ArticleAnnals of intensive care2024
Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study.
Article in Annals of intensive care, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 papers, 1 of them a synthesis that pooled it.
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Who cites it
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 32 citations in OpenAlex.
- ESICM guidelines on circulatory shock and hemodynamic monitoring 2025.Intensive care medicine · 2025Guideline
- Beyond macrocirculatory targets: a multimodal framework for microcirculatory and organ perfusion monitoring in sepsis.Critical care (London, England) · 2026Review
- Understanding the Nuanced Concept of Hemodynamic Incoherence and Its Underlying Physiology.Journal of clinical medicine · 2026Review
- Twenty-five years of septic shock hemodynamic resuscitation trials: a conceptual perspective.Critical care (London, England) · 2026Review
- Acute hemodynamic tests to determine the status of macro-to-microcirculatory coupling during septic shock resuscitation.Critical care (London, England) · 2026Article
- Proof of concept of noninvasive detection of norepinephrine induced stroke volume changes using perfusion index in cardiac surgery.Scientific reports · 2026Observational
- Capillary refill time changes are associated with Vascular Waterfall response in post-cardiac surgery patients.Annals of intensive care · 2026Article
- Applied physiology at the bedside: using invasive blood pressure as a true monitoring tool.Annals of intensive care · 2025Review
- 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
- Research Progress on the Measurement Methods and Clinical Significance of Capillary Refill Time.Sensors (Basel, Switzerland) · 2024Review
- Capillary Refill Time as a Part of Routine Physical Examination in Critically Ill Patients Undergoing Vasoactive Therapy: A Prospective Study.Journal of clinical medicine · 2024Article
- Dynamic changes of hepatic vein Doppler velocities predict preload responsiveness in mechanically ventilated critically ill patients.Intensive care medicine experimental · 2024Article
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Authors and funding
16 authors at 3 institutions in 4 countries.
Funding
Abstract
backgroundSeveral 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.
methodsThirty-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).
resultsCRT 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.
conclusionsOur 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.
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