The Value of Peripheral Arterial Resistive Index in Evaluation of Tissue Perfusion in Patients With Septic Shock

Baxter Starling Monitor for measuring cardiac output and systemic vascular resistance (SVRI) which is using bioreactance technology. We need to place four electrodes on chest wall (upper left, upper right, down left, down right) and input monitor demographic parameters. Also enter mean arterial pressure (MAP) for calculating SVRI so we input MAP every minute.Patient bed set as 45 degree head elevated and legs 0 degree. Just after start measuring, monitor needs to synchronize itself for patient. After synchronisation we start fluid challenge with passive leg raising option. This test has two stages. First stage calculating baseline parameters which takes 3 minutes and second stage is measuring difference with fluid challenge which also takes 3 minutes. At the end of first stage monitor shows to perform passive leg raise and we perform trendelenburg maneuver till head comes to 0 degree. After second stage measurement has finished.

We use ultrasonography at the same time with cardiac output monitor in both stages. First we determine the location of radial artery at wrist snuffbox at 1.5 centimeters depth with linear probe and confirm pulsatile flow with color mode. In Starling's baseline stage we measure and calculate resistive index with doppler P-mode in triplex setting 3 times. When received 3 same result successively we noted as SBRI-1. Second measurement is initiated at last 30 seconds of passive leg raising as described before and we noted our measurement as SBRI-2

During all stages Masimo Rad-87 rainbow probe is placed patients index or middle finger and we note PVI-1 and PVI-2 at the same time with SBRI-1 and SBRI-2