Table 1

Integrative clinical approach to define a state of shock

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

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^-1 or

SvO₂ < 60%

Organ dysfunction

Diuresis < 0.5 ml kg^-1 h^{-1 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; Tc, core temperature; ^aDue to present disease. T_p, peripheral toe temperature.

Spronk et al. Critical Care 2004 8:462   doi:10.1186/cc2894