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CE: Assessing Patients During Septic Shock Resuscitation
1Elizabeth Bridges is a clinical nurse researcher at the University of Washington Medical Center, Seattle, and a professor in the University of Washington School of Nursing. Contact author: ebridges@u.washington.edu. The author and planners have disclosed no potential conflicts of interest, financial or otherwise.
The American Journal of Nursing
|September 16, 2017
Summary
The Surviving Sepsis Campaign now recommends reassessing septic shock patients
Area of Science:
- Critical Care Medicine
- Emergency Medicine
- Cardiovascular Physiology
Background:
- The 2015 Surviving Sepsis Campaign guidelines emphasize reassessment of fluid resuscitation effectiveness.
- Septic shock management requires ongoing evaluation of tissue perfusion.
- Noninvasive bedside assessments are crucial for timely clinical decision-making.
Purpose of the Study:
- To detail the practice and interpretation of capillary refill time (CRT) and skin mottling score (SMS) in adults.
- To guide the integration of CRT and SMS into septic shock resuscitation protocols.
- To enhance the clinical utility of focused examinations in critical care.
Main Methods:
- Review of current literature and clinical practice guidelines.
- Description of the standardized technique for assessing CRT and SMS.
- Discussion of physiological underpinnings and interpretation of findings.
Main Results:
- Capillary refill time and skin mottling score provide objective measures of peripheral perfusion.
- Abnormal CRT and SMS indicate inadequate resuscitation or persistent hypoperfusion.
- These parameters can guide further fluid administration or vasopressor use.
Conclusions:
- Capillary refill time and skin mottling score are valuable, noninvasive tools for monitoring septic shock resuscitation.
- Integrating these assessments improves the dynamic evaluation of tissue perfusion.
- Consistent application of these measures supports adherence to updated sepsis guidelines.
