How is tissue perfusion evaluated in septic shock and what are the signs of inadequate perfusion?

Updated: Oct 07, 2020
  • Author: Andre Kalil, MD, MPH; Chief Editor: Michael R Pinsky, MD, CM, Dr(HC), FCCP, FAPS, MCCM  more...
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Elevation of the blood lactate level on serial measurements of lactate can indicate inadequate tissue perfusion. In addition, mixed venous oxyhemoglobin saturation serves as an indicator of the balance between oxygen delivery and consumption. A decrease in maximal venous oxygen (MVO2) can be secondary to decreased cardiac output; however, maldistribution of blood flow in patients experiencing septic shock may artificially elevate the MVO2 levels. An MVO2 of less than 65% generally indicates decreased tissue perfusion.

Regional perfusion in patients with septic shock is evaluated by assessing the adequacy of organ function. Indications of inadequate perfusion may include any of the following:

  • Evidence of myocardial ischemia

  • Renal dysfunction, manifested by decreased UOP or increased creatinine levels

  • Central nervous system (CNS) dysfunction, indicated by a decreased level of consciousness

  • Hepatic injury, shown by increased levels of transaminases

  • Splanchnic hypoperfusion, manifested by stress ulceration, ileus, or malabsorption

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