Observational studyCritical care (London, England)2023
Effect on capillary refill time of volume expansion and increase of the norepinephrine dose in patients with septic shock.
Observational study in Critical care (London, England), 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT04870892 (Effects of Norepinephrine and Volume Expansion in Capillary Refill Time in Septic Shock), which is not on this map. Cited by 16 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Effects of Norepinephrine and Volume Expansion in Capillary Refill Time in Septic Shock
Who cites it
16 citing papers in PubMed, 1 synthesis or guideline pooled it, 22 citations in OpenAlex.
- ESICM guidelines on circulatory shock and hemodynamic monitoring 2025.Intensive care medicine · 2025Guideline
- The use of capillary refill time In adult critically ill patients: a narrative review on potentials, pitfalls, and perspectives.Journal of clinical monitoring and computing · 2026Review
- Beyond macrocirculatory targets: a multimodal framework for microcirculatory and organ perfusion monitoring in sepsis.Critical care (London, England) · 2026Review
- Assessment of the Microcirculation During Extracorporeal Blood Purification in Septic Patients: A Narrative Review.Medicina (Kaunas, Lithuania) · 2026Review
- Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion.Acute and critical care · 2026Article
- Acute hemodynamic tests to determine the status of macro-to-microcirculatory coupling during septic shock resuscitation.Critical care (London, England) · 2026Article
- Perfusion index and fluid responsiveness: Are we asking the right question?Journal of intensive medicine · 2026Article
- The time course of fluid responsiveness.Annals of intensive care · 2026Review
- DiCARTJournal of clinical monitoring and computing · 2025Article
- The intricate relationship between capillary refill time and systemic hemodynamics in septic shock.Annals of intensive care · 2025Review
- Point of View: A Holistic Four-Interface Conceptual Model for Personalizing Shock Resuscitation.Journal of personalized medicine · 2025Review
- Why do we use transpulmonary thermodilution and pulmonary artery catheter in severe shock patients?Annals of intensive care · 2025Article
- Research Progress on the Measurement Methods and Clinical Significance of Capillary Refill Time.Sensors (Basel, Switzerland) · 2024Review
- Recent advances in cardiorespiratory monitoring in acute respiratory distress syndrome patients.Journal of intensive care · 2024Review
- Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study.Annals of intensive care · 2024Article
- Vasoconstriction in septic shock.Intensive care medicine · 2024Article
Corrections and comments
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Authors and funding
7 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCapillary refill time (CRT) has been suggested as a variable to follow during the course of septic shock. We systematically investigated the effects on CRT of volume expansion and norepinephrine.
methodsIn 69 septic shock patients, we recorded mean arterial pressure (MAP), cardiac index (CI), and 5 consecutive CRT measurements (video method, standardized pressure applied on the fingertip) before and after a 500-mL saline infusion in 33 patients and before and after an increase of the norepinephrine dose in 36 different patients. Fluid responders were defined by an increase in CI ≥ 15%, and norepinephrine responders by an increase in MAP ≥ 15%.
resultsThe least significant change of CRT was 23%, so that changes in CRT were considered significant if larger than 23%. With volume expansion, CRT remained unchanged on average in patients with baseline CRT < 3 s (n = 7) and in all but one patient with baseline CRT ≥ 3 s in whom fluid increased CI < 15% (n = 13 "fluid non-responders"). In fluid responders with baseline CRT ≥ 3 s (n = 13), CRT decreased in 8 patients and remained unchanged in the others, exhibiting a dissociation between CI and CRT responses. The proportion of patients included > 24 h after starting norepinephrine was higher in patients with such a dissociation than in the other ones (60% vs. 0%, respectively). Norepinephrine did not change CRT significantly (except in one patient) if baseline CRT was ≥ 3 s and the increase in MAP < 15% (n = 6). In norepinephrine responders with prolonged baseline CRT (n = 11), it increased in 4 patients and remained unchanged in the other ones, which exhibited a dissociation between MAP and CRT responses.
conclusionsIn septic shock patients with prolonged CRT, CRT very rarely improves with treatment when volume expansion increases cardiac output < 15% and increasing norepinephrine increases MAP < 15%. When the effects of fluid infusion on cardiac output and of norepinephrine on MAP are significant, the response of CRT is variable, as it decreases in some patients and remains stable in others which exhibit a dissociation between changes in macrohemodynamic variables and in CRT. In this regard, CRT behaves as a marker of microcirculation.
trial registrationClinicalTrial.gov (NCT04870892). Registered January15, 2021. Ethics committee approval CE SRLF 21-25.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.