Peripheral Perfusion in Relation to Systemic Hemodynamics

Abstract

Hemodynamic monitoring is a cornerstone in the care of the critically ill patient. Monitoring techniques have greatly improved over the last decade and technologies have evolved from invasive to non-invasive monitoring devices. The rationale of peripheral perfusion monitoring is based on the concept that peripheral tissues are the first to reflect a disturbance of the circulation that frequently characterizes shock*, independent of systemic hemodynamics. Peripheral perfusion monitoring not only provides a different point of reference for patient circulation, but is also non-invasive can be used directly at the bedside. In patients after out-of-hospital cardiac arrest, after major abdominal surgery, and in a heterogeneous intensive care unit population, persistence of these alterations is associated with organ failure and death, independent of systemic hemodynamics (i.e., heart rate, blood pressure, and cardiac output). Moreover, in septic shock patients, early peripheral perfusion targeted fluid resuscitation leads to a trend towards less fluids when compared to a conventional regimen based on systemic hemodynamic parameters. These findings demonstrate that assessment of the peripheral perfusion could be used to early identify specifically those patients in need of additional therapy and open the perspective of peripheral perfusion targeted resuscitation. It can thus be concluded that assessment of the peripheral perfusion can be easily performed at the bedside, can be rapidly instituted throughout the hospital, and could be a potential target to optimize the circulation. Still, its role as an efficient target for resuscitation warrants further investigation.