May be a more sensitive indicator of occult shock, especially in trauma or acute hemorrhage.
When to Use
- The Shock Index has been mostly investigated as a tool to identify patients at increased risk for transfusion in the setting of hemorrhage and trauma.
- The use of the Shock Index has also been proposed in the setting of endotracheal intubation to help identify groups of patients at risk of post-intubation hypotension.
- The Protocol-Based Care for Early Septic Shock (ProCESS) trial used the Shock Index to guide fluid administration in one of its intervention groups. It failed however to demonstrate a mortality improvement.
- A large retrospective single-center study found the Shock Index to be as sensitive as the SIRS criteria to identify patients at risk for Sepsis.
- Blood pressure and heart rate are unreliable determinants of hypovolemic shock.
- The Shock Index has been proposed as a reliable and easy to use tool for the early identification of hypovolemic shock, and the need for intervention, in a number of settings.
- There are currently no well designed, prospective studies that validate the use of the Shock Index to guide resuscitative interventions.
- Blood pressure and heart rate, when used individually, fail to accurately predict the severity of hypovolemia and shock in major trauma.
- Massive transfusion of blood products can be associated with significant risk if initiated on the wrong patient. Identifying patients at risk for massive transfusion can be difficult however, and a number of clinical decision scores such as the Shock Index are being investigated.
- Current scores such as the Assessment of Blood Consumption score have shown promising results but still need to be validated prospectively.