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Noninvasive monitoring of peripheral perfusion

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Applied Physiology in Intensive Care Medicine 2

Abstract

Background: Early hemodynamic assessment of global parameters in critically ill patients fails to provide adequate information on tissue perfusion. It requires invasive monitoring and may represent a late intervention initiated mainly in the intensive care unit. Noninvasive monitoring of peripheral perfusion can be a complementary approach that allows very early application throughout the hospital. In addition, as peripheral tissues are sensitive to alterations in perfusion, monitoring of the periphery could be an early marker of tissue hypoperfusion. This review discusses noninvasive methods for monitoring perfusion in peripheral tissues based on clinical signs, body temperature gradient, optical monitoring, transcutaneous oximetry, and sublingual capnometry. Discussion: Clinical signs of poor peripheral perfusion consist of a cold, pale, clammy, and mottled skin, associated with an increase in capillary refill time. The temperature gradients peripheral-to-ambient, central-to-peripheral and forearm-to-fingertip skin are validated methods to estimate dynamic variations in skin blood flow. Commonly used optical methods for peripheral monitoring are perfusion index, near-infrared spectroscopy, laser Doppler flowmetry and orthogonal polarization spectroscopy. Continuous noninvasive transcutaneous measurement of oxygen and carbon dioxide tensions can be used to estimate cutaneous blood flow. Sublingual capnometry is a noninvasive alternative for gastric tonometry.

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  1. Department of Intensive care, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands

    Alexandre Lima & Jan Bakker

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  1. Alexandre Lima
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Editors and Affiliations

  1. Dept. of Critical Care Medicine, University of Pittsburgh Medical Center, Scaife Hall 606 3550 Terrace Street, Pittsburgh, PA, 15261, USA

    Michael R. Pinsky MD

  2. Dept. Intensive Care Medicine, Hôpital Henri Mondor, 51 av. Maréchal Lattre de Tassigny, 94010, Créteil, CX, France

    Laurent Brochard MD

  3. Dept. Intensive Care Medicine, Hospital de Sant Pau, Avda. S. Antonio M. Claret 167, 08025, Barcelona, Spain

    Jordi Mancebo MD

  4. General Intensive Care Unit, Università Cattolica des Sacro Cuore, Largo A. Gemelli 8, 00168, Rome, Italy

    Massimo Antonelli

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Lima, A., Bakker, J. (2012). Noninvasive monitoring of peripheral perfusion. In: Pinsky, M.R., Brochard, L., Mancebo, J., Antonelli, M. (eds) Applied Physiology in Intensive Care Medicine 2. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-28233-1_4

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