From the Guidelines
Skin temperature gradient assessment is a valuable clinical tool in sepsis evaluation, as it reflects impaired peripheral perfusion, with a normal gradient being minimal (less than 3-4°C difference) and in sepsis often exceeding 7°C with notably cool extremities despite fever. In sepsis, peripheral skin temperature is often cooler than core temperature, creating an abnormal gradient that reflects impaired peripheral perfusion. To assess this gradient, compare the temperature of central areas (trunk, forehead) with distal extremities (hands, feet) by touch or using surface thermometers. This occurs because sepsis triggers vasoconstriction in peripheral vessels as the body redistributes blood flow to vital organs, as noted in the management of intra-abdominal infections guidelines 1. The gradient typically worsens with disease progression and shock. Serial monitoring of this gradient can help track treatment response, with normalization suggesting improved perfusion. This simple bedside assessment requires no special equipment and complements other vital signs in evaluating circulatory status in septic patients.
Some key points to consider when evaluating skin temperature gradient in sepsis include:
- The importance of early recognition of sepsis and prompt administration of intravenous fluids for resuscitation, as emphasized in the Surviving Sepsis Campaign guidelines 1 and the management of intra-abdominal infections guidelines 1.
- The need to monitor clinical endpoints, such as mean arterial pressure, skin color and capillary refill, mental status, or urinary output, to guide fluid resuscitation, as recommended in the management of intra-abdominal infections guidelines 1.
- The potential for other conditions, like heart failure or environmental factors, to affect skin temperature, so this finding should be interpreted within the complete clinical context, as noted in the example answer.
- The value of serial monitoring of skin temperature gradient in tracking treatment response and evaluating the effectiveness of interventions aimed at improving peripheral perfusion, as suggested by the haemodynamic management of severe sepsis recommendations 1.
Overall, skin temperature gradient assessment is a useful tool in the evaluation and management of sepsis, and its use should be integrated into a comprehensive approach to sepsis care, as supported by the most recent and highest quality studies, including the management of intra-abdominal infections guidelines 1.
From the Research
Significance of Skin Temperature Gradient in Sepsis
- The skin temperature gradient is a significant indicator of peripheral tissue perfusion in septic shock patients 2, 3, 4, 5.
- A high core-to-skin temperature gradient is associated with increased mortality in septic shock patients, with a gradient greater than 7°C being a predictor of day-8 mortality 2.
- The skin temperature gradient is correlated with other tissue perfusion markers, such as capillary refill time, mottling score, and arterial lactate levels 2, 5.
- Peripheral perfusion monitoring, including skin temperature gradient measurement, is a useful tool for early detection of septic shock, autonomic dysfunction, and organ damage 6, 3, 4.
- The skin temperature gradient can be used to evaluate treatment effectiveness, direct fluid resuscitation, and monitor vascular reactivity, microcirculatory disorders, and endothelial cell damage 6, 5.
Clinical Applications
- The skin temperature gradient can be measured non-invasively using infrared thermographic cameras, making it a quick and easy method for assessing peripheral tissue perfusion 2, 5.
- The use of skin temperature gradient measurement can be combined with other monitoring techniques, such as capillary refill time and mottling score, to provide a comprehensive assessment of peripheral tissue perfusion 3, 4, 5.
- The skin temperature gradient can be used to guide hemodynamic support in septic shock patients, allowing for more individualized therapy 4, 5.