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Integrative clinical approach for defining a state of shock |
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| Item evaluated |
Points |
|
|
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| Hemodynamic variables |
2 |
| Heart rate > 100 bpm or |
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| MAP < 50 mmHg and (CVP < 2 or CVP > 15 mmHg) or |
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| CI < 2.2 l/min per m2 |
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| Peripheral circulation |
2 |
| Mottled skin or |
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| Tc-Tp difference > 5°C or |
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| Pfi < 0.3 or |
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| Impaired peripheral capillary refill |
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| Microvascular variables |
1 |
| Increased tonometric CO2 gap or |
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| Increased sublingual CO2 gap or |
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| Impaired sublingual microvascular perfusion (OPS imaging) |
|
| Systemic markers of tissue oxygenation |
1 |
| Lactate > 4 mmol/l or |
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| SvO2 < 60% |
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| Organ dysfunction |
|
| Diuresis < 0.5 ml/kg per houra |
1 |
| Decreased mental statea |
1 |
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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; Tp, peripheral toe temperature. aDue to present disease. Reprinted with permission [22]. | |
Trzeciak and Rivers Critical Care 2005 9(Suppl 4):S20 doi:10.1186/cc3744 |
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