Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 24 , ISSUE 8 ( August, 2020 ) > List of Articles

ORIGINAL RESEARCH

Mottling Incidence and Mottling Score According to Arterial Lactate Level in Septic Shock Patients

Arnaud Ferraris, Camille Bouisse, Fabrice Thiollière, Vincent Piriou, Bernard Allaouchiche

Keywords : Lactate, Microcirculation, Mottling score, Septic shock

Citation Information : Ferraris A, Bouisse C, Thiollière F, Piriou V, Allaouchiche B. Mottling Incidence and Mottling Score According to Arterial Lactate Level in Septic Shock Patients. Indian J Crit Care Med 2020; 24 (8):672-676.

DOI: 10.5005/jp-journals-10071-23531

License: CC BY-NC 4.0

Published Online: 21-09-2020

Copyright Statement:  Copyright © 2020; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Objectives: Mottling score is estimated from 0–5 according to mottling over the knee and described as clinical evaluation of tissue perfusion. This score was developed with ancient definitions of sepsis without lactate level, a major prognostic parameter when superior to 2 mmol/L. This study describes mottling incidence and mottling score in septic shock patients according to lactate level. Materials and methods: We reanalyzed our prospective study in a French tertiary hospital in the intensive care unit (ICU) which studied mottling score and thermography correlation. Patients admitted to septic shock diagnosis and requiring vasoactive drugs were included. We recorded hemodynamic variables, mottling score, and lactate. Data collection was realized at ICU admission (H0) and after six hours (H6). Results: Forty-three patients were included. Mean age was 67 (±4), mean sequential organ failure assessment (SOFA) score was 11 (8–12), and SAPS II 58 ±20. Mortality rate at day 28 was 30%. Among patients with lactate ≥2 mmol/L, mottling was more prevalent in 82.6% vs 47.4% (p value = 0.016), and at H6 mottling score was higher (p value = 0.009). Although, mottling incidence was not different between dead (85%) and survivors (81%; p value = 0.795). Conclusion: A new sepsis definition implies a new epidemiology in mottling according to lactate threshold. Patients with lactate ≥2 mmol/L presented a higher incidence and score of mottling. However, mortality was not influenced by mottling in this study. Clinical significance: • Arterial lactate is a major prognostic parameter when superior to 2 mmol/L. • A new definition of sepsis was published in 2016 with a new paradigm and epidemiology of septic shock • Patients with lactate ≥2 mmol/L presented a higher incidence and score of mottling. • Mottling score is a clinical sign of microcirculatory alteration, related to lactate level in septic shock.


PDF Share
  1. Vincent J-L, De Backer D. Microvascular dysfunction as a cause of organ dysfunction in severe sepsis. Crit Care Lond Engl 2005;9(Suppl 4):S9–S12. DOI: 10.1186/cc3748.
  2. Vincent J-L, De Backer D. Circulatory shock. N Engl J Med 2013;369(18):1726–1734. DOI: 10.1056/NEJMra1208943.
  3. Ince C. The microcirculation is the motor of sepsis. Crit Care Lond Engl 2005;9(Suppl. 4):S13–S19.
  4. De Backer D, Creteur J, Preiser J-C, Dubois M-J, Vincent J-L. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med 2002;166(1):98–104. DOI: 10.1164/rccm.200109-016oc.
  5. De Backer D, Ospina-Tascon G, Salgado D, Favory R, Creteur J, Vincent J-L. Monitoring the microcirculation in the critically ill patient: current methods and future approaches. Intensive Care Med 2010;36(11):1813–1825. DOI: 10.1007/s00134-010-2005-3.
  6. Lima A, van Bommel J, Sikorska K, van Genderen M, Klijn E, Lesaffre E, et al. The relation of near-infrared spectroscopy with changes in peripheral circulation in critically ill patients. Crit Care Med 2011;39(7):1649–1654. DOI: 10.1097/CCM.0b013e3182186675.
  7. Ait-Oufella H, Bourcier S, Alves M, Galbois A, Baudel J-L, Margetis D, et al. Alteration of skin perfusion in mottling area during septic shock. Ann Intensive Care 2013;3(1):31. DOI: 10.1186/2110-5820-3-31.
  8. Coudroy R, Jamet A, Frat J-P, Veinstein A, Chatellier D, Goudet V, et al. Incidence and impact of skin mottling over the knee and its duration on outcome in critically ill patients. Intensive Care Med 2015;41(3):452–459. DOI: 10.1007/s00134-014-3600-5.
  9. Ait-Oufella H, Lemoinne S, Boelle PY, Galbois A, Baudel JL, Lemant J, et al. Mottling score predicts survival in septic shock. Intensive Care Med 2011;37(5):801–807. DOI: 10.1007/s00134-011-2163-y.
  10. Singer M, Deutschman CS, Seymour CW, Shankar-Hari M, Annane D, Bauer M, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA 2016;315(8):801–810. DOI: 10.1001/jama.2016.0287.
  11. Ferraris A, Bouisse C, Mottard N, Thiollière F, Anselin S, Piriou V, et al. Mottling score and skin temperature in septic shock: relation and impact on prognosis in ICU. PLoS ONE 2018;13(8):e0202329. DOI: 10.1371/journal.pone.0202329.
  12. Dellinger RP, Levy MM, Rhodes A, Annane D, Gerlach H, Opal SM, et al. Surviving sepsis campaign: International guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med 2013;39(2):165–228. DOI: 10.1007/s00134-012-2769-8.
  13. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (sepsis-related organ failure assessment) score to describe organ dysfunction/failure. On behalf of the working group on sepsis-related problems of the European society of intensive care medicine. Intensive Care Med 1996;22(7):707–710. DOI: 10.1007/BF01709751.
  14. Le Gall JR, Lemeshow S, Saulnier F. A new simplified acute physiology score (SAPS II) based on a European/North American multicenter study. JAMA 1993;270(24):2957–2963. DOI: 10.1001/jama.270.24.2957.
  15. Schriger DL, Baraff L. Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med 1988;17(9):932–935. DOI: 10.1016/s0196-0644(88)80675-9.
  16. Ait-Oufella H, Bourcier S, Lehoux S, Guidet B. Microcirculatory disorders during septic shock. Curr Opin Crit Care 2015;21(4):271–275. DOI: 10.1097/MCC.0000000000000217.
  17. Miranda M, Balarini M, Caixeta D, Bouskela E. Microcirculatory dysfunction in sepsis: pathophysiology, clinical monitoring, and potential therapies. Am J Physiol Heart Circ Physiol 2016;311(1):H24–H35. DOI: 10.1152/ajpheart.00034.2016.
  18. De Backer D, Creteur J, Dubois M-J, Sakr Y, Vincent J-L. Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 2004;147(1):91–99. DOI: 10.1016/j.ahj.2003.07.006.
  19. Lee Y-LL, Simmons JD, Gillespie MN, Alvarez DF, Gonzalez RP, Brevard SB, et al. Evaluation of microvascular perfusion and resuscitation after severe injury. Am Surg 2015;81(12):1272–1278. DOI: 10.1177/000313481508101231.
  20. Ait-Oufella H, Bige N, Boelle PY, Pichereau C, Alves M, Bertinchamp R, et al. Capillary refill time exploration during septic shock. Intensive Care Med 2014;40(7):958–964. DOI: 10.1007/s00134-014-3326-4.
  21. Bourcier S, Pichereau C, Boelle P-Y, Nemlaghi S, Dubée V, Lejour G, et al. Toe-to-room temperature gradient correlates with tissue perfusion and predicts outcome in selected critically ill patients with severe infections. Ann Intensive Care 2016;6(1):63. DOI: 10.1186/s13613-016-0164-2.
  22. Ait-Oufella H, Joffre J, Boelle PY, Galbois A, Bourcier S, Baudel JL, et al. Knee area tissue oxygen saturation is predictive of 14-day mortality in septic shock. Intensive Care Med 2012;38(6):976–983. DOI: 10.1007/s00134-012-2555-7.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.