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. 2018 Jun 5;5(4):321-328.
doi: 10.1002/ams2.348. eCollection 2018 Oct.

Association between venous blood lactate levels and differences in quantitative capillary refill time

Yasufumi Oi  1   2 , Kosuke Sato  1   2 , Ayako Nogaki  1   2 , Mafumi Shinohara  1   2 , Jun Matsumoto  1   2 , Takeru Abe  2   3 , Naoto Morimura  2   4
Affiliations

Association between venous blood lactate levels and differences in quantitative capillary refill time

Yasufumi Oi et al. Acute Med Surg. .

Abstract

Aim: Capillary refill time has been widely adopted for clinical assessment of the circulatory status of patients in emergency settings. We previously introduced quantitative capillary refill time and found a positive association between longer quantitative capillary refill time and higher lactate levels in the intensive care units, but not in the emergency department. In this study, we aimed to identify a quantitative and clinically applicable index of circulatory status (ΔA b) that can be measured with quantitative capillary refill time, then evaluated the linear association between this index and lactate levels in the emergency department.

Methods: We undertook a prospective single-center observational study at a university hospital from November 2015 to July 2016. We included 139 patients with endogenous diseases to test the association between quantitative capillary refill time, ΔA b (measured with a pulse oximeter), and lactate levels.

Results: ΔA b was independently and significantly associated with high lactate levels (odds ratio [95% confidence interval]: 0.16 [0.05-0.45]).

Conclusions: We introduced ΔA b, measured using quantitative capillary refill time, as a surrogate index of lactate levels to overcome the shortcomings of capillary refill time. We showed that ΔA b is a feasible, non-invasive, and rapid assessment of patients with high lactate levels in emergency primary care settings. Future multicenter studies with a longitudinal design should be undertaken to verify our findings.

Keywords: Blood gas analysis; emergency services; lactic acid; shock; triage.

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Figures

Figure 1
Figure 1
Wearing of the apparatus for measuring quantitative capillary refill time. Put the apparatus on the finger with a pulse oximeter.
Figure 2
Figure 2
Schematic of quantitative capillary refill time measurements. Transmitted light quantity obtained by a pulse oximeter equipped with a hemoglobin saturation of oxygen sensor is related to blood volume, based on Lambert–Beer's law.5 Q‐CRT, quantitative capillary refill time.
Figure 3
Figure 3
Calculation of the ∆A b index of circulatory status. Dimmed light quantity by blood alone defines ∆A b (delta A b), which is the difference between the degree of dimmed light under infrared light and under red light.
See this image and copyright information in PMC

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