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Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb
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[A prolonged capillary refill is predictor of low central venous oxygen saturation]

R Bustos, O Padilla

    Revista Chilena De Pediatria
    |February 21, 2015
    PubMed

    Insights

    A prolonged capillary refill time (>2 seconds) effectively predicts low central venous oxygen saturation (<70%) in pediatric intensive care patients. This finding supports current guidelines and may aid emergency care where central venous access is limited.

    Area of Science:

    • Pediatric critical care medicine
    • Hemodynamic monitoring
    • Shock management

    Context:

    • Pediatric life support guidelines recommend capillary refill time (CRT) >2 seconds as a shock indicator.
    • Central venous catheter (CVC) insertion for central venous oxygen saturation (ScvO2) monitoring can be a barrier in emergency settings.
    • Early goal-directed therapy in pediatric emergencies often faces challenges with invasive monitoring.

    Purpose:

    • To determine if CRT >2 seconds can predict ScvO2 <70% in pediatric intensive care unit (ICU) patients.
    • To validate CRT as a non-invasive predictor of adequate tissue perfusion.
    • To assess the utility of CRT in resource-limited emergency environments.

    Summary:

    • A prospective study involving 48 pediatric ICU patients measured ScvO2 and CRT simultaneously.
    • Results showed an inverse correlation between CRT and ScvO2 (r=-0.58).
    • ROC curve analysis demonstrated excellent predictive ability for CRT >2 seconds to identify ScvO2 <70% (AUC 0.94).

    Impact:

    • Prolonged CRT (>2 seconds) is a validated predictor of low ScvO2 in pediatric ICU patients.
    • Supports current pediatric life support recommendations for shock assessment.
    • Offers a valuable, non-invasive assessment tool for emergency departments where CVC and ScvO2 monitoring are unavailable.
    Abstract

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