Evaluation of Tissue Perfusion in Septic Shock Using Cardiac Output Monitoring and Transcutaneous Oxygen Challenge...

Area of Science:

• Critical Care Medicine
• Hemodynamics
• Septic Shock Pathophysiology

Background:

• Tissue perfusion monitoring is crucial for managing septic shock.
• Traditional cardiac output (CO) and oxygenation markers may not fully capture microcirculatory dysfunction in septic shock.

Purpose of the Study:

• To evaluate tissue perfusion in septic shock using the 10-minute oxygen challenge test (10min-OCT) and cardiac output (CO) monitoring.
• To assess the prognostic value of oxygenation and hemodynamic parameters in septic shock.

Main Methods:

• Prospective observational study of 54 septic shock patients and 29 controls.
• Ultrasound for velocity time integral (VTI) and vena cava diameter.
• Transcutaneous oxygen monitoring (10min-OCT), blood gas analysis, and lactate levels.
• Data collected every 12 hours for 24 hours; 28-day mortality analyzed using Cox regression.

Main Results:

• Septic shock patients exhibited lower 10min-OCT and VTI at enrollment compared to controls.
• Non-survivors had higher lactate and lower arterial oxygen content (CaO₂) and venous oxygen content (CvO₂) than survivors.
• Lactate, CaO₂, and CvO₂ were independent predictors of 28-day mortality; their combination improved prognostic accuracy.

Conclusions:

• The 10min-OCT is a reliable, non-invasive marker for microcirculatory perfusion in septic shock, correlating with lactate.
• VTI was more sensitive than CO or cardiac index in reflecting circulatory status.
• Combined CaO₂, CvO₂, and lactate significantly enhance prognostic precision for 28-day mortality in septic shock.