An observational study to correlate arterial lactate level and peripheral perfusion index in context of tissue perfusion in sepsis

Priyanka R. Singla; Sanket K. Mahajan

doi:10.18203/2320-6012.ijrms20231333

Authors

Priyanka R. Singla Department of Anaesthesiology, Dr. Kiran C. Patel Medical College & Research Institute, Bharuch, Gujarat India
Sanket K. Mahajan Department of Medicine, Dr. Kiran C. Patel Medical College & Research Institute, Bharuch, Gujarat India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20231333

Keywords:

Arterial lactate, Perfusion Index, Sepsis

Abstract

Background: In view of goal directed therapies, the predictive value of the course of peripheral perfusion parameters over time has not been studied. Moreover serial assessment of peripheral perfusion index (PI) can be more predictive for mortality when compared to a single assessment of peripheral perfusion. Successfully normalized PI (≥1.4) during treatment might be an indication to stop the resuscitation, whereas pursuing normalized PI (≥1.4) might not result in better outcomes compared with mild-to moderate PI impairment after a normalized arterial lactate level. Complementing arterial lactate assessment with PI during resuscitation can better identify the endpoint of resuscitation and patients at higher risk of adverse outcomes. By simple clinical assessment of peripheral perfusion immediately during and after resuscitation, clinicians will be able to discriminate patients at high risk for developing severe complications even in the rural setups.

Methods: This prospective study was conducted on 100 patients admitted at Dr. Kiran C. Patel Medical College and Research Institute, over a period of 12months (Janury 2022 to December 2022). Patients of sepsis were selected on the basis of criteria for tissue hypoperfusion and classification of sepsis.

Results: On statistical analysis, PI was found to have significant correlation with arterial lactate levels (P<0.001) in PI <1.4 sub-measurement and not in PI >1.4. SOFA score & metabolic parameters were also found to have statistical significance.

Conclusions: We inferred that peripheral perfusion index monitoring could provide useful information to determine the possibility of hyperlactatemia in critically ill patients thus providing a noninvasive source of tissue-bed perfusion monitoring even in the absence of facilities and infrastructure to measure the lactate levels thereby providing a gross insight in the perfusion haemodynamics of the patients of sepsis even in the primary healthcare setups too.

Metrics

Metrics Loading ...

References

Chien LC, Lu KJ, Wo CC, Shoemaker WC. Hemodynamic patterns preceding circulatory deterioration and death after trauma. J Trauma. 2007;62:928-32.

Poeze M, Solberg BC, Greve JW, Ramsay G. Monitoring global volume related hemodynamic or regional variables after initial resuscitation: what is a better predictor of outcome in critically ill septic patients? Crit Care Med. 2005;33:2494-500.

Lima A, van Bommel J, Sikorska K. The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med. 2011;39:1649-54.

Levy B. Lactate and shock state: the metabolic view. Curr Opin Crit Care. 2006;12:315-21.

Bakker J, Nijsten MW, Jansen TC. Clinical use of lactate monitoring in critically ill patients. Annals Intensive Care. 2013;3(1):12.

Moore JPR, Fraser JF. Clinical monitoring of peripheral perfusion: perspective on ProCess. Crit Care. 2014;18:619.

Todi S, Chatterjee S, Sahu S: Epidemiology of severe sepsis in India: an update. Critical Care 2010;14(1):P382.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock. Intensive Care Med. 2013;39(2):165-228.

Lima A, Jansen TC, Bommel J. The prognostic value of the subjective assessment of peripheral perfusion in critically ill patients. Crit Care Med. 2009;37:934-8.

Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30:1210-3.

Lima A, van Genderen M, Klijn E, et al: Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy. Intensive Care Med. 2012;38:606-11.

Huaiwu He, Yun Long, Dawei Liu, Xiaoting Wang, Xiang Zhou. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Critical Care. 2015;19:330.

Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D. SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference. Crit Care Med. 2001;03:1250–6.

Geroulanos S, Douka ET. Historical perspective of the word sepsis. Intensive Care Med. 2006;32:2077.

Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving Sepsis Campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165-228.

Vincent JL, Pelosi P, Pearse R, Payen D, Perel A, Hoeft A, et al. Perioperative cardiovascular monitoring of high-risk patients: a consensus of 12. Crit Care. 2015;19(1):224-9.

Fuller BM, Dellinger RP. Lactate as a hemodynamic marker in the critically ill. Curr Opin Crit Care. 2012;18(3):267-72.

Mayer K, Trzeciak S, Puri NK. Assessment of the adequacy of oxygen delivery. Curr Opin Crit Care. 2016;22:437-43.

Mikkelsen ME, Miltiades AN, Gaieski DF, Goyal M, Fuchs BD, Shah CV, et al. Serum lactate is associated with mortality in severe sepsis independent of organ failure and shock. Crit Care Med. 2009;37(5):1670-7.

Trzeciak S, Dellinger RP, Chansky ME, Arnold RC, Schorr C, Milcarek B, et al. Serum lactate as a predictor of mortality in patients with infection. Intensive Care Med. 2007;33(6):970-7.

Nguyen HB, Rivers EP, Knoblich BP, Jacobsen G, Muzzin A, Ressler JA, et al. Early lactate clearance is associated with improved outcome in severe sepsis and septic shock. Crit Care Med. 2004;32(8):1637-42.

Lima AP, Beelen P, Bakker J. Use of a peripheral perfusion index derived from the pulse oximetry signal as a noninvasive indicator of perfusion. Crit Care Med. 2002;30(6):1210-3.

He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Crit Care. 2015;19(1):330.

Pe M, Goad A, Thompson C, Taylor K, Harry B, Passmore L, et al. Early peripheral perfusion–guided fluid therapy in patients with septic Shock. Am J Respir Crit Care Med. 2015;191(4):477–80.

Lima A, Genderen M, Klijn E. Peripheral vasoconstriction influences thenar oxygen saturation as measured by near-infrared spectroscopy. Intensive Care Med. 2012;38:606-11.