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Oscillation frequency of skin microvascular blood flow is associated with mortality in critically ill patients


Microcirculatory dysfunction has been hypothesized to play a key role in the pathophysiology of multiple organ failure, and consequently to patient outcome. The objective of the present study was to investigate differences in reactive hyperemia response and oscillation frequencies in survivors and nonsurvivors of patients with multiple organ dysfunction syndrome (MODS).


Twenty-nine patients (15 survivors; 14 nonsurvivors) with two or more organ failures were eligible for study entry. All patients were hemodynamically stabilized, and demographic and clinical data were recorded. A laser Doppler flowmeter was used to measure the cutaneous microcirculatory response. Reactive hyperemia and oscillatory changes in the Doppler signal were measured during 3 minutes before and after a 5-minute period of forearm ischemia during hyperemia.


Nonsurvivors demonstrated a significantly higher MODS score when compared with survivors (P = 0.004). Norepinephrine requirements were higher in nonsurvivors (P = 0.018). Non-survivors had higher arterial lactate levels (P = 0.046), decreased arterial pH levels (P= 0.001), and decreased arterial PO2 values (P = 0.013) when compared with survivors. A higher oscillation frequency of skin microvasculature at rest (P = 0.033) and after an ischemic stimulus (P = 0.009) was observed in nonsurvivors. No differences were observed in reactive hyperemia response between groups. The flowmotion frequency observed in reactive hyperemia was associated with the severity of the MODS (P = 0.009), and – although not statistically significant – arterial lactate concentration (P = 0.052).


An increased skin microvascular oscillation frequency during rest and after an ischemic stimulus is associated with increased mortality in patients suffering from MODS. We suggest that the underlying mechanism of the increased flowmotion could be a response of the skin microvasculature to hypoxia or to an impaired oxygen utilization of the skin tissue.

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Knotzer, H., Maier, S., Pajk, W. et al. Oscillation frequency of skin microvascular blood flow is associated with mortality in critically ill patients. Crit Care 11 (Suppl 2), P266 (2007).

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