ArticleBMC pediatrics2024
The association between prolonged capillary refill time and microcirculation changes in children with sepsis.
Article in BMC pediatrics, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 16 papers.
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Who cites it
16 citing papers in PubMed, 23 citations in OpenAlex.
- Monitoring and Targeted Regulation of Oxygen Metabolism in Pediatric Sepsis: Current Paradigms and Future Perspectives.International journal of molecular sciences · 2026Review
- Care Pathway and Outcomes in Pediatric Septic Shock: A Narrative Review from Emergency Department Recognition to PICU Management.Children (Basel, Switzerland) · 2026Review
- Acute hemodynamic tests to determine the status of macro-to-microcirculatory coupling during septic shock resuscitation.Critical care (London, England) · 2026Article
- Septic Cardiomyopathy: Age-Dependent Physiology and Hemodynamic Aspects-A Narrative Review.Children (Basel, Switzerland) · 2026Review
- Microvascular phenotypes in pediatric sepsis identified by machine learning: prognostic implications for organ dysfunction and mortality.Critical care (London, England) · 2026Article
- Association between serum endothelial glycocalyx biomarkers and prognosis in paediatric sepsis.BMC infectious diseases · 2026Observational
- Device-measured capillary refill time identifies critically ill cases in the emergency department.Scientific reports · 2026Observational
- The Usefulness of Peripheral and Organ Perfusion Monitoring in Predicting Mortality in Patients with Severe SARS-CoV-2.Biomedicines · 2025Article
- Can we trust naked eye assessments of the capillary refill test in children? An experimental study.BMC emergency medicine · 2025Article
- Study on the predictive value of early microcirculation perfusion indicators combined with neuroelectrophysiological monitoring for the occurrence and prognosis of sepsis-associated encephalopathy in neurocritical care patients.Frontiers in neurology · 2025Article
- The Resuscitation, Equilibrium and De-escalation (RED) strategy: a phased, personalized hemodynamic support in children with sepsis.Frontiers in pediatrics · 2025Review
- Research Progress on the Measurement Methods and Clinical Significance of Capillary Refill Time.Sensors (Basel, Switzerland) · 2024Review
- Peripheral and Organ Perfusion's Role in Prognosis of Disease Severity and Mortality in Severe COVID-19 Patients: Prospective Cohort Study.Journal of clinical medicine · 2024Article
- Association between the lactate-albumin ratio and microcirculation changes in Pediatric Septic patients.Scientific reports · 2024Article
- Microcirculation, endothelium and glycocalyx changes associated with the use of milrinone in children with septic shock.Translational pediatrics · 2024Article
- New Phoenix criteria for pediatric sepsis and septic shock: the strengths and the future of a comprehensive perspective.Critical care science · 2024Article
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
Abstract
backgroundsIn children with sepsis, circulatory shock and multi-organ failure remain major contributors to mortality. Prolonged capillary refill time (PCRT) is a clinical tool associated with disease severity and tissue hypoperfusion. Microcirculation assessment with videomicroscopy represents a promising candidate for assessing and improving hemodynamic management strategies in children with sepsis. Particularly when there is loss of coherence between the macro and microcirculation (hemodynamic incoherence). We sought to evaluate the association between PCRT and microcirculation changes in sepsis.
methodsThis was a prospective cohort study in children hospitalized with sepsis. Microcirculation was measured using sublingual video microscopy (capillary density and flow and perfused boundary region [PBR]-a parameter inversely proportional to vascular endothelial glycocalyx thickness), phalangeal tissue perfusion, and endothelial activation and glycocalyx injury biomarkers. The primary outcome was the association between PCRT and microcirculation changes.
resultsA total of 132 children with sepsis were included, with a median age of two years (IQR 0.6-12.2). PCRT was associated with increased glycocalyx degradation (PBR 2.21 vs. 2.08 microns; aOR 2.65, 95% CI 1.09-6.34; p = 0.02) and fewer 4-6 micron capillaries recruited (p = 0.03), with no changes in the percentage of capillary blood volume (p = 0.13). Patients with hemodynamic incoherence had more PBR abnormalities (78.4% vs. 60.8%; aOR 2.58, 95% CI 1.06-6.29; p = 0.03) and the persistence of these abnormalities after six hours was associated with higher mortality (16.5% vs. 6.1%; p < 0.01). Children with an elevated arterio-venous CO
conclusionsWe found an association between PCRT and microcirculation changes in children with sepsis. These patients had fewer small capillaries recruited and more endothelial glycocalyx degradation. This leads to nonperfused capillaries, affecting oxygen delivery to the tissues. These disorders were associated with hemodynamic incoherence and worse clinical outcomes when the CRT continued to be abnormal 24 h after admission.
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