Perspectives for capillary refill time in clinical practice for sepsis

IF 4.9 2区 医学 Q1 NURSING
Weipeng Huang , Yiyan Huang , Li Ke , Chang Hu , Pengyu Chen , Bo Hu
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Abstract

Background

Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. Recent studies demonstrated the benefits of CRT in guiding fluid therapy for sepsis. However, lack of consistency among physicians in how to perform and interpret CRT has led to a low interobserver agreement for this assessment tool, which prevents its availability in sepsis clinical settings.

Objective

To give physicians a concise overview of CRT and explore recent evidence on its reliability and value in the management of sepsis.

Research design

A narrative review.

Results

This narrative review summarizes the factors affecting CRT values, for example, age, sex, temperature, light, observation techniques, work experience, training level and differences in CRT measurement methods. The methods of reducing the variability of CRT are synthesized. Based on studies with highly reproducible CRT measurements and an excellent inter-rater concordance, we recommend the standardized CRT assessment method. The threshold of normal CRT values is discussed. The application of CRT in different phases of sepsis management is summarized.

Conclusions

Recent data confirm the value of CRT in critically ill patients. CRT should be detected by trained physicians using standardized methods and reducing the effect of ambient-related factors. Its association with severe infection, microcirculation, tissue perfusion response, organ dysfunction and adverse outcomes makes this approach a very attractive tool in sepsis. Further studies should confirm its value in the management of sepsis.

Implications for clinical practice

As a simple assessment, CRT deserves more attention even though it has not been widely applied at the bedside. CRT could provide nursing staff with patient’s microcirculatory status, which may help to develop individualized nursing plans and improve the patient’s care quality and treatment outcomes.

脓毒症临床实践中毛细血管再充盈时间的前景
背景毛细血管再充盈时间(CRT)是指施加压力导致毛细血管床发白后颜色恢复到外部毛细血管床所需的时间。最近的研究表明,CRT 有助于指导败血症的输液治疗。研究设计一篇叙事性综述。结果这篇叙事性综述总结了影响 CRT 值的因素,如年龄、性别、温度、光线、观察技术、工作经验、培训水平和 CRT 测量方法的差异。综述了减少 CRT 变异性的方法。根据具有高度可重复性的 CRT 测量和极好的评分者间一致性的研究,我们推荐使用标准化 CRT 评估方法。讨论了 CRT 正常值的阈值。结论最近的数据证实了 CRT 在重症患者中的价值。CRT 应由训练有素的医生使用标准化方法检测,并减少环境相关因素的影响。CRT 与严重感染、微循环、组织灌注反应、器官功能障碍和不良预后有关,因此这种方法在败血症中是一种非常有吸引力的工具。对临床实践的启示 作为一种简单的评估方法,CRT 值得更多关注,尽管它尚未在床边得到广泛应用。CRT 可为护理人员提供患者的微循环状况,有助于制定个性化护理计划,提高患者的护理质量和治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
6.30
自引率
15.10%
发文量
144
审稿时长
57 days
期刊介绍: The aims of Intensive and Critical Care Nursing are to promote excellence of care of critically ill patients by specialist nurses and their professional colleagues; to provide an international and interdisciplinary forum for the publication, dissemination and exchange of research findings, experience and ideas; to develop and enhance the knowledge, skills, attitudes and creative thinking essential to good critical care nursing practice. The journal publishes reviews, updates and feature articles in addition to original papers and significant preliminary communications. Articles may deal with any part of practice including relevant clinical, research, educational, psychological and technological aspects.
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