Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis

Jacquet-Lagrèze, Matthias; Pernollet, Aymeric; Kattan, Eduardo; Ait-Oufella, Hafid; Chesnel, Delphine; Ruste, Martin; Schweizer, Rémi; Allaouchiche, Bernard; Hernandez, Glenn; Fellahi, Jean-Luc

doi:10.1186/s13054-023-04751-9

Cited by 6 publications

(1 citation statement)

References 51 publications

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“…2- more suitable in dark skin than skin mottling score [ 2 ]. Furthermore, a recent meta-analysis questioned the prognostic value of the CRT in adult patients at risk of death or acute circulatory failure [ 6 ]. Temperature gradients such as central-to-toe gradient and toe-to-ambient gradient were reported as perfect perfusion indices [ 7 ].…”

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confidence: 99%

The use of thermal imaging for evaluation of peripheral tissue perfusion in surgical patients with septic shock

Hasanin,

Fekry,

Mostafa

et al. 2024

BMC Anesthesiol

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Background In this study, we aimed to evaluate the ability of central-to-peripheral temperature gradients using thermal imaging to predict in-hospital mortality in surgical patients with septic shock. Methods This prospective observational study included adult patients with septic shock admitted to the intensive care unit postoperatively. Serum lactate (in mmol/L), capillary refill time (CRT) (in seconds), toe (peripheral) and canthal (central) temperature by infrared thermography and the corresponding room temperature in (Celsius [°C]) were assessed at the time of admission, 6- and 12 h after admission. The canthal-toe and room-toe temperature gradients were calculated. According to their final outcomes, patients were divided into survivors and non-survivors. The ability of canthal-toe temperature gradient (primary outcome), room-toe temperature gradient, toe temperature, serum lactate and CRT, measured at the prespecified timepoints to predict in-hospital mortality was analyzed using the area under receiver operating characteristic curve (AUC). Results Fifty-six patients were included and were available for the final analysis and 41/56 (73%) patients died. The canthal-toe and room-toe temperature gradients did not show significant accuracy in predicting mortality at any timepoint. Only the toe temperature measurement at 12 h showed good ability in predicting in-hospital mortality with AUC (95% confidence interval) of 0.72 (0.58–0.84) and a negative predictive value of 70% at toe temperature of ≤ 25.5 °C. Both serum lactate and CRT showed good ability to predict in-hospital mortality at all timepoints with high positive predictive values (> 90%) at cut-off value of > 2.5–4.3 mmol/L for the serum lactate and > 3-4.2 s for the CRT. Conclusion In post-operative emergency surgical patients with septic shock, high serum lactate and CRT can accurately predict in-hospital mortality and were superior to thermal imaging, especially in the positive predictive values. Toe temperature > 25.5 °C, measured using infrared thermal imaging can exclude in-hospital mortality with a negative predictive value of 70%.

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Section: Introductionmentioning

confidence: 99%

The use of thermal imaging for evaluation of peripheral tissue perfusion in surgical patients with septic shock

Hasanin,

Fekry,

Mostafa

et al. 2024

BMC Anesthesiol

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Resuscitating the macro- vs. microcirculation in septic shock

González,

Urbano,

López-Herce

2024

Current Opinion in Pediatrics

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Purpose of review This review summarizes current literature about the relationships between macro and microcirculation and their practical clinical implications in children with septic shock. Recent findings Current evidence from experimental and clinical observational studies in children and adults with septic shock reveals that the response to treatment and resuscitation is widely variable. Furthermore, there is a loss of hemodynamic coherence, as resuscitation-induced improvement in macrocirculation (systemic hemodynamic parameters) does not necessarily result in a parallel improvement in the microcirculation. Therefore, patient-tailored monitoring is essential in order to adjust treatment requirements during resuscitation in septic shock. Optimal monitoring must integrate macrocirculation (heart rate, blood pressure, cardiac output, and ultrasound images), microcirculation (videomicroscopy parameters and capillary refill time) and cellular metabolism (lactic acid, central venous blood oxygen saturation, and difference of central venous to arterial carbon dioxide partial pressure). Summary There is a dire need for high-quality studies to assess the relationships between macrocirculation, microcirculation and tissue metabolism in children with septic shock. The development of reliable and readily available microcirculation and tissue perfusion biomarkers (other than lactic acid) is also necessary to improve monitoring and treatment adjustment in such patients.

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Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study

Hernández,

Valenzuela,

Kattan

et al. 2024

Ann. Intensive Care

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Background Several studies have validated capillary refill time (CRT) as a marker of tissue hypoperfusion, and recent guidelines recommend CRT monitoring during septic shock resuscitation. Therefore, it is relevant to further explore its kinetics of response to short-term hemodynamic interventions with fluids or vasopressors. A couple of previous studies explored the impact of a fluid bolus on CRT, but little is known about the impact of norepinephrine on CRT when aiming at a higher mean arterial pressure (MAP) target in septic shock. We designed this observational study to further evaluate the effect of a fluid challenge (FC) and a vasopressor test (VPT) on CRT in septic shock patients with abnormal CRT after initial resuscitation. Our purpose was to determine the effects of a FC in fluid-responsive patients, and of a VPT aimed at a higher MAP target in chronically hypertensive fluid-unresponsive patients on the direction and magnitude of CRT response. Methods Thirty-four septic shock patients were included. Fluid responsiveness was assessed at baseline, and a FC (500 ml/30 mins) was administered in 9 fluid-responsive patients. A VPT was performed in 25 patients by increasing norepinephrine dose to reach a MAP to 80–85 mmHg for 30 min. Patients shared a multimodal perfusion and hemodynamic monitoring protocol with assessments at at least two time-points (baseline, and at the end of interventions). Results CRT decreased significantly with both tests (from 5 [3.5–7.6] to 4 [2.4–5.1] sec, p = 0.008 after the FC; and from 4.0 [3.3–5.6] to 3 [2.6 -5] sec, p = 0.03 after the VPT. A CRT-response was observed in 7/9 patients after the FC, and in 14/25 pts after the VPT, but CRT deteriorated in 4 patients on this latter group, all of them receiving a concomitant low-dose vasopressin. Conclusions Our findings support that fluid boluses may improve CRT or produce neutral effects in fluid-responsive septic shock patients with persistent hypoperfusion. Conversely, raising NE doses to target a higher MAP in previously hypertensive patients elicits a more heterogeneous response, improving CRT in the majority, but deteriorating skin perfusion in some patients, a fact that deserves further research.

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Prognostic value of capillary refill time in adult patients: a systematic review with meta-analysis

Cited by 6 publications

References 51 publications

The use of thermal imaging for evaluation of peripheral tissue perfusion in surgical patients with septic shock

The use of thermal imaging for evaluation of peripheral tissue perfusion in surgical patients with septic shock

Resuscitating the macro- vs. microcirculation in septic shock

Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study

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