الفهرس 
The Use of Thermal Imaging for Evaluation of Peripheral Tissue Perfusion in Septic Shock Patients
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Abstract
Background
Evaluation and maintenance of peripheral tissue perfusion is essential during management of septic shock and impaired tissue perfusion is associated with poor outcomes. Temperature gradients such as central-to-toe gradient and room-toe gradient were reported as perfect perfusion indices. In this study, we aim to evaluate the ability of temperature gradients using thermal imaging to predict in-hospital mortality in surgical patients with septic shock
Methods
This prospective observational study included adult patients with septic shock. serum lactate, capillary refill time (CRT), toe and central temperature by infrared thermography and the corresponding room temperature were assessed at the time of admission, 6- and 12 h after admission. The canthal-toe and room-toe temperature gradients were calculated.According to their final outcome, patients were divided into survivors and non-survivors. The ability of canthal-toe temperature gradient (primary outcome), room-toe temperature gradient, toe temperature, serum lactate and CRT measured at the prespecified timepoint to predict in-hospital mortality was analyzed using the area under receiver operating characteristic curve (AUC).
Results
Fifty-six patients were included and were available for the final analysis and of whom 39 (70%) died. The canthal-toe and room-toe temperature gradients did not show significant accuracy in predicting mortality at any timepoint. Toe temperature measurement only at 12 h can predict in-hospital mortality with AUC (95% confidence interval) of 0.72 (0.58-0.84) with negative predictive value of 70% at toe temperature of ≤25.5 °C. Both serum lactate and CRT showed good ability to predict mortality at all timepoints with high positive predictive values (>90%)
Conclusion
In post-operative emergency surgical patients with septic shock, high serum lactate and CRT can accurately predict in-hospital mortality with high positive predictive value. High toe temperature>25.5 °C, measured using infrared thermal imaging can exclude in-hospital mortality with negative predictive value of 70%.