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Table 1 Integrative clinical approach to define a state of shock

From: Bench-to-bedside review: Sepsis is a disease of the microcirculation

Item evaluated Points
Hemodynamic variables 2
   Heart rate > 100 b.p.m. or  
   MAP < 50 mmHg and (CVP < 2 or CVP > 15 mmHg) or  
   CI < 2.2 l min-1 m-2  
Peripheral circulation 2
   Mottled skin or  
   Tc-Tp difference > 5°C or  
   Pfi < 0.3 or  
   Impaired peripheral capillary refill  
Microvascular variables 1
   Increased tonometric CO2 gap or  
   Increased sublingual CO2 gap or  
   Impaired sublingual microvascular perfusion (OPS imaging)  
Systemic markers of tissue oxygenation 1
   Lactate > 4 mmol l-1 or  
   SvO2 < 60%  
Organ dysfunction  
   Diuresis < 0.5 ml kg-1 h-1 a 1
   Decreased mental statea 1
  1. A state of shock is present if the score exceeds 2 points. CI, cardiac index; CVP, central venous pressure; MAP, mean arterial pressure; OPS, orthogonal polarization spectral imaging; Pfi, peripheral perfusion index; SvO2, mixed venous oxygen saturation; T c, core temperature; aDue to present disease. Tp, peripheral toe temperature.