Free On-line Access

SPCI - Sociedade Portuguesa de Cuidados Intensivos

Revista Brasileira de Terapia Intensiva

AMIB - Associação de Medicina Intensiva Brasileira

OFFICIAL JOURNAL OF THE ASSOCIAÇÃO BRASILEIRA DE MEDICINA INTENSIVA AND THE SOCIEDADE PORTUGUESA DE CUIDADOS INTENSIVOS

ISSN: 0103-507X
Online ISSN: 1982-4335

Ícone Fechar

How to Cite


 

Das M, Bardakci O, Beyazit Y. Para: Uso do índice de perfusão para avaliar reatividade microvascular no choque séptico após ressuscitação volêmica. Rev Bras Ter Intensiva. 2019;31(2):273-274

 

 

2019 2019;31(2):273-274
LETTERS TO THE EDITOR

10.5935/0103-507X.20190019

To: Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation

Para: Uso do índice de perfusão para avaliar reatividade microvascular no choque séptico após ressuscitação volêmica

Murat Daş, Okan Bardakci, Yavuz Beyazit

Department of Emergency Medicine, Canakkale Onsekiz Mart University - Canakkale, Turkey.
Department of Internal Medicine, Canakkale Onsekiz Mart University - Canakkale, Turkey.

Conflicts of interest: None.

Corresponding author: Murat Daş, Department of Emergency Medicine, Canakkale Onsekiz Mart University, kepez, Canakkale 17100, Turkey, E-mail: muratdas58@gmail.com

 

Dear Editor,

In a recent issue of your journal, Menezes et al.(1) presented a superb evaluation of the perfusion index in septic shock patients following fluid resuscitation. In a novel and fascinating piece of research, the authors seem to successfully evaluate microvascular reactivity byoximetry-derived perfusion index and reactive hyperemia. However, as already mentioned by the authors, there are a number of factors that can potentially impact on the results. Inlight of this, we would like to mention the important effect of patient position on perfusion index, which we believe warrants attention in evaluating the study''s results.

Perfusion index derived from pulse oximetry provides a rapid indicator of microcirculatory changes and can help clinicians to detect abnormalities in the peripheral circulation.(2,3) This method reflects real-time alterations in peripheral blood flow through use of a pulse oximeter device, which delivers readings noninvasively and continuously;(4) however, it does have some flaws and limitations that should be accounted for during implementation. In this context, we believe that patient position is one of the important factors affecting the results of perfusion index measurement.

The effect of patient position on peripheral perfusion index is a novel topic; Tapar et al.(5) were the first researchers to show that perfusion index values among healthy individuals vary according to body position, with use of supine measurements as a baseline. These authors demonstrated significant hemodynamic changes in different body positions, including supine, Trendelenburg, prone, and sitting supine. Moreover, in a study by Smith et al.,(6) it was demonstrated that in conscious, healthy subjects, a head-up tilt triggers a prompt and balanced response, the immediate period being the first few seconds and the ''balanced'' period being between 30 secs and 20 mins. This suggests that position alterations can cause blood pressure fluctuations, and that hemodynamic changes can cause alterations in peripheral perfusion index measurements.

In conclusion, we are of the opinion that in studies designed to measure the perfusion index in distinct disease states, the effect of the patient''s position should be borne in mind.

Murat Daş
Department of Emergency Medicine, Canakkale Onsekiz Mart University - Canakkale, Turkey.
Okan Bardakci
Department of Emergency Medicine, Canakkale Onsekiz Mart University - Canakkale, Turkey.
Yavuz Beyazit
Department of Internal Medicine, Canakkale Onsekiz Mart University - Canakkale, Turkey.

REFERENCES

Menezes IA, Cunha CL, Carraro Júnior H, Luy AM. Perfusion index for assessing microvascular reactivity in septic shock after fluid resuscitation. Rev Bras Ter Intensiva. 2018;30(2):135-43. Link PubMed
van Genderen ME, van Bommel J, Lima A. Monitoring peripheral perfusion in critically ill patients at the bedside. Curr Opin Crit Care. 2012;18(3):273-9. Link DOILink PubMed
Mowafi HA, Ismail SA, Shafi MA, Al-Ghamdi AA. The efficacy of perfusion index as an indicator for intravascular injection of epinephrine-containing epidural test dose in propofol-anesthetized adults. Anesth Analg. 2009;108(2):549-53. Link DOILink PubMed
Tutoglu A, Boyaci A, Küçük A, Sakalar A, Sert H, Yalçin S. Perfusion index is increased in acute complex regional pain syndrome type 1. Arch Rheumatol. 2015;30(1):40-4. Link DOI
Tapar H, Karaman S, Dogru S, Karaman T, Sahin A, Tapar GG, et al. The effect of patient positions on perfusion index. BMC Anesthesiol. 2018;18(1):111. Link DOILink PubMed
Smith JJ, Porth CM, Erickson M. Hemodynamic response to the upright posture. J Clin Pharmacol. 1994;34(5):375-86. Link DOILink PubMed

Submission On-line

Indexed in

Scopus

SciELO

LILACS

Associação de Medicina Intensiva Brasileira - AMIB

Rua Arminda nº 93 - 7º andar - Vila Olímpia - São Paulo, SP, Brasil - Tel./Fax: (55 11) 5089-2642 | e-mail: rbti.artigos@amib.org.br

GN1 - Systems and Publications