Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion

Abstract

BackgroundA 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.MethodsThirty-four patients with acute circulatory failure were selected. Haemodynamic variables, metabolic variables (PCO2gap), 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\u2009min. Receiver operating characteristic curves were built, and areas under the curves were calculated (ROCAUC). Confidence intervals (CI) were performed using a bootstrap analysis. We recorded mortality at day 90.ResultsThe 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 ROCAUC of ΔCRT-PLR was 0.94 [95% CI, 0.87–1.0]. The ROCAUC of baseline capillary refill time was 0.73 [95% CI, 0.54–0.90] and of baseline PCO2gap was 0.79 [0.61–0.93]. Capillary refill time was significantly longer in non-survivors than in survivors at day 90.ConclusionΔCRT-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 registrationCPP Lyon Sud-Est II ANSM: 2014-A01034-43Clinicaltrial.gov, NCT02248025, registered 13th of September 2014