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Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive
S M Tibby1, M Hatherill, I A Murdoch
1Department of Paediatric Intensive Care, Guy's Hospital, London, UK.
Insights
Capillary refill time (CRT) weakly correlates with hemodynamic parameters in general pediatric intensive care patients. A normal CRT of ≤2 seconds may not reliably predict outcomes in this population, especially those with septic shock.
Area of Science:
- Pediatric critical care medicine
- Hemodynamics
- Shock management
Background:
- Capillary refill time (CRT) is a clinical indicator used in assessing shock.
- Its utility in the postresuscitation phase in pediatric intensive care units (PICU) requires further evaluation.
- Core-peripheral temperature gap is also considered for circulatory assessment.
Purpose of the Study:
- To assess the relationship between CRT and hemodynamic parameters in postresuscitation PICU patients.
- To compare CRT with the core-peripheral temperature gap in this cohort.
- To evaluate the predictive value of a normal CRT for patient outcomes.
Main Methods:
- Ninety standardized CRT measurements were performed on 55 pediatric patients (27 postcardiac surgery, 28 general, including 24 with septic shock).
- Hemodynamic variables measured included cardiac index, central venous pressure, systemic vascular resistance index, stroke volume index (SVI), and blood lactate.
- Seventy measurements were taken during inotropic or vasodilator therapy.
Main Results:
- CRT and temperature gap showed poor correlation with hemodynamic variables in postcardiac surgery patients.
- In general ICU patients, CRT correlated with SVI and lactate; temperature gap correlated poorly.
- Prolonged CRT (> or = 6 seconds) best predicted reduced SVI in general ICU patients.
Conclusions:
- In ventilated general ICU patients, CRT has a weak association with blood lactate and SVI.
- A normal CRT value of ≤2 seconds has limited predictive value and may be too conservative for this patient group, particularly those with septic shock.
Objectives:
Capillary refill time is an important diagnostic adjunct in the acute resuscitation phase of the shocked child. This study assesses its relation to commonly measured haemodynamic parameters in the postresuscitation phase when the child has reached the intensive care unit, and compares this with core-peripheral temperature gap.
Methods:
Ninety standardised measurements of capillary refill time were made on 55 patients, who were divided into postcardiac surgery (n = 27), and general (n = 28), most of whom had septic shock (n = 24). A normal capillary refill time was defined as < or = 2 seconds. Measured haemodynamic variables included: cardiac index, central venous pressure, systemic vascular resistance index, stroke volume index (SVI), and blood lactate. Seventy measurements were made on patients while being treated with inotropes or vasodilators.
Results:
Capillary refill time and temperature gap both correlated poorly with all haemodynamic variables among post-cardiac surgery children. For general patients, capillary refill time was related to SVI and lactate; temperature gap correlated poorly with all variables. General patients with a prolonged capillary refill time had a lower median SVI (28 v 38 ml/m2) but not a higher lactate (1.7 v 1.1 mmol/l). A capillary refill time of > or = 6 seconds had the best predictive value for a reduced SVI.
Conclusion:
Among ventilated, general intensive care patients, capillary refill time is related weakly to blood lactate and SVI. A normal value for capillary refill time of < or = 2 seconds has little predictive value and might be too conservative for this population; septic shock.