Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections

Simon Bourcier^{1

2}, Claire Pichereau^{1

2}, Pierre-Yves Boelle³, Safaa Nemlaghi^{1

4}, Vincent Dubée^{1

2}, Gabriel Lejour¹, Jean-Luc Baudel¹, Arnaud Galbois^{1

4}, Jean-Rémi Lavillegrand¹, Naïke Bigé¹, Jalel Tahiri¹, Guillaume Leblanc^{1

5}, Eric Maury^{1

2

6}, Bertrand Guidet^{1

2

6}, Hafid Ait-Oufella^{7

8

9}

Affiliations

¹ Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
² Université Pierre et Marie Curie-Paris 6, Paris, France.
³ Service de santé publique, AP-HP, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France.
⁴ Service de Réanimation polyvalente Quincy-sous-Sénart, Générale de Santé, Hôpital Privé Claude Galien, Quincy-Sous-Sénart, France.
⁵ Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
⁶ Inserm U1136, 75012, Paris, France.
⁷ Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. hafid.aitoufella@sat.aphp.fr.
⁸ Université Pierre et Marie Curie-Paris 6, Paris, France. hafid.aitoufella@sat.aphp.fr.
⁹ Inserm U970, Centre de recherche cardiovasculaire de Paris (PARCC), Paris, France. hafid.aitoufella@sat.aphp.fr.

PMID: 27401441
PMCID: PMC4940318
DOI: 10.1186/s13613-016-0164-2

Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections

Simon Bourcier et al. Ann Intensive Care. 2016 Dec.

. 2016 Dec;6(1):63.

doi: 10.1186/s13613-016-0164-2. Epub 2016 Jul 11.

Authors

Affiliations

¹ Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France.
² Université Pierre et Marie Curie-Paris 6, Paris, France.
³ Service de santé publique, AP-HP, Hôpital Saint-Antoine, 75571, Paris Cedex 12, France.
⁴ Service de Réanimation polyvalente Quincy-sous-Sénart, Générale de Santé, Hôpital Privé Claude Galien, Quincy-Sous-Sénart, France.
⁵ Department of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Université Laval, Québec, QC, Canada.
⁶ Inserm U1136, 75012, Paris, France.
⁷ Service de réanimation médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 184 rue du Faubourg Saint-Antoine, 75571, Paris Cedex 12, France. hafid.aitoufella@sat.aphp.fr.
⁸ Université Pierre et Marie Curie-Paris 6, Paris, France. hafid.aitoufella@sat.aphp.fr.
⁹ Inserm U970, Centre de recherche cardiovasculaire de Paris (PARCC), Paris, France. hafid.aitoufella@sat.aphp.fr.

PMID: 27401441
PMCID: PMC4940318
DOI: 10.1186/s13613-016-0164-2

Abstract

Background: Microcirculatory disorders leading to tissue hypoperfusion play a central role in the pathophysiology of organ failure in severe sepsis and septic shock. As microcirculatory disorders have been identified as strong predictive factors of unfavourable outcome, there is a need to develop accurate parameters at the bedside to evaluate tissue perfusion. We evaluated whether different body temperature gradients could relate to sepsis severity and could predict outcome in critically ill patients with severe sepsis and septic shock.

Method: We conducted a prospective observational study in a tertiary teaching hospital in France. During a 10-month period, all consecutive adult patients with severe sepsis or septic shock who required ICU admission were included. Six hours after initial resuscitation (H6), we recorded the hemodynamic parameters and four temperature gradients: central-to-toe, central-to-knee, toe-to-room and knee-to-room.

Results: We evaluated 40 patients with severe sepsis (40/103, 39 %) and 63 patients with septic shock (63/103, 61 %). In patients with septic shock, central-to-toe temperature gradient was significantly higher (12.5 [9.2; 13.8] vs 6.9 [3.4; 12.0] °C, P < 0.001) and toe-to-room temperature gradient significantly lower (1.2 [-0.3; 5.2] vs 6.0 [0.6; 9.5] °C, P < 0.001) than in patients with severe sepsis. Overall ICU mortality rate due to multiple organ failure (MOF) was 21 %. After initial resuscitation, toe-to-room temperature gradient was significantly lower in patients dead from MOF than in the survivors (-0.2 [-1.1; +1.3] °C vs +3.9 [+0.5; +7.2] °C, P < 0.001) and the difference in gradients increased during the first 24 h. Furthermore, toe-to-room temperature gradient was related to tissue perfusion parameters such as arterial lactate level (r = -0.54, P < 0.0001), urine output (r = 0.37, P = 0.0002), knee capillary refill time (r = -0.42, P < 0.0001) and mottling score (P = 0.001).

Conclusions: Toe-to-room temperature gradient reflects tissue perfusion at the bedside and is a strong prognosis factor in critically ill patients with severe infections.

Keywords: Microcirculation; Outcome; Sepsis; Shock; Temperature gradient.

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Figures

**Fig. 1**
Temperature gradients measured at 6 h in patients with severe sepsis or septic shock. **P < 0.01

**Fig. 2**
Time course of toe-to-room temperature gradients of pooled severe sepsis/septic shock patients according to ICU outcome. Three groups, survivors, MOF deaths (multiple organ failure) and late deaths. **P < 0.01

**Fig. 3**
Relationship between toe-to-room temperature gradient and hemodynamic parameters in a pooled analysis of patient with severe sepsis and septic shock at H6; a arterial lactate level, b urinary output, c cardiac index, d knee capillary refill time, e norepinephrine dose and f mottling score. ***P < 0.001

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Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections

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Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections

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Abstract

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