Effect of goal-directed fluid resuscitation therapy based on peripheral perfusion index on acute skin failure in
Bing Xu1, Jiuying Ji2, Yin Yan3
1Department of Dermatology, Hai'an People's Hospital, Nantong, Jiangsu Province, China.
Background:
This study aimed to evaluate the effect of the peripheral perfusion index (PPI)-based goal-directed fluid resuscitation strategy for reducing the incidence of acute skin failure (ASF) in elderly critically ill patients.
Methods:
We conducted a prospective, randomized, parallel-controlled study by enrolling 216 elderly critically ill patients who required early active fluid resuscitation from January 2025 to December 2025. They were randomly assigned to 2 categories: PPI-guided and conventional resuscitation groups. The intervention group considered PPI ≥1.4 as an additional resuscitation endpoint with conventional macrohemodynamic goals. Based on routine indicators, the control group received fluid management only. Our primary outcome comprised the incidence of ASF within 7 days of intensive care unit admission. Secondary outcomes included time to ASF onset, resuscitation quality indicators, organ function, and long-term prognosis. Data were analyzed according to the intention-to-treat principle.
Results:
Our study involved 204 patients (103 intervention and 101 control). The intervention group (14.6%, 15/103) experienced a significantly reduced 7-day incidence of ASF compared with the control group (29.7%, 30/101, P = .009). However, the median time to ASF onset was prolonged in the intervention group (5.2 days vs 3.1 days, log-rank P = .012). Regarding the resuscitation quality, the intervention group demonstrated a higher 6-hour lactate clearance rate (28.5% ± 12.3% vs 21.8% ± 14.1%, P = .001) and reduced cumulative positive fluid balance at 72 hours (+1250 ± 980 mL vs +1850 ± 1100 mL, P < .001). The 28-day all-cause mortality between the groups remained nonsignificant.
Conclusion:
A PPI-based goal-directed fluid resuscitation strategy significantly reduces the risk of ASF in elderly critically ill patients, improves early perfusion marker assessments, and optimizes fluid management. This noninvasive, bedside monitoring approach provides a new clinical rationale for protecting skin health in critically ill patients.
