Table 1 |
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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 |
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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 |
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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 |
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Increased tonometric CO2 gap or |
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Increased sublingual CO2 gap or |
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Impaired sublingual microvascular perfusion (OPS imaging) |
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Systemic markers of tissue oxygenation |
1 |
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Lactate > 4 mmol/l or |
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SvO2 < 60% |
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Organ dysfunction |
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Diuresis < 0.5 ml/kg per houra |
1 |
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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]. |
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Trzeciak and Rivers Critical Care 2005 9(Suppl 4):S20 doi:10.1186/cc3744 |
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