Photoplethysmographic assessment of microcirculation and vascular reactivity in septic patientsy: Pilot study

S. Kazune, E. Strīķe, R. Erts, J. Spigulis

Research output: Contribution to journalMeeting Abstractpeer-review


INTRODUCTION. Clinical and experimental evidence indicates that microcirculatorydysfunction contributes to organ failure and mortality in sepsis but its non invasive assessmentat the bedside is difficult.OBJECTIVES. The purpose of this study was to evaluate utility of photoplethysmographic(PPG) assessment of microcirculatory perfusion in patients with sepsis, compare early microcirculatoryindices in sepsis survivors versus nonsurvivors, and describe patient variablesthat affect PPG measurements.METHODS. Prospective observational study. We studied 10 consecutive general ICUpatients (age 65 +/- 14 years) within 24 h of admission and 6 healthy volunteers (age47 +/- 27 years). Severity of sepsis was assessed with APACHE II score (15 +/- 7), SequentialOrganFailure Assessment (SOFA) score (6 +/- 4) and sepsis severity category (SIRS n = 3,severe sepsis n = 2 and septic shock n = 5). After 1 h observation to ensure that hemodynamicshave stabilized, mean arterial pressure (MAP), age and sepsis severity were recorded.3 min PPG signal recording was done with an originally designed photoplethysmograph at restand after 3 min of induced forearm ischemia. Outcomes were defined as development ofmultiple organ failure within 48 h and 28 day mortality.RESULTS. Of the 10 ICU patients 6 developed multiple organ failure and 3 died. The restingPPG pulsatile component mean amplitude decreased in groups from healthy to septic shock(healthy 18.7 +/- 5.2, SIRS 19.0 +/- 4.0, severe sepsis 16.3 +/- 2.7, septic shock 11.1 +/- 5.0arbitrary units) but the difference was only significant between septic shock and healthy group(p = 0.03), the median slope of recovery after ischemia was lower in septic non survivors (-0.53, IQ-1.97 to-0.30) versus survivors (-0.13, IQ-0.36 to 2.04), p = 0.04, with nodifference between other groups. Using linear regression PPG pulsatile component amplitudeof septic patients correlated well with survival, age and MAP (r = 0.88, p = 0.02). In healthypatients the slope of recovery after ischemia was proportional to resting amplitude, but in septicpatients direct relationship was lost and there was a weak correlation with outcome, but not ageorMAP(r = 0.68, p = 0.09). No correlation of amplitude or slope of recovery was found withmaximum SOFA score.CONCLUSIONS. Photplethysmographic microcirculatory indices vary between patients indifferent sepsis categories but are also influenced by age and MAP. Slope of postischemicrecovery depends on resting amplitude but in the subgroup of patients with severe sepsis couldpredict poor outcome regardless of resting amplitude, age or MAP. Larger study is needed toconfirm this finding.
Original languageEnglish
Article number0860
Pages (from-to)S220
Number of pages1
JournalIntensive Care Medicine
Issue numberSuppl. 1
Publication statusPublished - 2011
Externally publishedYes
Event24 Annual Congress of European Society of Intensive Care Medicine - Berlin, Germany
Duration: 1 Oct 20115 Oct 2011


  • apache
  • blood vessel reactivity
  • forearm
  • human
  • intelligence quotient
  • intensive care
  • ischemia
  • linear regression analysis
  • mean arterial pressure
  • microcirculation
  • mortality
  • multiple organ failure
  • normal human
  • observational study
  • patient
  • perfusion
  • pilot study
  • recording
  • sepsis
  • septic shock
  • society
  • survival
  • survivor

Field of Science*

  • 3.1 Basic medicine
  • 3.2 Clinical medicine

Publication Type*

  • 3.3. Publications in conference proceedings indexed in Web of Science and/or Scopus database


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