery pressure (MAP), lactate, heart rate (HR), PPI and body temperature. Data were compared between the 2 groups. Multivariable binary logistic regression and ROC (receiver operating characteristic) curves were performed to find the association between perfusion indictors and ICU LOS. Results: Eventually, 168 patients were included, 65 in PG and 103 in nPG. Compared to nPG, patients in PG had higher blood lactate and lower PPI. PPI showed significant difference between two groups earlier than lactate (T 0 vs T 1). The value of PPI at two time points was lower in PG than nPG(T0: 1.09 ± 0.33 vs 1.41 ± 0.45, p = 0.001; T1: 1.08 ± 0.37 vs 1.49 ± 0.41, p < 0.001). Increased lactate T1 (OR 3.216; 95% CI 1.253-8.254, P = 0.015) and decreased PPI T1 (OR 0.070; 95% CI 0.016-0.307, P < 0.001) were independently associated with prolonged ICU stay. The area under ROC of the PPI T1 for predicting ICU stay> 48 h was 0.772, and the cutoff value for PPI T1 was 1.35, with 83.3% sensitivity and 73.8% specificity. Conclusions: PPI and blood lactate at T 1 (6 h after ICU admission) are associated with ICU LOS in surgical patient. Compared to lactate, PPI indicates hypoperfusion earlier and more accurate in predicting prolonged ICU stay.

Use of peripheral perfusion index (PI) as a predictor of cardiovascular complications in hospitalised Covid 19 patients - A pilot study

“…Previous studies on non-Covid shock patients have found that PI could be used as a measure to predict onset of shock or to mark its severity (20)(21)(22). Studies have shown that PI has been found useful in post-surgical care of patients where hemodynamic monitoring is required (23,24). It has been previously recorded that PI could be correlated with BP measured using arterial catheter in post surgical patients validating its utility as a standin for BP monitoring (25).…”

A low peripheral perfusion index can accurately detect prolonged capillary refill time during general anesthesia

“…A low perfusion status in the early postoperative period is associated with perioperative complications. [ 9 , 10 , 11 ] Maintaining an adequate perfusion status from the intraoperative to the postoperative period can decrease avoidable complications. The PI can be continuously evaluated, and a PI <1.8 could suggest an intraoperative low perfusion status.…”

Assessment of Tissue Perfusion Using the Peripheral Perfusion Index and Lactate Clearance in Shock in Pediatric Patients

“…In this setting, lactate concentrations do not immediately respond to altered perfusion, which creates an interval between the onset of hypoperfusion and the detection of elevated lactate concentrations. In contrast, the PI might more rapidly identify hypoperfusion and thus provide a more accurate prediction of a prolonged intensive care unit stay among adult surgical patients (22). Therefore, the present study aimed to determine whether PI, lactate, and/or lactate clearance could be used to predict outcomes among pediatric patients with shock.…”