From the Research
To improve a patient's mottling score, focus on treating the underlying cause of poor peripheral perfusion, primarily by optimizing cardiac output and tissue perfusion, as a high mottling score is a strong predictor of 14-day mortality in septic patients, as shown in a study published in 2019 1.
Key Interventions
- Start with adequate fluid resuscitation using crystalloids like normal saline or lactated Ringer's solution, typically 20-30 ml/kg as an initial bolus, followed by reassessment, as recommended by a study in 2017 2.
- If hypotension persists despite fluid resuscitation, initiate vasopressors such as norepinephrine (starting at 0.05-0.1 mcg/kg/min) to maintain mean arterial pressure above 65 mmHg.
- Ensure proper oxygenation with supplemental oxygen to maintain SpO2 above 94% and consider mechanical ventilation if respiratory failure is present.
- Treat any underlying infection with appropriate antibiotics within the first hour of recognition.
- Position the patient properly to optimize circulation, avoiding pressure on mottled areas, and maintain normothermia using warming devices if needed.
Importance of Mottling Score
- The mottling score is a strong predictor of survival in septic shock, as shown in a study published in 2011 3, and its variation during resuscitation is also predictive of mortality.
- A decrease in mottling score during resuscitation is significantly associated with better outcomes, as shown in a study published in 2019 1.
Choice of Resuscitation Fluid
- Crystalloids should be considered as the first-choice fluid for volume resuscitation in patients with septic shock, as recommended by a study published in 2013 4 and 2017 2.
- Balanced crystalloids may improve patient-centered outcomes and should be considered as an alternative to normal saline, if available, as recommended by a study published in 2017 2.
- Semi-synthetic colloids, such as hydroxyethyl starch, should be avoided due to their potential to impair renal function, as shown in a study published in 2012 5.