Table 1

Integrative clinical approach for defining a state of shock

Item evaluated

Points


Hemodynamic variables

2

Heart rate > 100 bpm or

MAP < 50 mmHg and (CVP < 2 or CVP > 15 mmHg) or

CI < 2.2 l/min per m2

Peripheral circulation

2

Mottled skin or

Tc-Tp 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 or

SvO2 < 60%

Organ dysfunction

Diuresis < 0.5 ml/kg per houra

1

Decreased mental statea

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; 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