[Association between peripheral perfusion, microcirculation and mortality in sepsis: a systematic review]

Area of Science:

• Critical Care Medicine
• Vascular Biology
• Sepsis Pathophysiology

Background:

• Peripheral perfusion monitoring is increasingly recognized in sepsis management.
• A systematic review on the association between peripheral microcirculation and sepsis mortality was lacking.

Purpose of the Study:

• To systematically review the association between peripheral perfusion/microcirculation and mortality in septic patients.

Main Methods:

• A comprehensive database search was conducted for studies published until February 2018.
• Inclusion criteria focused on studies assessing the link between peripheral perfusion/microcirculation and mortality in sepsis.
• Twenty-six articles involving 2465 sepsis patients met the criteria.

Main Results:

• Near-Infrared Spectroscopy (NIRS) and Sidestream Dark-Field (SDF) imaging were common measurement methods.
• Sublingual/buccal microcirculation was the most studied vascular bed.
• The majority of studies (23/26) found a significant association between poor peripheral perfusion and increased mortality.

Conclusions:

• Hypoperfusion and microcirculatory abnormalities in peripheral non-vital organs are associated with increased mortality in sepsis.
• Further research is required to determine if these findings are markers of severity or causative factors in sepsis-induced organ failure.