The intricate relationship between capillary refill time and systemic hemodynamics in septic shock.

IF 5.5 1区 医学 Q1 CRITICAL CARE MEDICINE
Glenn Hernandez, Eduardo Kattan, Gustavo Ospina-Tascón, Sebastian Morales, Nicolás Orozco, Gustavo García-Gallardo, Macarena Amthauer, Jing-Chao Luo, Jan Bakker
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Abstract

The emergence and validation of capillary refill time (CRT) as a resuscitation target together with its rapid kinetics of response to increases in systemic blood flow makes it the ideal variable to assess clinical reperfusion and the status of macro-to-microcirculatory coupling in septic shock. Moreover, previous studies have shown that resuscitation can be safely stopped after CRT normalization, thus decreasing the risk of over-resuscitation. From a physiological point of view, CRT is a complex variable integrating microvascular flow and reactivity. Additionally, it may be understood as a dynamic test that evaluates the preservation or disruption of normal responses of the microcirculation to maintain blood flow after transient ischemic challenges. The relationship between systemic hemodynamics and CRT is complex. Indeed, single time-point asssessments of CRT are not able to predict absolute cardiac output values and this is logical since they belong to different phsyiological categories. An abnormal CRT may be explained by insufficient macrohemodynamic resuscitation but also by several derangements at the microvascular level that may preclude CRT normalization, thus signaling a state of macro-to-microcirculatory uncoupling. CRT response to an acute fluid or mean arterial pressure challenge, may not only reveal the adequacy of systemic blood flow but also contribute to tailor interventions to personalize septic shock resuscitation. The lack of CRT response to these challenges discloses a more complex pathophysiological condition that is associated with higher mortality. Further research efforts should be focused on better understanding the factors associated with CRT non-response as a first step to develop a more phsyiologically-based resuscitation, that could eventually improve outcomes.

感染性休克中毛细血管再充血时间与全身血流动力学的复杂关系。
毛细血管再灌注时间(CRT)作为复苏指标的出现和验证,以及它对全身血流量增加的快速反应动力学,使其成为评估脓毒性休克临床再灌注和大循环-微循环耦合状态的理想变量。此外,既往研究表明,在CRT规范化后可以安全地停止复苏,从而降低过度复苏的风险。从生理学的角度来看,CRT是一个集微血管流动和反应性于一体的复杂变量。此外,它可以被理解为一种动态测试,用于评估在短暂性缺血挑战后微循环维持血流的正常反应的保存或破坏。系统血流动力学与CRT之间的关系是复杂的。事实上,CRT的单时间点评估不能预测绝对心输出量,这是合乎逻辑的,因为它们属于不同的生理类别。CRT异常可能是由于大血流动力学复苏不足,但也可能是由于微血管水平的一些紊乱,这些紊乱可能妨碍CRT正常化,从而表明大循环与微循环不耦合的状态。CRT对急性液体或平均动脉压挑战的反应,不仅可以揭示全身血流的充足性,而且有助于定制干预措施,以个性化感染性休克复苏。CRT缺乏对这些挑战的反应揭示了与高死亡率相关的更复杂的病理生理状况。进一步的研究工作应该集中在更好地了解与CRT无反应相关的因素,作为开发更基于生理的复苏的第一步,这可能最终改善结果。
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
Annals of Intensive Care
Annals of Intensive Care CRITICAL CARE MEDICINE-
CiteScore
14.20
自引率
3.70%
发文量
107
审稿时长
13 weeks
期刊介绍: Annals of Intensive Care is an online peer-reviewed journal that publishes high-quality review articles and original research papers in the field of intensive care medicine. It targets critical care providers including attending physicians, fellows, residents, nurses, and physiotherapists, who aim to enhance their knowledge and provide optimal care for their patients. The journal's articles are included in various prestigious databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, OCLC, PubMed, PubMed Central, Science Citation Index Expanded, SCOPUS, and Summon by Serial Solutions.
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