Capillary Refill Time Variation Induced by Passive Leg Raising Predicts Capillary Refill Time Response to Volume Expansion

Overview

Journal Crit Care

Specialty Critical Care

Date 2019 Aug 18

PMID 31420052

Citations 26

Authors

Matthias Jacquet-Lagreze

Nourredine Bouhamri

Philippe Portran

Remi Schweizer

Florent Baudin

Marc Lilot

William Fornier

Jean-Luc Fellahi

Affiliations

Soon will be listed here.

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 (PCOgap), 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 (ROC). 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 ROC of ΔCRT-PLR was 0.94 [95% CI, 0.87-1.0]. The ROC of baseline capillary refill time was 0.73 [95% CI, 0.54-0.90] and of baseline PCOgap 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.

Citing Articles

DiCART device to measure capillary refill time: a validation study in patients with acute circulatory failure.

Descamps A, Jacquet-Lagreze M, Aussal T, Fellahi J, Ruste M J Clin Monit Comput. 2025; .

PMID: 40011397 DOI: 10.1007/s10877-025-01271-5.

Sepsis Resuscitation: Time to Embrace a Restrictive Fluid Strategy?.

Toledo-Palacios H, Perez-Nieto O, Reyes-Monge R, Rodriguez-Guevara I, Mark N J Am Coll Emerg Physicians Open. 2025; 6(2):100040.

PMID: 39895809 PMC: 11780708. DOI: 10.1016/j.acepjo.2024.100040.

Research Progress on the Measurement Methods and Clinical Significance of Capillary Refill Time.

Xia Y, Guo Z, Wang X, Wang Z, Wang X, Wang Z Sensors (Basel). 2025; 24(24.

PMID: 39771680 PMC: 11679391. DOI: 10.3390/s24247941.

Capillary Refill Time as a Part of Routine Physical Examination in Critically Ill Patients Undergoing Vasoactive Therapy: A Prospective Study.

Wesolek F, Putowski Z, Staniszewska W, Latacz R, Krzych L J Clin Med. 2024; 13(19).

PMID: 39407842 PMC: 11476923. DOI: 10.3390/jcm13195782.

Early peripheral perfusion monitoring in septic shock.

Guo Q, Liu D, Wang X Eur J Med Res. 2024; 29(1):477.

PMID: 39350276 PMC: 11440805. DOI: 10.1186/s40001-024-02074-1.

References

van Genderen M, Engels N, van der Valk R, Lima A, Klijn E, Bakker J . Early peripheral perfusion-guided fluid therapy in patients with septic shock. Am J Respir Crit Care Med. 2015; 191(4):477-80. DOI: 10.1164/rccm.201408-1575LE. View

Klijn E, Niehof S, Groeneveld A, Lima A, Bakker J, Van Bommel J . Postural change in volunteers: sympathetic tone determines microvascular response to cardiac preload and output increases. Clin Auton Res. 2015; 25(6):347-54. PMC: 4662957. DOI: 10.1007/s10286-015-0286-x. View

De Backer D, Donadello K, Sakr Y, Ospina-Tascon G, Salgado D, Scolletta S . Microcirculatory alterations in patients with severe sepsis: impact of time of assessment and relationship with outcome. Crit Care Med. 2013; 41(3):791-9. DOI: 10.1097/CCM.0b013e3182742e8b. View

Monge Garcia M, Gracia Romero M, Gil Cano A, Aya H, Rhodes A, Grounds R . Dynamic arterial elastance as a predictor of arterial pressure response to fluid administration: a validation study. Crit Care. 2014; 18(6):626. PMC: 4271484. DOI: 10.1186/s13054-014-0626-6. View

Mallat J, Lazkani A, Lemyze M, Pepy F, Meddour M, Gasan G . Repeatability of blood gas parameters, PCO2 gap, and PCO2 gap to arterial-to-venous oxygen content difference in critically ill adult patients. Medicine (Baltimore). 2015; 94(3):e415. PMC: 4602629. DOI: 10.1097/MD.0000000000000415. View

Pettila V, Merz T, Wilkman E, Perner A, Karlsson S, Lange T . Targeted tissue perfusion versus macrocirculation-guided standard care in patients with septic shock (TARTARE-2S): study protocol and statistical analysis plan for a randomized controlled trial. Trials. 2016; 17:384. PMC: 4971711. DOI: 10.1186/s13063-016-1515-x. View

Maitland K, Pamba A, Newton C, Levin M . Response to volume resuscitation in children with severe malaria. Pediatr Crit Care Med. 2003; 4(4):426-31. DOI: 10.1097/01.PCC.0000090293.32810.4E. View

Cecconi M, De Backer D, Antonelli M, Beale R, Bakker J, Hofer C . Consensus on circulatory shock and hemodynamic monitoring. Task force of the European Society of Intensive Care Medicine. Intensive Care Med. 2014; 40(12):1795-815. PMC: 4239778. DOI: 10.1007/s00134-014-3525-z. View

Moura E, Amorim F, Santana A, Kanhouche G, de Souza Godoy L, de Jesus Almeida L . Skin mottling score as a predictor of 28-day mortality in patients with septic shock. Intensive Care Med. 2015; 42(3):479-480. DOI: 10.1007/s00134-015-4184-4. View

10.

Garcia-Alvarez M, Marik P, Bellomo R . Sepsis-associated hyperlactatemia. Crit Care. 2014; 18(5):503. PMC: 4421917. DOI: 10.1186/s13054-014-0503-3. View

11.

Brown L, Prasad N, Whitley T . Adverse lighting condition effects on the assessment of capillary refill. Am J Emerg Med. 1994; 12(1):46-7. DOI: 10.1016/0735-6757(94)90196-1. View

12.

Hernandez G, Bruhn A, Castro R, Regueira T . The holistic view on perfusion monitoring in septic shock. Curr Opin Crit Care. 2012; 18(3):280-6. DOI: 10.1097/MCC.0b013e3283532c08. View

13.

Monnet X, Marik P, Teboul J . Passive leg raising for predicting fluid responsiveness: a systematic review and meta-analysis. Intensive Care Med. 2016; 42(12):1935-1947. DOI: 10.1007/s00134-015-4134-1. View

14.

Guerin L, Teboul J, Persichini R, Dres M, Richard C, Monnet X . Effects of passive leg raising and volume expansion on mean systemic pressure and venous return in shock in humans. Crit Care. 2015; 19:411. PMC: 4657233. DOI: 10.1186/s13054-015-1115-2. View

15.

Blaxter L, Morris D, Crowe J, Henry C, Hill S, Sharkey D . An automated quasi-continuous capillary refill timing device. Physiol Meas. 2015; 37(1):83-99. PMC: 4770525. DOI: 10.1088/0967-3334/37/1/83. View

16.

De Backer D, Ortiz J, Salgado D . Coupling microcirculation to systemic hemodynamics. Curr Opin Crit Care. 2010; 16(3):250-4. DOI: 10.1097/MCC.0b013e3283383621. View

17.

Pottecher J, Deruddre S, Teboul J, Georger J, Laplace C, Benhamou D . Both passive leg raising and intravascular volume expansion improve sublingual microcirculatory perfusion in severe sepsis and septic shock patients. Intensive Care Med. 2010; 36(11):1867-74. DOI: 10.1007/s00134-010-1966-6. View

18.

Brunauer A, Kokofer A, Bataar O, Gradwohl-Matis I, Dankl D, Bakker J . Changes in peripheral perfusion relate to visceral organ perfusion in early septic shock: A pilot study. J Crit Care. 2016; 35:105-9. DOI: 10.1016/j.jcrc.2016.05.007. View

19.

Schriger D, Baraff L . Defining normal capillary refill: variation with age, sex, and temperature. Ann Emerg Med. 1988; 17(9):932-5. DOI: 10.1016/s0196-0644(88)80675-9. View

20.

Jacquet-Lagreze M, Izaute G, Fellahi J . Diagnostic Accuracy Studies: The Methodologic Approach Matters!. Anesthesiology. 2017; 127(4):728-729. DOI: 10.1097/ALN.0000000000001824. View