Skin Perfusion Assessment - Mottling Score

Question 1

Intro Card:

• studies have shown that microcirculation impairment has a huge role if severe infections
• therefore in septic shock pts, it is crucial to assess both macrocirculation and microcirculation

Answer 1

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Question 2

Role of Mottling Score

Answer 2

It is a strong predictor of 14 day survival in patients who present with septic shock

Disadvantage: cannot use on races of black skin

Question 3

Methods of assessing MACROcirculation

Answer 3

● Heart rate

● Mean arterial blood pressure (MAP)

● Central venous pressure (CVP)

● Cardiac Index (CI) - takes into account cardiac output

Question 4

Methods of assessing MICROcirculation

Answer 4

● Heart rate

● Mean arterial blood pressure (MAP)

● Central venous pressure (CVP)

● Cardiac Index (CI

Question 5

What is mottling?

Answer 5

Mottling, an easy to assess clinical sign, is defined as patchy skin discoloration

Question 6

Where is mottling usually seen first/

Answer 6

It usually starts around the knees in the supine patient.

Question 7

What is thought to cause mottling?

Answer 7

It is due to heterogenic small vessel vasoconstriction and is thought to reflect abnormal skin microperfusion.

Question 8

What are the 5 scores of mottling?

Answer 8

The mottling scale quantifies the degree of mottling over the extensor surface of the knees, on a 6 point scale - scored from 0-5, as follows:

Score 0: Indicates no mottling.

Score 1: A small mottling area (coin size) localized to the center of the knee.

Score 2: A mottling area that does not exceed the superior edge of the knee cap.

Score 3: A mottling area that does not exceed the middle thigh.

Score 4: A mottling area that does not go beyond the fold of the groin.

Score 5: An extremely severe mottling area that goes beyond the fold of the groin.