Tissue perfusion monitoring in children with acute circulatory dysfunction: narrative review

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 alterati...

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Bibliographic Details
Published in:Andes pediatrica : revista Chilena de pediatría 2024-04, Vol.95 (2), p.202
Main Authors: Rodríguez Rojas, María José, Donoso Fuentes, Alejandro
Format: Article
Language:Spanish
Subjects:
Acute Disease
Biomarkers - blood
Child
Hemodynamic Monitoring - methods
Hemodynamics - physiology
Humans
Microcirculation - physiology
Monitoring, Physiologic - methods
Sepsis - diagnosis
Sepsis - physiopathology
Sepsis - therapy
Shock, Septic - diagnosis
Shock, Septic - physiopathology
Shock, Septic - therapy
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Summary: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.
ISSN:2452-6053
2452-6053
DOI:10.32641/andespediatr.v95i2.4915