{"title":"对儿科毛细血管再充盈时间测量的自动手指按压法进行评估。","authors":"Amanda J Nickel, Shen Jiang, Natalie Napolitano, Aaron Donoghue, Vinay M Nadkarni, Akira Nishisaki","doi":"10.1097/PEC.0000000000003183","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Early shock reversal is crucial to improve patient outcomes. Capillary refill time (CRT) is clinically important to identify and monitor shock in children but has issues with inconsistency. To minimize inconsistency, we evaluated a CRT monitoring system using an automated compression device. Our objective was to determine proper compression pressure in children.</p><p><strong>Methods: </strong>Clinician force for CRT was collected during manual CRT measurement as a reference for automated compression in a previous study (12.9 N, 95% confidence interval, 12.5-13.4; n = 454). An automated compression device with a soft inflation bladder was fitted with a force sensor. We evaluated the effectiveness of the automated pressure to eliminate pulsatile blood flow from the distal phalange. Median and variance of CRT analysis at each pressure was compared.</p><p><strong>Results: </strong>A comparison of pressures at 300 to 500 mm Hg on a simulated finger yielded a force of 5 to 10 N, and these pressures were subsequently used for automated compression for CRT. Automated compression was tested in 44 subjects (median age, 33 months; interquartile range [IQR], 14-56 months). At interim analysis of 17 subjects, there was significant difference in the waveform with residual pulsatile blood flow (9/50: 18% at 300 mm Hg, 5/50:10% at 400 mm Hg, 0/51: 0% at 500 mm Hg, P = 0.008). With subsequent enrollment of 27 subjects at 400 and 500 mm Hg, none had residual pulsatile blood flow. There was no difference in the CRT: median 1.8 (IQR, 1.06-2.875) in 400 mm Hg vs median 1.87 (IQR, 1.25-2.8325) in 500 mm Hg, P = 0.81. The variance of CRT was significantly larger in 400 mm Hg: 2.99 in 400 mm Hg vs. 1.35 in 500 mm Hg, P = 0.02, Levene's test. Intraclass correlation coefficient for automated CRT was 0.56 at 400 mm Hg and 0.78 at 500 mm Hg.</p><p><strong>Conclusions: </strong>Using clinician CRT measurement data, we determined either 400 or 500 mm Hg is an appropriate pressure for automated CRT, although 500 mm Hg demonstrates superior consistency.</p>","PeriodicalId":19996,"journal":{"name":"Pediatric emergency care","volume":null,"pages":null},"PeriodicalIF":1.2000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Evaluation of Automated Finger Compression for Capillary Refill Time Measurement in Pediatrics.\",\"authors\":\"Amanda J Nickel, Shen Jiang, Natalie Napolitano, Aaron Donoghue, Vinay M Nadkarni, Akira Nishisaki\",\"doi\":\"10.1097/PEC.0000000000003183\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Early shock reversal is crucial to improve patient outcomes. Capillary refill time (CRT) is clinically important to identify and monitor shock in children but has issues with inconsistency. To minimize inconsistency, we evaluated a CRT monitoring system using an automated compression device. Our objective was to determine proper compression pressure in children.</p><p><strong>Methods: </strong>Clinician force for CRT was collected during manual CRT measurement as a reference for automated compression in a previous study (12.9 N, 95% confidence interval, 12.5-13.4; n = 454). An automated compression device with a soft inflation bladder was fitted with a force sensor. We evaluated the effectiveness of the automated pressure to eliminate pulsatile blood flow from the distal phalange. Median and variance of CRT analysis at each pressure was compared.</p><p><strong>Results: </strong>A comparison of pressures at 300 to 500 mm Hg on a simulated finger yielded a force of 5 to 10 N, and these pressures were subsequently used for automated compression for CRT. Automated compression was tested in 44 subjects (median age, 33 months; interquartile range [IQR], 14-56 months). At interim analysis of 17 subjects, there was significant difference in the waveform with residual pulsatile blood flow (9/50: 18% at 300 mm Hg, 5/50:10% at 400 mm Hg, 0/51: 0% at 500 mm Hg, P = 0.008). With subsequent enrollment of 27 subjects at 400 and 500 mm Hg, none had residual pulsatile blood flow. There was no difference in the CRT: median 1.8 (IQR, 1.06-2.875) in 400 mm Hg vs median 1.87 (IQR, 1.25-2.8325) in 500 mm Hg, P = 0.81. The variance of CRT was significantly larger in 400 mm Hg: 2.99 in 400 mm Hg vs. 1.35 in 500 mm Hg, P = 0.02, Levene's test. Intraclass correlation coefficient for automated CRT was 0.56 at 400 mm Hg and 0.78 at 500 mm Hg.</p><p><strong>Conclusions: </strong>Using clinician CRT measurement data, we determined either 400 or 500 mm Hg is an appropriate pressure for automated CRT, although 500 mm Hg demonstrates superior consistency.</p>\",\"PeriodicalId\":19996,\"journal\":{\"name\":\"Pediatric emergency care\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":1.2000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Pediatric emergency care\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/PEC.0000000000003183\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/6/14 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q3\",\"JCRName\":\"EMERGENCY MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Pediatric emergency care","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/PEC.0000000000003183","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/6/14 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"EMERGENCY MEDICINE","Score":null,"Total":0}
引用次数: 0
摘要
目的:尽早逆转休克对改善患者预后至关重要。毛细血管再充盈时间(CRT)对于识别和监测儿童休克具有重要的临床意义,但存在不一致的问题。为了尽量减少不一致性,我们对使用自动加压装置的 CRT 监测系统进行了评估。我们的目标是确定儿童的适当按压压力:方法:在之前的一项研究中,临床医生在手动测量 CRT 时收集了 CRT 的压力,作为自动加压的参考(12.9 N,95% 置信区间,12.5-13.4;n = 454)。带有软充气囊的自动加压装置安装有压力传感器。我们评估了自动加压消除远端指骨搏动性血流的效果。比较了每种压力下 CRT 分析的中位数和方差:在模拟手指上比较 300 至 500 mm Hg 的压力可产生 5 至 10 N 的力,这些压力随后被用于 CRT 的自动加压。44 名受试者(中位年龄为 33 个月;四分位距 [IQR],14-56 个月)接受了自动按压测试。在对 17 名受试者进行中期分析时,残余搏动性血流波形存在显著差异(9/50:300 mm Hg 时为 18%;5/50:400 mm Hg 时为 10%;0/51:500 mm Hg 时为 0%,P = 0.008)。随后又有 27 名受试者在 400 毫米汞柱和 500 毫米汞柱时出现了残余搏动性血流。CRT 没有差异:400 mm Hg 中位数为 1.8(IQR,1.06-2.875),500 mm Hg 中位数为 1.87(IQR,1.25-2.8325),P = 0.81。400毫米汞柱时 CRT 的方差明显更大:400毫米汞柱时为2.99,500毫米汞柱时为1.35,P = 0.02,Levene检验。自动 CRT 在 400 mm Hg 时的类内相关系数为 0.56,在 500 mm Hg 时为 0.78:利用临床医生的 CRT 测量数据,我们确定 400 或 500 mm Hg 都是自动 CRT 的合适压力,但 500 mm Hg 的一致性更好。
Evaluation of Automated Finger Compression for Capillary Refill Time Measurement in Pediatrics.
Objectives: Early shock reversal is crucial to improve patient outcomes. Capillary refill time (CRT) is clinically important to identify and monitor shock in children but has issues with inconsistency. To minimize inconsistency, we evaluated a CRT monitoring system using an automated compression device. Our objective was to determine proper compression pressure in children.
Methods: Clinician force for CRT was collected during manual CRT measurement as a reference for automated compression in a previous study (12.9 N, 95% confidence interval, 12.5-13.4; n = 454). An automated compression device with a soft inflation bladder was fitted with a force sensor. We evaluated the effectiveness of the automated pressure to eliminate pulsatile blood flow from the distal phalange. Median and variance of CRT analysis at each pressure was compared.
Results: A comparison of pressures at 300 to 500 mm Hg on a simulated finger yielded a force of 5 to 10 N, and these pressures were subsequently used for automated compression for CRT. Automated compression was tested in 44 subjects (median age, 33 months; interquartile range [IQR], 14-56 months). At interim analysis of 17 subjects, there was significant difference in the waveform with residual pulsatile blood flow (9/50: 18% at 300 mm Hg, 5/50:10% at 400 mm Hg, 0/51: 0% at 500 mm Hg, P = 0.008). With subsequent enrollment of 27 subjects at 400 and 500 mm Hg, none had residual pulsatile blood flow. There was no difference in the CRT: median 1.8 (IQR, 1.06-2.875) in 400 mm Hg vs median 1.87 (IQR, 1.25-2.8325) in 500 mm Hg, P = 0.81. The variance of CRT was significantly larger in 400 mm Hg: 2.99 in 400 mm Hg vs. 1.35 in 500 mm Hg, P = 0.02, Levene's test. Intraclass correlation coefficient for automated CRT was 0.56 at 400 mm Hg and 0.78 at 500 mm Hg.
Conclusions: Using clinician CRT measurement data, we determined either 400 or 500 mm Hg is an appropriate pressure for automated CRT, although 500 mm Hg demonstrates superior consistency.
期刊介绍:
Pediatric Emergency Care®, features clinically relevant original articles with an EM perspective on the care of acutely ill or injured children and adolescents. The journal is aimed at both the pediatrician who wants to know more about treating and being compensated for minor emergency cases and the emergency physicians who must treat children or adolescents in more than one case in there.