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Crit Care. 2019 Aug 16;23(1):281. doi: 10.1186/s13054-019-2560-0.

Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion.

Author information

1
Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France. matthias.jl@gmail.com.
2
Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France. matthias.jl@gmail.com.
3
Département d'Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.
4
Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008, Lyon, France.
5
Département de Réanimation Pédiatrique, Centre Hospitalier Femme mère enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.
6
Département d'Anesthésie Pédiatrique, Centre Hospitalier Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500, Bron, France.
7
Centre Lyonnais d'Enseignement par Simulation en Santé, SAMSEI, Université Claude Bernard Lyon 1, Lyon, France.
8
Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France.
9
EPICIME-CIC 1407 de Lyon, Inserm, Hospices Civils de Lyon, F-69677, Bron, France.

Abstract

BACKGROUND:

A peripheral perfusion-targeted resuscitation during early septic shock has shown encouraging results. Capillary refill time, which has a prognostic value, was used. Adding accuracy and predictability on capillary refill time (CRT) measurement, if feasible, would benefit to peripheral perfusion-targeted resuscitation. We assessed whether a reduction of capillary refill time during passive leg raising (ΔCRT-PLR) predicted volume-induced peripheral perfusion improvement defined as a significant decrease of capillary refill time following volume expansion.

METHODS:

Thirty-four patients with acute circulatory failure were selected. Haemodynamic variables, metabolic variables (PCO2gap), and four capillary refill time measurements were recorded before and during a passive leg raising test and after a 500-mL volume expansion over 20 min. Receiver operating characteristic curves were built, and areas under the curves were calculated (ROCAUC). Confidence intervals (CI) were performed using a bootstrap analysis. We recorded mortality at day 90.

RESULTS:

The least significant change in the capillary refill time was 25% [95% CI, 18-30]. We defined CRT responders as patients showing a reduction of at least 25% of capillary refill time after volume expansion. A decrease of 27% in ΔCRT-PLR predicted peripheral perfusion improvement with a sensitivity of 87% [95% CI, 73-100] and a specificity of 100% [95% CI, 74-100]. The ROCAUC of ΔCRT-PLR was 0.94 [95% CI, 0.87-1.0]. The ROCAUC of baseline capillary refill time was 0.73 [95% CI, 0.54-0.90] and of baseline PCO2gap was 0.79 [0.61-0.93]. Capillary refill time was significantly longer in non-survivors than in survivors at day 90.

CONCLUSION:

ΔCRT-PLR predicted peripheral perfusion response following volume expansion. This simple low-cost and non-invasive diagnostic method could be used in peripheral perfusion-targeted resuscitation protocols.

TRIAL REGISTRATION:

CPP Lyon Sud-Est II ANSM: 2014-A01034-43 Clinicaltrial.gov, NCT02248025 , registered 13th of September 2014.

KEYWORDS:

Capillary refill time; Circulatory shock; Fluid responsiveness; Microcirculation; PCO2gap; Passive leg raising; Peripheral perfusion

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