Cargando…

Alteration of skin perfusion in mottling area during septic shock

BACKGROUND: Mottling score has been reported to be a strong predictive factor during septic shock. However, the pathophysiology of mottling remains unclear. METHODS: In patients admitted in ICU for septic shock, we measured on the same area the mean skin perfusion by laser Doppler, the mottling scor...

Descripción completa

Detalles Bibliográficos
Autores principales: Ait-Oufella, Hafid, Bourcier, Simon, Alves, Mikael, Galbois, Arnaud, Baudel, Jean-Luc, Margetis, Dimitri, Bige, Naike, Offenstadt, Georges, Maury, Eric, Guidet, Bertrand
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848827/
https://www.ncbi.nlm.nih.gov/pubmed/24040941
http://dx.doi.org/10.1186/2110-5820-3-31
_version_ 1782293829457543168
author Ait-Oufella, Hafid
Bourcier, Simon
Alves, Mikael
Galbois, Arnaud
Baudel, Jean-Luc
Margetis, Dimitri
Bige, Naike
Offenstadt, Georges
Maury, Eric
Guidet, Bertrand
author_facet Ait-Oufella, Hafid
Bourcier, Simon
Alves, Mikael
Galbois, Arnaud
Baudel, Jean-Luc
Margetis, Dimitri
Bige, Naike
Offenstadt, Georges
Maury, Eric
Guidet, Bertrand
author_sort Ait-Oufella, Hafid
collection PubMed
description BACKGROUND: Mottling score has been reported to be a strong predictive factor during septic shock. However, the pathophysiology of mottling remains unclear. METHODS: In patients admitted in ICU for septic shock, we measured on the same area the mean skin perfusion by laser Doppler, the mottling score, and variations of both indices between T1 (6 hours after vasopressors were started) and T2 (24 hours later). RESULTS: Fourteen patients were included, SAPS II was 56 [37–71] and SOFA score at T1 was 10 [7–12]. The mean skin surface area analyzed was 4108 ± 740 mm(2); 1184 ± 141 measurements were performed over each defined skin surface area. Skin perfusion was significantly different according to mottling score and decreased from 37 [31–42] perfusion units (PUs) for a mottling score of [0–1] to 22 [20–32] PUs for a mottling score of [2–3] and 23 [16–28] for a score of [4–5] (Kruskal-Wallis test, P = 0.05). We analyzed skin perfusion changes during resuscitation in each patient and together with mottling score variations between T1 and T2 using a Wilcoxon signed-rank test. Among the 14 patients included, mottling score increased (worsened) in 5 patients, decreased (improved) in 5 patients, and remained stable in 4 patients. Baseline skin perfusion at T1 was arbitrarily scored 100%. Mean skin perfusion significantly decreased in all the patients whose mottling score worsened from 100% baseline to 63.2 ± 10.7% (P = 0.001), mean skin perfusion significantly increased in all patients whose mottling score improved from 100% baseline to 172.6 ± 46.8% (P = 0.001), and remained stable in patients whose mottling score did not change (100.5 ± 6.8%, P = 0.95). CONCLUSIONS: We have shown that mottling score variations and skin perfusion changes during septic shock resuscitation were correlated, providing additional evidence that mottling reflects skin hypoperfusion.
format Online
Article
Text
id pubmed-3848827
institution National Center for Biotechnology Information
language English
publishDate 2013
publisher Springer
record_format MEDLINE/PubMed
spelling pubmed-38488272013-12-06 Alteration of skin perfusion in mottling area during septic shock Ait-Oufella, Hafid Bourcier, Simon Alves, Mikael Galbois, Arnaud Baudel, Jean-Luc Margetis, Dimitri Bige, Naike Offenstadt, Georges Maury, Eric Guidet, Bertrand Ann Intensive Care Research BACKGROUND: Mottling score has been reported to be a strong predictive factor during septic shock. However, the pathophysiology of mottling remains unclear. METHODS: In patients admitted in ICU for septic shock, we measured on the same area the mean skin perfusion by laser Doppler, the mottling score, and variations of both indices between T1 (6 hours after vasopressors were started) and T2 (24 hours later). RESULTS: Fourteen patients were included, SAPS II was 56 [37–71] and SOFA score at T1 was 10 [7–12]. The mean skin surface area analyzed was 4108 ± 740 mm(2); 1184 ± 141 measurements were performed over each defined skin surface area. Skin perfusion was significantly different according to mottling score and decreased from 37 [31–42] perfusion units (PUs) for a mottling score of [0–1] to 22 [20–32] PUs for a mottling score of [2–3] and 23 [16–28] for a score of [4–5] (Kruskal-Wallis test, P = 0.05). We analyzed skin perfusion changes during resuscitation in each patient and together with mottling score variations between T1 and T2 using a Wilcoxon signed-rank test. Among the 14 patients included, mottling score increased (worsened) in 5 patients, decreased (improved) in 5 patients, and remained stable in 4 patients. Baseline skin perfusion at T1 was arbitrarily scored 100%. Mean skin perfusion significantly decreased in all the patients whose mottling score worsened from 100% baseline to 63.2 ± 10.7% (P = 0.001), mean skin perfusion significantly increased in all patients whose mottling score improved from 100% baseline to 172.6 ± 46.8% (P = 0.001), and remained stable in patients whose mottling score did not change (100.5 ± 6.8%, P = 0.95). CONCLUSIONS: We have shown that mottling score variations and skin perfusion changes during septic shock resuscitation were correlated, providing additional evidence that mottling reflects skin hypoperfusion. Springer 2013-09-16 /pmc/articles/PMC3848827/ /pubmed/24040941 http://dx.doi.org/10.1186/2110-5820-3-31 Text en Copyright © 2013 Ait-Oufella et al.; licensee Springer. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Ait-Oufella, Hafid
Bourcier, Simon
Alves, Mikael
Galbois, Arnaud
Baudel, Jean-Luc
Margetis, Dimitri
Bige, Naike
Offenstadt, Georges
Maury, Eric
Guidet, Bertrand
Alteration of skin perfusion in mottling area during septic shock
title Alteration of skin perfusion in mottling area during septic shock
title_full Alteration of skin perfusion in mottling area during septic shock
title_fullStr Alteration of skin perfusion in mottling area during septic shock
title_full_unstemmed Alteration of skin perfusion in mottling area during septic shock
title_short Alteration of skin perfusion in mottling area during septic shock
title_sort alteration of skin perfusion in mottling area during septic shock
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3848827/
https://www.ncbi.nlm.nih.gov/pubmed/24040941
http://dx.doi.org/10.1186/2110-5820-3-31
work_keys_str_mv AT aitoufellahafid alterationofskinperfusioninmottlingareaduringsepticshock
AT bourciersimon alterationofskinperfusioninmottlingareaduringsepticshock
AT alvesmikael alterationofskinperfusioninmottlingareaduringsepticshock
AT galboisarnaud alterationofskinperfusioninmottlingareaduringsepticshock
AT baudeljeanluc alterationofskinperfusioninmottlingareaduringsepticshock
AT margetisdimitri alterationofskinperfusioninmottlingareaduringsepticshock
AT bigenaike alterationofskinperfusioninmottlingareaduringsepticshock
AT offenstadtgeorges alterationofskinperfusioninmottlingareaduringsepticshock
AT mauryeric alterationofskinperfusioninmottlingareaduringsepticshock
AT guidetbertrand alterationofskinperfusioninmottlingareaduringsepticshock