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Updated: Jun 25, 2025
Real-Time Assessment of Spinal Cord Microperfusion in a Porcine Model of Ischemia/Reperfusion
Published on: December 10, 2020
[Tissue perfusion monitoring in children with acute circulatory dysfunction: narrative review]
María José Rodríguez Rojas1, Alejandro Donoso Fuentes1
1Hospital Clínico Dra. Eloísa Díaz I., Santiago, Chile.
Insights
Sepsis patients need more than just basic hemodynamic monitoring. Evaluating peripheral circulation using bedside tools can reveal early signs of organ damage and guide personalized treatment for better outcomes.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Microcirculation
Background:
- Sepsis is a leading cause of Intensive Care Unit (ICU) admission, often presenting with shock.
- Standard hemodynamic resuscitation focuses on macrocirculatory parameters, which may not reflect tissue perfusion.
- Persistent microcirculatory dysfunction despite macrohemodynamic restoration can lead to organ failure.
Purpose of the Study:
- To review and analyze existing tissue perfusion markers in sepsis.
- To update evidence on guiding hemodynamic support through individualized therapy.
- To highlight the importance of assessing peripheral circulation for early detection of systemic alterations.
Main Methods:
- Narrative review of current literature on tissue perfusion markers.
- Analysis of commonly used organ perfusion indicators (urinary output, lactatemia, ScvO2, pCO2 gap).
- Evaluation of noninvasive peripheral circulation monitoring techniques (skin temperature gradient, capillary refill time, mottling score, peripheral perfusion index).
Main Results:
- Macrohemodynamic parameters may not correlate with microcirculatory status in septic shock.
- Peripheral circulation markers are sensitive indicators of systemic hemodynamic alterations.
- Noninvasive bedside techniques offer a practical approach to assessing peripheral perfusion.
Conclusions:
- Assessing peripheral circulation provides valuable insights into tissue perfusion beyond macrohemodynamic measures.
- Noninvasive bedside monitoring of peripheral perfusion can aid in early detection and management of sepsis.
- Individualized hemodynamic support, informed by comprehensive perfusion assessment, is crucial for improving patient outcomes.
Abstract:
Sepsis is one of the main causes of admission to Intensive Care Units (ICU). The hemodynamic objectives usually sought during the resuscitation of the patient in septic shock correspond to macrohemodynamic parameters (heart rate, blood pressure, central venous pressure). However, persistent alterations in microcirculation, despite the restoration of macrohemodynamic parameters, can cause organ failure. This dissociation between the macrocirculation and microcirculation originates the need to evaluate organ tissue perfusion, the most commonly used being urinary output, lactatemia, central venous oxygen saturation (ScvO2), and veno-arterial pCO2 gap. Because peripheral tissues, such as the skin, are sensitive to disturbances in perfusion, noninvasive monitoring of peripheral circulation, such as skin temperature gradient, capillary refill time, mottling score, and peripheral perfusion index may be helpful as early markers of the existence of systemic hemodynamic alterations. Peripheral circulation monitoring techniques are relatively easy to interpret and can be used directly at the patient's bedside. This approach can be quickly applied in the intra- or extra-ICU setting. The objective of this narrative review is to analyze the various existing tissue perfusion markers and to update the evidence that allows guiding hemodynamic support in a more individualized therapy for each patient.
