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. 2024 Apr 1;14(1):49.
doi: 10.1186/s13613-024-01275-5.

Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study

Glenn Hernández  1 , Emilio Daniel Valenzuela  2 , Eduardo Kattan  2 , Ricardo Castro  2 , Camila Guzmán  2 , Alicia Elzo Kraemer  2 , Nicolás Sarzosa  2 , Leyla Alegría  2 , Roberto Contreras  2 , Vanessa Oviedo  2 , Sebastián Bravo  2 , Dagoberto Soto  2 , Claudia Sáez  3 , Hafid Ait-Oufella  4 , Gustavo Ospina-Tascón  5   6   7 , Jan Bakker  2   8
Affiliations

Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study

Glenn Hernández et al. Ann Intensive Care. .

Abstract

Background: Several studies have validated capillary refill time (CRT) as a marker of tissue hypoperfusion, and recent guidelines recommend CRT monitoring during septic shock resuscitation. Therefore, it is relevant to further explore its kinetics of response to short-term hemodynamic interventions with fluids or vasopressors. A couple of previous studies explored the impact of a fluid bolus on CRT, but little is known about the impact of norepinephrine on CRT when aiming at a higher mean arterial pressure (MAP) target in septic shock. We designed this observational study to further evaluate the effect of a fluid challenge (FC) and a vasopressor test (VPT) on CRT in septic shock patients with abnormal CRT after initial resuscitation. Our purpose was to determine the effects of a FC in fluid-responsive patients, and of a VPT aimed at a higher MAP target in chronically hypertensive fluid-unresponsive patients on the direction and magnitude of CRT response.

Methods: Thirty-four septic shock patients were included. Fluid responsiveness was assessed at baseline, and a FC (500 ml/30 mins) was administered in 9 fluid-responsive patients. A VPT was performed in 25 patients by increasing norepinephrine dose to reach a MAP to 80-85 mmHg for 30 min. Patients shared a multimodal perfusion and hemodynamic monitoring protocol with assessments at at least two time-points (baseline, and at the end of interventions).

Results: CRT decreased significantly with both tests (from 5 [3.5-7.6] to 4 [2.4-5.1] sec, p = 0.008 after the FC; and from 4.0 [3.3-5.6] to 3 [2.6 -5] sec, p = 0.03 after the VPT. A CRT-response was observed in 7/9 patients after the FC, and in 14/25 pts after the VPT, but CRT deteriorated in 4 patients on this latter group, all of them receiving a concomitant low-dose vasopressin.

Conclusions: Our findings support that fluid boluses may improve CRT or produce neutral effects in fluid-responsive septic shock patients with persistent hypoperfusion. Conversely, raising NE doses to target a higher MAP in previously hypertensive patients elicits a more heterogeneous response, improving CRT in the majority, but deteriorating skin perfusion in some patients, a fact that deserves further research.

Keywords: Capillary refill time; Fluid challenge; Perfusion.; Septic shock; Vasopressor test.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Study Flow
Fig. 2
Fig. 2
Pre- and post-intervention measurements of CRT after either a fluid challenge or and a vasopressor test. Panel A shows absolute change while panel B shows relative changes of CRT.
See this image and copyright information in PMC

References

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