The association between prolonged capillary refill time and microcirculation changes in children with sepsis

Area of Science:

• Pediatric critical care medicine
• Hemodynamics
• Microcirculation research

Background:

• Sepsis in children can lead to shock and organ failure, with prolonged capillary refill time (PCRT) indicating severity.
• Microcirculation assessment using videomicroscopy offers insights into hemodynamic management, especially in cases of macro- and microcirculation incoherence.

Purpose of the Study:

• To investigate the association between prolonged capillary refill time (PCRT) and microcirculatory alterations in pediatric sepsis.
• To determine if PCRT can predict hemodynamic incoherence and clinical outcomes in children with sepsis.

Main Methods:

• Prospective cohort study involving 132 children hospitalized with sepsis.
• Microcirculation assessed via sublingual video microscopy, measuring capillary density, flow, perfused boundary region (PBR), and tissue perfusion.
• Biomarkers for endothelial activation and glycocalyx injury were analyzed.

Main Results:

• PCRT correlated with increased glycocalyx degradation (PBR) and reduced recruitment of small capillaries.
• Hemodynamic incoherence was associated with abnormal PBR, and its persistence predicted higher mortality.
• Elevated CO2 difference (DCO2) and prolonged CRT on admission predicted abnormal PBR and capillary blood volume.

Conclusions:

• Prolonged capillary refill time in pediatric sepsis is associated with microcirculatory dysfunction, including fewer recruited capillaries and glycocalyx degradation.
• These microcirculatory changes contribute to impaired oxygen delivery and hemodynamic incoherence.
• Persistent abnormal CRT at 24 hours indicates worse outcomes and predicts longer hospital stays.