Re-thinking resuscitation: leaving blood pressure cosmetics behind and moving forward to permissive hypotension and a tissue perfusion-based approach

Table 1 Tissue perfusion-based resuscitation endpoints

Category	Parameter	Endpoint	Suggested measurement interval	Pathophysiologic background	Therapeutic implications
Peripheral perfusion	Capillary refill time	<4.5 seconds	15-60 minutes^a	Inadequate systemic blood flow	Fluids, red blood cells, inotropes, vasodilator.
	Skin mottling	Absent
	Peripheral temperature	Warm			Vasopressors only to ensure minimum mean arterial blood pressure for coronary and cerebral perfusion!
	Peripheral perfusion index	≥1.4	Continuous
	Tissue oxygen saturation	≥70%
Venous oxygen saturation	Central	≥65% - 70%	Continuous
	Mixed	≥60% - 65%
Arterial lactate	Absolute value	<2 mmol/L	2 hours	Inadequate systemic blood flow or excessive vasodilation	Fluids, blood, inotropes, vasodilators, and/or vasopressors
	Clearance	>20%/2 hours
Urine output		≥0.5 mL/kg per hour	15-60 minutes^a

^aDepending on the phase of resuscitation (15 minutes during the early, unstable phase; 60 minutes during the subsequent, more stable phase). Presence of two or more abnormal categories (arterial lactate, venous oxygen saturation, arterial lactate, and urine output) indicates shock. Shock reversal can be assumed if one or no category reveals abnormalities.

ISSN: 1364-8535