Double Product and Shock Index: Can These Macrocirculatory Parameters Provide Sufficient Information About Microcirculation?
Melis Tosun, Bülent Güçyetmez, Fevzi Toraman
Acıbadem Bakırköy Hastanesi
Giriş: Vital parameters like heart rate and systolic arterial pressure help assess the patient’s clinical condition, stabilize hemodynamics, and indirectly evaluate the adequacy of oxygen delivery to tissues. Unfortunately, it is recognized that assessing hemodynamic parameters alone may not be sufficient (1,2). Formulations incorporating different parameters have been developed to address these limitations, such as Double Product (DP) and Shock Index (SI). This study examines the relationship between microcirculation and macrocirculation in the early period after extracorporeal circulation (ECC). Specifically, it aims to investigate whether macrocirculation parameters DP and SI can predict microcirculation by studying their correlation with lactate levels, a marker of microcirculation, in the early post-ECC period.
Gereç ve Yöntem: The study analyzed the demographic, hemodynamic, and laboratory data of 2039 patients who underwent isolated coronary bypass surgery with ECC at Acıbadem Kadıköy and Acıbadem Altunizade Hospitals between 1999 and 2023. The data included serum lactate levels, DP, and SI measurements taken before induction and after ECC for all patients as well as for the subgroup with DP values above 12000.
Bulgular: The analysis did not find any correlation between plasma lactate levels and DP and SI during the post-ECC period; p=0.11, r=0.04 (-0.01; 0.08), p<0.001, r=0.11 (0.06;0.15), respectively. Similarly, no correlation was found between plasma lactate values and DP in patients with DP values >12000 (n=284) (p=0.643, r=0.03 (-0.09;0.14)).
Tartışma ve Sonuç: Vital parameters do not fully capture circulatory disorders. It is better to evaluate multiple vital signs together (1,2). Furthermore, in patient groups with disrupted macro and microcirculation relationships, basic monitoring parameters may not indicate tissue-level hypoperfusion, necessitating advanced monitoring (3). It would be more appropriate for critically ill patients to directly assess microcirculation using parameters such as lactate( 4). Therefore, further studies are necessary to evaluate microcirculation and develop independent parameters.
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