Toe temperature versus transcutaneous oxygen tension monitoring during acute circulatory failure

Abstract

Measurements of toe temperature and transcutaneous PO2 (PtcO2) have been both suggested for non-invasive assessment of peripheral blood flow in acute circulatory failure. The underlying principle of the two methods is that cutaneous vasoconstriction occurs early when tissue perfusion is altered. In 15 patients, we compared the two measurements during cardiogenic shock (27 measurements) or septic shock (29 measurements). Toe-ambiant temperature gradient and PtcO2 correlated well together (r = 0.66, p less than 0.001) especially in hyperkinetic septic shock (r = 0.79, p less than 0.001). In cardiogenic shock, toe-ambiant temperature correlated well with cardiac index (r = 0.63), stroke index (r = 0.64) and oxygen transport (r = 0.65), and these correlations were stronger than for PtcO2. In septic shock, both techniques were poor indicators of blood flow indexes but PtcO2 rather correlated with arterial pressure (r = 0.66) and left ventricular work (r = 0.66). Trend evaluation of data revealed in cardiogenic shock that the increase in toe temperature usually preceded the increase in PtcO2. Since measurement of PtcO2 is technically more complicated, correlates less well with standard hemodynamic parameters and later reflects cardiovascular improvement, it has no advantage over measurement of toe temperature in circulatory shock. In cardiogenic shock, measurements of toe temperature can reliably track cardiac output changes. In septic states, however, non-invasive assessment of skin perfusion is of limited interest.

Skin temperature and core-peripheral temperature gradient as markers of hemodynamic status in critically ill patients: A review

“…11 These associations were further validated in later investigations of adult shock patients of mixed etiology 13,54,55 and postoperative patients, 28 although Vincent et al reported that associations present during cardiogenic shock were absent during septic shock. 55 Strong correlations between CPTG and cardiovascular status have also been found within pediatric settings. 12,35,51 Low temperature of the great toe, in conjunction with the temperature gradient between the peripheries and core or ambient temperature, have also been used as prognostic markers of survival.…”

“…Abnormal temperature gradients have been shown to persist in nonsurvivors yet normalise in survivors. 11,13,54,55 Separation of survivors from nonsurvivors has additionally been shown to be more likely using temperature gradients than cardiac index, 13 lactate, and arterial blood pressure 13,56 in acute myocardial infarction and shock patients, respectively. Abnormal temperature gradients have been shown to precede, or to occur simultaneously with, changes in hemodynamic parameters, including cardiac output, 10,28 demonstrating the value of monitoring skin temperature sequentially.…”

“…The value of measuring CPTG may then lie in its ability to predict change in cardiac output; thus, serial measurements may be required to elicit a more accurate assessment of hemodynamic status. 10,28,55 The conclusions of the most quoted opponents of this practice 14,15 were based on isolated measurements of CPTG, cardiac output, and SVR. They did not allow for changes in temperature gradient that may occur before or after any alteration in cardiac output or vascular resistance.…”

Interactions among peripheral perfusion, cardiac activity, oxygen saturation, thermal profile and body position in growing low birth weight infants

“…Furthermore, the practical application of these indices and the relationship with central hemodynamics or tissue oxygenation are not well studied. In adults with cardiogenic shock and in cardiac surgery patients, a crude correlation between central-to-toe temperature difference and cardiac output has been reported (14,23). In paediatric post-cardiac surgical patients, both capillary refill time and temperature gradients do not correlate well with the hemodynamic variables (13).…”

Clinical examination for diagnosing circulatory shock

“…Two studies demonstrated that a subjectively cool skin temperature was associated with a lower CO [31,32]. Studies evaluating the correlation between objective temperature measurements and CO showed conflicting results; some observed moderate correlations [33,35,40], whereas most observed no correlation [34–38]. Skin temperature measurement methods differ widely and are likely influenced by several factors: age, ambient temperature, hypothermia, peripheral vascular disease, vasopressors, pain and anxiety have all been proposed as influencing circumstances [44,45].…”