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

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

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.

Publication types

  • Observational Study

MeSH terms

  • Aged
  • Area Under Curve
  • Capillaries / physiology*
  • Cardiac Output / physiology*
  • Female
  • Hemodynamics / physiology
  • Humans
  • Male
  • Middle Aged
  • Plasma Substitutes / standards*
  • Plasma Substitutes / therapeutic use
  • Prospective Studies
  • ROC Curve
  • Shock / blood*
  • Shock / physiopathology
  • Time Factors

Substances

  • Plasma Substitutes

Associated data

  • ClinicalTrials.gov/NCT02248025