Skin temperature

Cold extremities can be a sign of poor organ perfusion. A capillary refill time of more than 2 seconds is significant. The central-peripheral temperature gradient has long been used in surgical specialties as an early warning sign for hypovolaemia. When the difference between core (nasopharynx or tympanic) and peripheral (great toe) temperature increases, it is due to vasoconstriction. This can be a sign of hypovolaemia although pain, vasoactive drugs and central hypothermia are confounding variables.

One study looked at whether physical examination alone in combination with biochemical markers could accurately diagnose hypoperfusion: 264 consecutive surgical intensive care patients were divided into two groups - those with cool extremities and those with warm extremities. Vital signs, arterial blood gases and lactate, haemoglobin, and PA catheter data were collected from these patients. There was no difference between the two groups with regard to heart rate, systolic blood pressure, pulmonary arterial occlusion pressure, haemoglobin, PaO2, or PaCO2. However cardiac output and pH were significantly lower in the cool extremity patients compared with the warm extremity patients. The investigators concluded that combining physical examination with serum bicarbonate and lactate readily identified patients with hypoperfusion.

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