Capillary refill time exploration during septic shock

Area of Science:

• Critical Care Medicine
• Hemodynamics
• Microcirculation

Background:

• Assessing microvascular perfusion is crucial in septic shock management.
• Skin analysis, specifically capillary refill time (CRT), offers a potential method for this evaluation.

Purpose of the Study:

• To investigate the reproducibility and prognostic value of skin capillary refill time (CRT) in a septic shock population.
• To determine if CRT measurements can predict 14-day mortality after initial resuscitation.

Main Methods:

• A prospective observational study was conducted in a tertiary teaching hospital.
• Capillary refill time (CRT) was measured on the index finger tip and knee area after initial resuscitation at 6 hours (H6).
• Hemodynamic parameters were recorded, and their predictive value for 14-day mortality was analyzed.

Main Results:

• CRT measurements demonstrated high reproducibility between raters.
• Patients with higher CRT values at H6 had significantly increased 14-day mortality.
• CRT at H6 was a strong predictor of 14-day mortality, with specific thresholds identified for index (2.4s) and knee (4.9s) measurements.
• CRT correlated with tissue perfusion markers like arterial lactate and SOFA score.

Conclusions:

• Capillary refill time (CRT) is a reproducible clinical parameter for assessing microvascular perfusion in septic shock.
• CRT measured after initial resuscitation is a significant predictor of 14-day mortality in septic shock patients.