Cutting-Edge Technology for Rapid Bedside Assessment of Capillary Refill Time for Early Diagnosis and Resuscitation of Sepsis.
Cutting-Edge Technology for Rapid Bedside Assessment of Capillary Refill Time for Early Diagnosis and Resuscitation of Sepsis.
复制标题
用于快速床边评估毛细血管再充盈时间的尖端技术，用于脓毒症的早期诊断和复苏。
DOI：
10.3389/fmed.2020.612303
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发表时间：
2020
影响因子：
3.9
通讯作者：
Hansen ML
中科院分区：
文献类型：
--
作者：
Sheridan DC;Cloutier R;Kibler A;Hansen ML
脓毒症目前影响全球超过3000万人，死亡率约为30%。急诊科及时诊断和开始复苏可改善预后;数据显示，诊断每延迟1小时，死亡率增加8%。一旦发现脓毒症，目前针对成人患者的脓毒症生存指南要求在急诊科分诊后3小时内开始使用抗生素，以及每公斤30毫升的静脉输液。虽然这些都是重要的参数，但许多急诊科由于各种原因未能达到这些目标，包括血液检查的周转，如血清乳酸盐可能会延迟或需要昂贵的实验室设备。然而，患者通常在就诊后30分钟内进行生命体征评估和测量。这为尖端技术的实施点创造了一个独特的机会，可以显著缩短潜在脓毒症患者的诊断时间，从而更早地开始治疗。除了败血症的早期诊断的实际和临床困难之外，最近的临床试验已经显示当败血症患者过度复苏时具有更高的发病率和死亡率。允许对患者对复苏的生理反应进行更真实的时间监测的技术可以允许在急诊科和重症监护环境中进行更个性化的护理。在床边的一个这样的措施是毛细血管再充盈。这表明有利于区分可能需要或可能不需要复苏的患者子集的能力，并更准确地解释血液值。这是一种公认的远端灌注指标，与脓毒症结局相关。这项体检结果是常规进行的，然而，根据谁在执行它的测量有显着的变化。因此，技术允许快速，客观，无创测量毛细血管再充盈可以提高败血症的识别相比，需要实验室检查，包括乳酸或白色血细胞计数的算法。本文将讨论毛细血管再充盈在复苏护理和脓毒症中的广泛应用，特别是在成人患者中，但也可以应用于儿科。然后，作者将介绍一种新技术，该技术是通过基于问题的创新方法开发的，允许临床医生在床边或急诊科分诊时快速评估终末器官灌注，并将其纳入电子病历。未来的应用程序，以确定病人失代偿在院前和家庭环境中也将进行讨论。这项新技术有三大优势：[1]使用反射光技术进行毛细血管再充盈评估，以提供比透射红外光更深的组织穿透，其信噪比更低，[2]能够显著改善临床结果，而无需对临床工作流程或提供者实践进行大的改变，和[3]它可以由接受过最少培训的个人使用，甚至在资源匮乏的环境中使用，以提高该技术的实用性。应该注意的是，这种观点侧重于毛细血管再充盈在脓毒症护理中的效用，但它可以被认为是评估终末器官灌注的下一个护理标准生命体征。该传感器的最终目标是将其集成到医疗保健系统内的现有监视器中。
Sepsis currently affects over 30 million people globally with a mortality rate of ~30%. Prompt Emergency Department diagnosis and initiation of resuscitation improves outcomes; data has found an 8% increase in mortality for every hour delay in diagnosis. Once sepsis is recognized, the current Surviving Sepsis Guidelines for adult patients mandate the initiation of antibiotics within 3 h of emergency department triage as well as 30 milliliters per kilogram of intravenous fluids. While these are important parameters to follow, many emergency departments fail to meet these goals for a variety of reasons including turnaround on blood tests such as the serum lactate that may be delayed or require expensive laboratory equipment. However, patients routinely have vital signs assessed and measured in triage within 30 min of presentation. This creates a unique opportunity for implementation point for cutting-edge technology to significantly reduce the time to diagnosis of potentially septic patients allowing for earlier initiation of treatment. In addition to the practical and clinical difficulties with early diagnosis of sepsis, recent clinical trials have shown higher morbidity and mortality when septic patients are over-resuscitated. Technology allowing more real time monitoring of a patient's physiologic responses to resuscitation may allow for more individualized care in emergency department and critical care settings. One such measure at the bedside is capillary refill. This has shown favor in the ability to differentiate subsets of patients who may or may not need resuscitation and interpreting blood values more accurately. This is a well-recognized measure of distal perfusion that has been correlated to sepsis outcomes. This physical exam finding is performed routinely, however, there is significant variability in the measurement based on who is performing it. Therefore, technology allowing rapid, objective, non-invasive measurement of capillary refill could improve sepsis recognition compared to algorithms that require lab tests included lactate or white blood count. This manuscript will discuss the broad application of capillary refill to resuscitation care and sepsis in particular for adult patients but much can be applied to pediatrics as well. The authors will then introduce a new technology that has been developed through a problem-based innovation approach to allow clinicians rapid assessment of end-organ perfusion at the bedside or emergency department triage and be incorporated into the electronic medical record. Future applications for identifying patient decompensation in the prehospital and home environment will also be discussed. This new technology has 3 significant advantages: [1] the use of reflected light technology for capillary refill assessment to provide deeper tissue penetration with less signal-to-noise ratio than transmitted infrared light, [2] the ability to significantly improve clinical outcomes without large changes to clinical workflow or provider practice, and [3] it can be used by individuals with minimal training and even in low resource settings to increase the utility of this technology. It should be noted that this perspective focuses on the utility of capillary refill for sepsis care, but it could be considered the next standard of care vital sign for assessment of end-organ perfusion. The ultimate goal for this sensor is to integrate it into existing monitors within the healthcare system.
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影响因子：
8.1
作者：
Hernandez G;Luengo C;Bruhn A;Kattan E;Friedman G;Ospina-Tascon GA;Fuentealba A;Castro R;Regueira T;Romero C;Ince C;Bakker J
通讯作者：
Bakker J
影响因子：
8.1
作者：
Alegria, Leyla;Vera, Magdalena;Hernandez, Glenn
通讯作者：
Hernandez, Glenn
影响因子：
3.7
作者：
Hernandez, Glenn;Pedreros, Cesar;Ince, Can
通讯作者：
Ince, Can
影响因子：
7.1
作者：
Yasufumi, Oi;Morimura, Naoto;Takeuchi, Ichiro
通讯作者：
Takeuchi, Ichiro
影响因子：
15.1
作者：
Jacquet-Lagreze, Matthias;Bouhamri, Nourredine;Fellahi, Jean-Luc
通讯作者：
Fellahi, Jean-Luc