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Updated: Aug 19, 2025
Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb
Published on: December 2, 2017
Capillary refill time in sepsis: A useful and easily accessible tool for evaluating perfusion in children
Shirley Lamprea1, Jaime Fernández-Sarmiento1, Sofía Barrera1
1Department of Critical Care Medicine and Pediatrics, Universidad de La Sabana, Fundación Cardioinfantil-Instituto de Cardiología, Bogotá, Colombia.
Insights
Capillary refill time (CRT) aids in early sepsis recognition and guides fluid resuscitation in children. Standardizing CRT measurement improves its utility in assessing hemodynamic coherence and patient outcomes.
Area of Science:
- Pediatrics
- Critical Care Medicine
- Emergency Medicine
Background:
- Sepsis and septic shock remain leading causes of mortality in children, particularly in resource-limited settings.
- Despite current guidelines, high mortality persists, often linked to cardiovascular compromise and hemodynamic dysfunction.
- Early assessment of macro- and microcirculation is crucial for improving outcomes in pediatric septic shock.
Purpose of the Study:
- To clarify common questions surrounding Capillary Refill Time (CRT) measurement.
- To guide the standardized and correct use of CRT in pediatric sepsis management.
- To highlight CRT's role in assessing microcirculatory function and guiding fluid resuscitation.
Main Methods:
- This review synthesizes current evidence on CRT's application in pediatric sepsis.
- It discusses factors influencing CRT measurement and standardization strategies.
- The review examines CRT's utility in evaluating hemodynamic coherence and guiding therapy.
Main Results:
- Capillary Refill Time (CRT) is an accessible bedside tool for assessing peripheral perfusion and microcirculatory status.
- CRT can identify children with more severe sepsis and guide fluid resuscitation effectiveness.
- Standardized CRT measurement, preferably on upper extremities, enhances its reliability.
Conclusions:
- CRT is a valuable, easily accessible clinical sign for evaluating hemodynamic status in pediatric septic shock.
- Properly applied and standardized, CRT can aid in optimizing fluid resuscitation and patient management.
- Further standardization of CRT assessment is recommended for consistent clinical application in sepsis care.
Abstract:
The international sepsis guidelines emphasize the importance of early identification along with the combined administration of fluids, antibiotics and vasopressors as essential steps in the treatment of septic shock in childhood. However, despite these recommendations, septic shock mortality continues to be very high, especially in countries with limited resources. Cardiovascular involvement is common and, in most cases, determines the outcomes. Early recognition of hemodynamic dysfunction, both in the macro and microcirculation, can help improve outcomes. Capillary refill time (CRT) is a useful, available and easily accessible tool at all levels of care. It is a clinical sign of capillary vasoconstriction due to an excessive sympathetic response which seeks to improve blood redistribution from the micro- to the macrocirculation. An important reason for functionally evaluating the microcirculation is that, in septic shock, the correction of macrocirculation variables is assumed to result in improved tissue perfusion. This has been termed "hemodynamic coherence." However, this coherence often does not occur in advanced stages of the disease. Capillary refill time is useful in guiding fluid resuscitation and identifying more seriously affected sepsis patients. Several factors can affect its measurement, which should preferably be standardized and performed on the upper extremities. In this review, we seek to clarify a few common questions regarding CRT and guide its correct use in patients with sepsis.
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