Kinetics of capillary refill time after fluid challenge,Annals of Intensive Care

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Kinetics of capillary refill time after fluid challenge
Annals of Intensive Care ( IF 5.7 ) Pub Date : 2022-08-13 , DOI: 10.1186/s13613-022-01049-x
Lisa Raia ₁ , Paul Gabarre _{1,

2} , Vincent Bonny _{1,

2} , Tomas Urbina ₁ , Louai Missri ₁ , Pierre-Yves Boelle _{2,

3} , Jean-Luc Baudel ₁ , Bertrand Guidet ₁ , Eric Maury _{1,

2} , Jeremie Joffre _{1,

2} , Hafid Ait-Oufella _{1,

2,

4}

Affiliation

Background

Capillary refill time (CRT) is a valuable tool for triage and to guide resuscitation. However, little is known about CRT kinetics after fluid infusion.

Methods

We conducted a prospective observational study in a tertiary teaching hospital. First, we analyzed the intra-observer variability of CRT. Next, we monitored fingertip CRT in sepsis patients during volume expansion within the first 24 h of ICU admission. Fingertip CRT was measured every 2 min during 30 min following crystalloid infusion (500 mL over 15 min).

Results

First, the accuracy of repetitive fingertip CRT measurements was evaluated on 40 critically ill patients. Reproducibility was excellent, with an intra-class correlation coefficient of 99.5% (CI 95% [99.3, 99.8]). A CRT variation larger than 0.2 s was considered as significant. Next, variations of CRT during volume expansion were evaluated on 29 septic patients; median SOFA score was 7 [5–9], median SAPS II was 57 [45–72], and ICU mortality rate was 24%. Twenty-three patients were responders as defined by a CRT decrease > 0.2 s at 30 min after volume expansion, and 6 were non-responders. Among responders, we observed that fingertip CRT quickly improved with a significant decrease at 6–8 min after start of crystalloid infusion, the maximal improvement being observed after 10–12 min (−0.7 [−0.3;−0.9] s) and maintained at 30 min. CRT variations significantly correlated with baseline CRT measurements (R = 0.39, P = 0.05).

Conclusions

CRT quickly improved during volume expansion with a significant decrease 6–8 min after start of fluid infusion and a maximal drop at 10–12 min.

中文翻译：

流体挑战后毛细管再填充时间的动力学

背景

毛细管再充盈时间 (CRT) 是一种有价值的分诊和指导复苏的工具。然而，对于输液后的 CRT 动力学知之甚少。

方法

我们在一家三级教学医院进行了一项前瞻性观察研究。首先，我们分析了 CRT 的观察者内部变异性。接下来，我们在 ICU 入院后 24 小时内对脓毒症患者的指尖 CRT 进行监测。在晶体液输注后的 30 分钟内，每 2 分钟测量一次指尖 CRT（500 mL，超过 15 分钟）。

结果

首先，对 40 名危重患者进行了重复指尖 CRT 测量的准确性评估。重现性非常好，类内相关系数为 99.5% (CI 95% [99.3, 99.8])。大于 0.2 s 的 CRT 变化被认为是显着的。接下来，对 29 名脓毒症患者进行扩容期间 CRT 的变化评估；SOFA 评分中位数为 7 [5-9]，SAPS II 中位数为 57 [45-72]，ICU 死亡率为 24%。23 名患者为反应者，定义为在扩容后 30 分钟 CRT 下降 > 0.2 秒，6 名患者为无反应者。在响应者中，我们观察到指尖 CRT 迅速改善，在晶体液输注开始后 6-8 分钟显着下降，在 10-12 分钟后观察到最大改善（-0.7 [-0.3;-0.9] s）并保持在30分钟。R = 0.39，P = 0.05）。