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Peripheral perfusion response to semiorthostatic stress: a simple method for assessing autonomic dysfunction in
Lilian Barth Guimarães1, César Maistro Guimarães2, Hipólito Carraro Junior1
1Intensive Care Unit, Hospital de Clínicas, Universidade Federal do Paraná - Curitiba (PR), Brazil.
Critical Care Science
|December 4, 2024
Summary
The perfusion index response to semiorthostatic stress can monitor sympathetic-vascular responses in sepsis patients. This simple bedside test may also offer prognostic value for sepsis severity.
Area of Science:
- Critical Care Medicine
- Hemodynamics
- Autonomic Nervous System Function
Background:
- Sepsis significantly impacts sympathetic-vascular regulation.
- Monitoring sympathetic responses in sepsis is crucial for timely intervention.
- Current monitoring methods may lack bedside applicability or simplicity.
Purpose of the Study:
- To determine if perfusion index (PI) response to semiorthostatic stress reflects sympathetic-vascular activity in sepsis.
- To assess the prognostic value of PI response in sepsis patients.
Main Methods:
- A semiorthostatic stress test (0-60 degree head elevation) was performed on healthy individuals (Group A), critically ill non-septic patients (Group B), and septic patients (Group C).
- Hemodynamic parameters, PI, cardiac ultrasound data, and Sequential Organ Failure Assessment (SOFA) scores were analyzed.
- Septic patients were compared based on PI changes after the stress test.
Main Results:
- Healthy individuals showed expected hemodynamic and PI changes with semiorthostatic stress, unlike septic patients.
- Septic patients exhibited heterogeneous PI responses to the stress test.
- A reduced PI post-test in septic patients correlated with a significant decrease in SOFA score at 72 hours.
Conclusions:
- Perfusion index response to semiorthostatic stress is a simple, inexpensive bedside method to assess sympathetic-microvascular response in sepsis.
- This PI response demonstrates potential prognostic value in sepsis management.
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