Lack of agreement between different observers and methods in the measurement of capillary refill time in healthy volunteers: an observational study

Espinoza, Emilio Daniel Valenzuela; Welsh, Sebastián; Dubin, Arnaldo

doi:10.5935/0103-507x.20140038

Cited by 35 publications

(22 citation statements)

References 27 publications

(31 reference statements)

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“…Peripheral perfusion index (PPI) has been investigated for its use in hemodynamic monitoring. Using pulse oximetry, PPI is calculated from the ratio between the pulsatile and non-pulsatile signals of absorbed light ( 31 ) and provides insight on the circulatory status of vital organs during shock ( 32 ). In a study on healthy newborn infants, Zaramella et al ( 32 ) compared the relationship between foot PPI and variables of peripheral perfusion measured by NIRS on the calf.…”

Section: Methods To Monitor Peripheral Perfusionmentioning

confidence: 99%

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

et al. 2020

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Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. By monitoring peripheral perfusion status, clinicians can promptly initiate life-saving therapy and reduce the likelihood of shock-associated death. Historically, abnormal perfusion has been indicated by the observation of pale, cold, and clammy skin with increased capillary refill time. The utility of these assessments has been debated given that clinicians may vary in their clinical interpretation of body temperature and refill time. Considering these constraints, current sepsis bundles suggest the need to revise resuscitation guidelines. New technologies have been developed to calculate capillary refill time in the hopes of identifying a new gold standard for clinical care. These devices measure either light reflected at the surface of the fingertip (reflected light), or light transmitted through the inside of the fingertip (transmitted light). These new technologies may enable clinicians to monitor peripheral perfusion status more accurately and may increase the potential for ubiquitous hemodynamic monitoring across different clinical settings. This review will summarize the different methods available for peripheral perfusion monitoring and will discuss the advantages and disadvantages of each approach.

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Section: Methods To Monitor Peripheral Perfusionmentioning

confidence: 99%

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

et al. 2020

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“…and Operational Definition (OD) Hypoxia (31)(32)38,42) CD: decrease in oxygen supply to tissues and cells that will influence cardiac autonomic modulation, being evaluated by spontaneous fluctuations in heart rate (usually reduction of oxygen supply) and reduction of partial arterial oxygen pressure (PaO 2 ) leading to decreased arterial oxygen saturation (SaO 2 , below 85%) ((31-32,38,42) . OD: dyspnea, fatigue, respiratory rate above 20 respiratory movements per minute with decreased breadth, presence of cytosis in extremities, agitation, mental confusion, in addition to decreased O 2 saturation, HR and blood pressure (31,38,42) .…”

Section: Description Of the Conceptual Definition (Cd)mentioning

confidence: 99%

“…Slow capillary refill (5,14,31,42,45) CD: slow refill (above three seconds) of the digitalis distal capillary bed to recover the basal perfusion (its color) after sufficient compression applied by the examiner to cause pallor (its bleaching), being one of the components of peripheral perfusion assessment (5,14,31,42,45) . OD: capillary refill time greater than three seconds obtained after compression caused by the examiner with the middle fingers and indicator in patients' digital pulps in order to cause pallor (5,31,45) .…”

Section: Description Of the Conceptual Definition (Cd)mentioning

confidence: 99%

Conceptual and operational definition of the components of the nursing diagnosis hypothermia (00006) in the perioperative period

et al. 2021

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Objective: to construct the conceptual and operational definitions of the defining and conceptual characteristics of the related factors of the nursing diagnosis (ND) hypothermia (00006) of NANDA-I, 2015-2017, in adult patients in the perioperative period. Method: an integrative literature review in the Medical Literature Analysis and Retrieval System Online, Cochrane Library, The Cumulative Index to Nursing and Allied Health Literature and in Latin & American Literature in Health Sciences databases. Results: 2,041 articles were found, 95 selected for reading in full and 24 used to construct such definitions. Gay literature was also explored to ensure robustness to the elucidation of topics not found in articles. Conclusion: such definitions will assist nurses in surgical practice in information collection, in accurate determination of the referred ND, in teaching and in future research related to this theme, as well as in the next validation stages of such ND to the referred population.

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“…Despite the appealing simplicity of CRT there are several limitations of this parameter: The inter-observer variability has been poorly investigated and resulted in contradictory findings (38–40). Furthermore, a variety of different cut-offs are suggested depending on age and gender of the patients (39, 41, 42).…”

Section: Clinical Assessment Of Micro-circulationmentioning

confidence: 99%

Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques

et al. 2019

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Sufficient organ perfusion essentially depends on preserved macro- and micro-circulation. The last two decades brought substantial progress in the development of less and non-invasive monitoring of macro-hemodynamics. However, several recent studies suggest a frequent incoherence of macro- and micro-circulation. Therefore, this review reports on interactions of macro- and micro-circulation as well as on specific regional and micro-circulation. Regarding global micro-circulation the last two decades brought advances in a more systematic approach of clinical examination including capillary refill time, a graded assessment of mottling of the skin and accurate measurement of body surface temperatures. As a kind of link between macro- and microcirculation, a number of biochemical markers can easily be obtained. Among those are central-venous oxygen saturation (S cv O 2 ), plasma lactate and the difference between central-venous and arterial CO 2 (cv-a-pCO 2 -gap). These inexpensive markers have become part of clinical routine and guideline recommendations. While their potential to replace parameters of macro-circulation such as cardiac output (CO) is limited, they facilitate the interpretation of the adequacy of CO and other macro-circulatory markers. Furthermore, they give additional hints on micro-circulatory impairment. In addition, a number of more sophisticated technical approaches to quantify and visualize micro-circulation including video-microscopy, laser flowmetry, near-infrared spectroscopy (NIRS), and partial oxygen pressure measurement have been introduced within the last 20 years. These technologies have been extensively used for scientific purposes. Moreover, they have been successfully used for educational purposes and to visualize micro-circulatory disturbances during sepsis and other causes of shock. Despite several studies demonstrating the association of these techniques and parameters with outcome, their practical application still is limited. However, future improvements in automated and “online” diagnosis will help to make these technologies more applicable in clinical routine. This approach is promising with regard to several studies which demonstrated the potential to guide therapy in different types of shock. Finally several organs have specific patterns of circulation related to their special anatomy (liver) or their auto-regulatory capacities (brain, kidney). Therefore, this review also discusses specific issues of monitoring liver, brain, and kidney circulation and function.

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Lack of agreement between different observers and methods in the measurement of capillary refill time in healthy volunteers: an observational study

Cited by 35 publications

References 27 publications

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status

Conceptual and operational definition of the components of the nursing diagnosis hypothermia (00006) in the perioperative period

Assessment of Regional Perfusion and Organ Function: Less and Non-invasive Techniques

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