Treatment of Shock with Vasodilators Measuring Skin Temperature on the Big Toe

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

“…[18][19][20] The ensuing state of intense vasoconstriction, particularly within the vascular beds of the skin and muscle, 21 manifests in increased vascular resistance and cold skin. 22,23,[24][25][26] Normal skin temperature of the toe, measured objectively using a skin temperature probe, lies between 33 C and 34 C, whereas core temperature typically ranges between 36.5 C and 37.5 C. Peripheral circulation is reported to be normal only if the temperature difference between the skin and core is <3 C to 4 C. 24,25,27,28 Cold skin and CPTGs >5 C have thus been associated with poor peripheral perfusion and impaired cardiac function. 11,13,15 The presence of cool skin on its own, however, is nonspecific and may have other, less sinister causes.…”

“…24 He described experimental data wherein an induced blood loss of 500 ml was associated with an 8 C decrease in skin temperature, whereas blood pressure remained unaffected. This work and later studies 25,53 led clinicians to recognize a decrease in skin temperature, particularly of the great toe, as a marker of peripheral vasoconstriction during shock.…”

“…Although the overwhelming majority of measurements were taken from the great toe, a host of alternative sites extending down the limbs were used in addition to foot temperature. 11,14,24,33,47,51,62,68,69 Skin temperatures measured in the hand have also been found to be less reliable than those of the toe because hands tend to rewarm faster. 11,24,51,53,76 Moreover, many studies examining the relation between CPTGs and cardiac output chose the rectum as their site to measure core temperature.…”

“…11,14,24,33,47,51,62,68,69 Skin temperatures measured in the hand have also been found to be less reliable than those of the toe because hands tend to rewarm faster. 11,24,51,53,76 Moreover, many studies examining the relation between CPTGs and cardiac output chose the rectum as their site to measure core temperature. 9,[11][12][13]53,54,70 This practice will reportedly lead to inaccuracies because rectal temperature lags behind that of the pulmonary artery and tympanic membrane in cardiac surgical patients during the rewarming phase as well as in shock patients because of the decrease in splanchic blood flow.…”

Using skin temperature gradients or skin heat flux measurements to determine thresholds of vasoconstriction and vasodilatation

“…Examination of the data published previously (Sessler et al 1988a, b) shows that the greatest reductions in SkBF, as identified by LDF, were accompanied by large inflections in T sk-diff , with T sk-diff ‡4.0°C being delayed by approximately 30 min, as seen in this study. Ibsen (1967) used differences in toe pad T sk and T re (T sk -T re ) to indicate vasomotor tone when treating hypothermic patients. They commonly had initial T sk -T re values greater than 20°C; these fell to less than 4°C when circulating blood volume was restored and vasodilatation occurred.…”