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Exploring the relationship between capillary refill time, skin blood flow and microcirculatory reactivity during early resuscitation of patients with septic shock: a pilot study

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Abstract

Capillary refill time (CRT), a costless and widely available tool, has emerged as a promising target to guide septic shock resuscitation. However, it has yet to gain universal acceptance due to its potential inter-observer variability. Standardization of CRT assessment may minimize this problem, but few studies have compared this approach with techniques that directly assess skin blood flow (SBF). Our objective was to determine if an abnormal CRT is associated with impaired SBF and microvascular reactivity in early septic shock patients. Twelve septic shock patients were subjected to multimodal perfusion and hemodynamic monitoring for 24 h. Three time-points (0, 1, and 24 h) were registered for each patient. SBF was measured by laser doppler. We performed a baseline SBF measurement and two microvascular reactivity tests: one with a thermal challenge at 44 °C and other with a vascular occlusion test. Ten healthy volunteers were evaluated to obtain reference values. The patients (median age 70 years) exhibited a 28-day mortality of 50%. Baseline CRT was 3.3 [2.7–7.3] seconds. In pooled data analysis, abnormal CRT presented a significantly lower SBF when compared to normal CRT [44 (13.3–80.3) vs 193.2 (99.4–285) APU, p = 0.0001]. CRT was strongly associated with SBF (R2 0.76, p < 0.0001). An abnormal CRT also was associated with impaired thermal challenge and vascular occlusion tests. Abnormal CRT values observed during early septic shock resuscitation are associated with impaired skin blood flow, and abnormal skin microvascular reactivity. Future studies should confirm these results.

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Funding

The present study was supported by ANID-FONDECYT Chile Grants, Project Numbers 1200246 and 11201220.

Author information

Authors and Affiliations

  1. Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Avenida Diagonal Paraguay 362, 8330077, Santiago, Chile

    Roberto Contreras, Glenn Hernández, Emilio Daniel Valenzuela, Cecilia González, Rodrigo Ulloa, Dagoberto Soto, Ricardo Castro, Camila Guzmán, Vanessa Oviedo, Leyla Alegría, Sebastian Morales, Jan Bakker & Eduardo Kattan

  2. Intensive Care Unit, Hospital Biprovincial Quillota - Petorca, Valparaiso, Chile

    Roberto Contreras

  3. Intensive Care Unit, Hospital las Higueras, Talcahuano, Chile

    Rodrigo Ulloa

  4. Departamento de Ingeniería Industrial y de Sistemas, Facultad de Ingenieria, Pontificia Universidad Católica de Chile, Santiago, Chile

    Diego Vidal

  5. Department of Intensive Care Medicine, Fundación Valle del Lili, Universidad ICESI, Cali, Colombia

    Gustavo Adolfo Ospina-Tascón

  6. Department of Intensive Care Adults, Erasmus MC University Medical Center, Rotterdam, The Netherlands

    Jan Bakker

  7. Department of Pulmonary and Critical Care, New York University, New York, USA

    Jan Bakker

  8. Division of Pulmonary, Allergy, and Critical Care Medicine, Columbia University Medical Center, New York, USA

    Jan Bakker

Authors
  1. Roberto Contreras
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  2. Glenn Hernández
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  3. Emilio Daniel Valenzuela
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Contributions

RC: Study design, data collection, data interpretation, manuscript writing and revision. GH: Study design, data analysis, data interpretation manuscript writing and revision. EV: Study design, data collection, data interpretation, manuscript revision. CG: data collection, data interpretation, manuscript revision. RU: data collection, data interpretation, manuscript revision. DS: data collection, data interpretation, manuscript revision. RC: Study design, data analysis, data interpretation manuscript writing and revision. CG: data collection, data interpretation, manuscript revision. VO: data collection, data interpretation, manuscript revision. LA: data collection, data interpretation, manuscript revision. DV: data collection, data interpretation, manuscript revision. SM: data collection, data interpretation, manuscript revision. GOT: Study design, data analysis, data interpretation manuscript writing and revision. JB: Study design, data analysis, data interpretation manuscript writing and revision. EK: Study design, data analysis, data interpretation manuscript writing and revision. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Eduardo Kattan.

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Competing Interests

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

The background trials of this observational study were approved by our local Institutional Review Board (Comité de Ética Asistencial, Facultad de Medicina, Pontificia Universidad Católica de Chile, No 190527001 and No 200318004, respectively).

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All patients or their next of kin signed an informed consent to be included in the original studies.

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Supplementary file1 (DOCX 13 kb)

10877_2022_946_MOESM2_ESM.tif

Supplementary file2 (TIF 94 kb). Electronic Supplementary Material 2: Baseline skin blood flow, vascularoclusion test and heat challenge, measured by laser doppler technique, ina healthy volunteer (A) and a septic shock patient (B).APU: Arbitrary perfusion units

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Contreras, R., Hernández, G., Valenzuela, E.D. et al. Exploring the relationship between capillary refill time, skin blood flow and microcirculatory reactivity during early resuscitation of patients with septic shock: a pilot study. J Clin Monit Comput 37, 839–845 (2023). https://doi.org/10.1007/s10877-022-00946-7

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