Capillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study

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dc.catalogadorpau
dc.contributor.authorHernández, Glenn
dc.contributor.authorValenzuela, Emilio Daniel
dc.contributor.authorKattan, Eduardo
dc.contributor.authorCastro, Ricardo
dc.contributor.authorGuzmán, Camila
dc.contributor.authorKraemer, Alicia Elzo
dc.contributor.authorSarzosa, Nicolás
dc.contributor.authorAlegria, Leyla
dc.contributor.authorContreras, Roberto
dc.contributor.authorOviedo, Vanessa
dc.contributor.authorBravo, Sebastián
dc.contributor.authorSoto, Dagoberto
dc.contributor.authorSáez, Claudia
dc.contributor.authorAit-Oufella, Hafid
dc.contributor.authorOspina Tascón, Gustavo
dc.contributor.authorBakker, Jan
dc.date.accessioned2024-04-09T19:19:32Z
dc.date.available2024-04-09T19:19:32Z
dc.date.issued2024
dc.date.updated2024-04-07T00:04:37Z
dc.description.abstractBackground: Several 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. Methods Thirty-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). Results CRT 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. Conclusions Our 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.
dc.fechaingreso.objetodigital2024-04-09
dc.format.extent7 páginas
dc.fuente.origenAutoarchivo
dc.identifier.citationAnnals of Intensive Care. 2024 Apr 01;14(1):49
dc.identifier.doi10.1186/s13613-024-01275-5
dc.identifier.urihttps://doi.org/10.1186/s13613-024-01275-5
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/85008
dc.identifier.wosidWOS:001195631900003
dc.information.autorucEscuela de Medicina; Hernández, Glenn; 0000-0002-3032-4087; 98874
dc.information.autorucEscuela de Medicina; Valenzuela, Emilio Daniel; 0000-0001-9758-3473; 1056714
dc.information.autorucEscuela de Medicina; Kattan, Eduardo; 0000-0002-1997-6893; 172152
dc.information.autorucEscuela de Medicina; Castro, Ricardo; 0000-0002-0978-9891; 4537
dc.information.autorucEscuela de Medicina; Sarzosa, Nicolás; S/I; 1027996
dc.information.autorucEscuela de Medicina; Alegria, Leyla; 0000-0002-0930-4452; 121090
dc.information.autorucEscuela de Medicina; Oviedo, Vanessa; S/I; 1009275
dc.information.autorucEscuela de Medicina; Soto, Dagoberto; S/I; 1008458
dc.information.autorucEscuela de Medicina; Bakker, Jan; 0000-0003-2236-7391; 1044227
dc.issue.numero49
dc.language.isoen
dc.nota.accesoContenido completo
dc.revistaAnnals of Intensive Care
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subjectCapillary refill time
dc.subjectSeptic shock
dc.subjectFluid challenge
dc.subjectVasopressor test
dc.subjectPerfusion
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.ods03 Good health and well-being
dc.subject.odspa03 Salud y bienestar
dc.titleCapillary refill time response to a fluid challenge or a vasopressor test: an observational, proof-of-concept study
dc.typeartículo
dc.volumen14
sipa.codpersvinculados98874
sipa.codpersvinculados1056714
sipa.codpersvinculados172152
sipa.codpersvinculados4537
sipa.codpersvinculados1027996
sipa.codpersvinculados121090
sipa.codpersvinculados1009275
sipa.codpersvinculados1008458
sipa.codpersvinculados1044227
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