Clinical manifestations of disordered microcirculatory perfusion in severe sepsis

Table 1 Integrative clinical approach for defining a state of shock

Item evaluated	Points
Hemodynamic variables	2
Heart rate > 100 bpm or
MAP < 50 mmHg and (CVP < 2 or CVP > 15 mmHg) or
CI < 2.2 l/min per m²
Peripheral circulation	2
Mottled skin or
T_c-T_p 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 or
SvO₂ < 60%
Organ dysfunction
Diuresis < 0.5 ml/kg per hour^a	1
Decreased mental state^a	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; T_p, peripheral toe temperature. ^aDue to present disease. Reprinted with permission [22].

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