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Abstract
Sepsis is one of the main reasons for intensive care unit admission and is responsible for high morbidity and mortality. The usual hemodynamic targets for resuscitation of patients with septic shock use macro-hemodynamic parameters (hearth rate, mean arterial pressure, central venous pressure). However, persistent alterations of microcirculatory blood flow despite restoration of macro-hemodynamic parameters can lead to organ failure. This dissociation between macro- and microcirculatory compartments brings a need to assess end organs tissue perfusion in patients with septic shock. Traditional markers of tissue perfusion may not be readily available (lactate) or may take time to assess (urine output). The skin, an easily accessible organ, allows clinicians to quickly evaluate the peripheral tissue perfusion with noninvasive bedside parameters such as the skin temperatures gradient, the capillary refill time, the extent of mottling and the peripheral perfusion index.
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Details
1 Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris Cedex 12, France; Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France
2 Division of Critical Care Medicine, Department of Anesthesiology and Critical Care Medicine, Université Laval, Québec City, QC, Canada; Population Health and Optimal Health Practices Research Unit (Trauma – Emergency – Critical Care Medicine), Centre de recherche du CHU de Québec – Université Laval, Université Laval, Québec City, QC, Canada
3 Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris Cedex 12, France
4 Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris Cedex 12, France; Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France; Inserm U1136, Paris, France
5 Department Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands; Department of Pulmonology and Critical Care, Columbia University Medical Center, New York, USA; Department of Pulmonology and Critical Care, New York University Medical Center – Bellevue Hospital, New York, USA; Department of Intensive Care, Pontificia Universidad Católica de Chile, Santiago, Chile
6 Service de réanimation médicale, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Saint-Antoine, Paris Cedex 12, France; Sorbonne Université, Université Pierre-et-Marie Curie-Paris 6, Paris, France; Inserm U970, Centre de Recherche Cardiovasculaire de Paris (PARCC), Paris, France