Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion
Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion
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DOI：
10.1186/s13054-019-2560-0
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发表时间：
2019-08-16
期刊：
影响因子：
15.1
通讯作者：
Fellahi, Jean-Luc
中科院分区：
文献类型：
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作者：
Jacquet-Lagreze, Matthias;Bouhamri, Nourredine;Fellahi, Jean-Luc
背景 早期感染性休克期间外周灌注靶向复苏已显示出令人鼓舞的结果。使用具有预后价值的毛细血管再充盈时间。如果可行的话，增加毛细血管再充盈时间（CRT）测量的准确性和可预测性将有利于外周灌注靶向复苏。我们评估了被动抬腿（Delta CRT-PLR）过程中毛细血管再充盈时间的减少是否预示着容量引起的外周灌注改善，定义为容量扩张后毛细血管再充盈时间的显着减少。方法选取急性循环衰竭患者34例。在被动抬腿测试之前和期间以及在 20 分钟内进行 500 mL 扩容之后，记录血流动力学变量、代谢变量 (PCO(2)gap) 和四次毛细血管再充盈时间测量值。建立接受者操作特征曲线，并计算曲线下面积（ROCAUC）。使用引导分析进行置信区间 (CI)。我们记录了第 90 天的死亡率。结果 毛细血管再充盈时间的最小显着变化为 25% [95% CI, 18-30]。我们将 CRT 反应者定义为在扩容后毛细血管再充盈时间减少至少 25% 的患者。 Delta CRT-PLR 降低 27% 预测外周灌注改善，敏感性为 87% [95% CI, 73-100]，特异性为 100% [95% CI, 74-100]。 Delta CRT-PLR 的 ROCAUC 为 0.94 [95% CI, 0.87-1.0]。基线毛细血管再充盈时间的 ROCAUC 为 0.73 [95% CI, 0.54-0.90]，基线 PCO(2) 间隙的 ROCAUC 为 0.79 [0.61-0.93]。第 90 天时，非幸存者的毛细血管再充盈时间明显长于幸存者。 结论 Delta CRT-PLR 可以预测扩容后的外周灌注反应。这种简单的低成本和非侵入性诊断方法可用于外周灌注靶向复苏方案。
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 (Delta CRT-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 (PCO(2)gap), 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 (ROCAUC). 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 Delta CRT-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 Delta CRT-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 PCO(2)gap was 0.79 [0.61-0.93]. Capillary refill time was significantly longer in non-survivors than in survivors at day 90. Conclusion Delta CRT-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.