Hostname: page-component-77c89778f8-fv566 Total loading time: 0 Render date: 2024-07-17T07:49:33.675Z Has data issue: false hasContentIssue false
  • English
  • Français

Cut-Off Value of Capillary Refill Time for Peripheral Circulatory Failure Diagnosis

Published online by Cambridge University Press:  05 June 2023

Masayoshi Shinozaki Open the ORCID record for Masayoshi Shinozaki [Opens in a new window] ,
Taka-aki Nakada ,
Daiki Saito ,
Keisuke Tomita ,
Yukihiro Nomura  and
Toshiya Nakaguchi
Masayoshi Shinozaki*
Affiliation:
Department of Medical Engineering, Graduate School of Science and Engineering, Chiba University, Chiba, Japan
Taka-aki Nakada
Affiliation:
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Daiki Saito
Affiliation:
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Keisuke Tomita
Affiliation:
Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
Yukihiro Nomura
Affiliation:
Center for Frontier Medical Engineering, Chiba University, Chiba, Japan Department of Computational Diagnostic Radiology and Preventive Medicine, The University of Tokyo Hospital, Tokyo, Japan
Toshiya Nakaguchi
Affiliation:
Center for Frontier Medical Engineering, Chiba University, Chiba, Japan
*
Correspondence: Masayoshi Shinozaki Department of Medical Engineering Graduate School of Science and Engineering Chiba University 1-33, Yayoicho, Inage-ku, Chiba-shi, Chiba, 263-8522 Japan E-mail: shinozaki.masayoshi@chiba-u.jp
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Capillary refill time (CRT) is an indicator of peripheral circulation and is recommended in the 2021 guidelines for treating and managing sepsis.

Study Objective:

This study developed a portable device to realize objective CRT measurement. Assuming that peripheral blood flow obstruction by the artery occlusion test (AOT) or venous occlusion test (VOT) increases the CRT, the cut-off value for peripheral circulatory failure was studied by performing a comparative analysis with CRT with no occlusion test (No OT).

Methods:

Fourteen (14) healthy adults (age: 20–26 years) participated in the study. For the vascular occlusion test, a sphygmomanometer was placed on the left upper arm of the participant in the supine position, and a pressure of 30mmHg higher than the systolic pressure was applied for AOT, a pressure of 60mmHg was applied for VOT, respectively, and no pressure was applied for No OT. The CRT was measured from the index finger of the participant’s left hand.

Results:

Experimental results revealed that CRT was significantly longer in the AOT and did not differ significantly in the VOT. The cut-off value for peripheral circulatory failure was found to be 2.88 seconds based on Youden’s index by using receiver operating characteristic (ROC) analysis with AOT as positive and No OT as negative.

Conclusion:

Significant results were obtained in a previous study on the evaluation of septic shock patients when CRT > three seconds was considered abnormal, and the cut-off value for peripheral circulatory failure in the current study validated this.

Keywords

capillary refill timecut-off valuemeasurement deviceocclusion testperipheral circulatory failure
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 38 , Issue 3 , June 2023 , pp. 319 - 325
Check for updates
Copyright
© The Author(s), 2023. Published by Cambridge University Press on behalf of the World Association for Disaster and Emergency Medicine

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Evans, L, Rhodes, A, Alhazzani, W, et al. Surviving sepsis campaign: international guidelines for management of sepsis and septic shock 2021. Intensive Care Med. 2021;47(11):1181–1247.CrossRefGoogle Scholar
Kawaguchi, R, Nakada, TA, Oshima, T, et al. Optimal pressing strength and time for capillary refilling time. Crit Care. 2019;23(1):4.CrossRefGoogle ScholarPubMed
Shinozaki, M, Nakada, TA, Kawaguchi, R, et al. Feedback function for capillary refilling time measurement device. Crit Care. 2019;23(1):295.CrossRefGoogle ScholarPubMed
Shinozaki, M, Shimizu, R, Saito, D, et al. Portable measurement device to quantitatively measure capillary refilling time. Artif Life Robotics. 2022;27:48–57.CrossRefGoogle Scholar
Bruins, AA, Geboers, DGPJ, Bauer, JR, et al. The vascular occlusion test using multispectral imaging: a validation study: The VASOIMAGE study. J Clin Monit Comput. 2021;35(1):113–121.CrossRefGoogle ScholarPubMed
Davies, L, Gather, U. The identification of multiple outliers. J American Statistical Association. 1993;88(44):782–792.CrossRefGoogle Scholar
Otsu, N. A threshold selection method from gray-level histograms. IEEE Transactions on Systems, Man, and Cybernetics. 1979;9(1):62–66.CrossRefGoogle Scholar
Casavola, C, Paunescu, LA, Fantini, S, et al. Application of near-infrared tissue oximetry to the diagnosis of peripheral vascular disease. Clin Hemorheol Microcirc. 1999;21(3-4):389–393.Google Scholar
The R project for Statistical Computing. R 4.2.2 version [software]. Vienna, Austria. https://www.r-project.org/. Accessed April 14, 2023.Google Scholar
Posit. Tidyverse. 1.3.2 version [software]. Boston, Massachusetts USA. https://www.tidyverse.org/. Accessed April 14, 2023.Google Scholar
Python Software Foundation. Python 3.8.10 version [software]. Wilmington, Delaware USA. https://www.python.org/psf/records/incorporation/. Accessed April 14, 2023.Google Scholar
NumFOCUS. Pandas 1.5.2 version [software], Matplotlib 3.6.2 version [software], Sklearn 0.0.post1 version [software]. Austin, Texas USA. https://numfocus.org/sponsored-projects. Accessed April 14, 2023.Google Scholar
Youden, WJ. Index for rating diagnostic tests. Cancer. 1950;3(1):32–35.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Espinoza, ED, Welsh, S, Dubin, A. Lack of agreement between different observers and methods in the measurement of capillary refill time in healthy volunteers: an observational study. Rev Bras Ter Intensiva. 2014;26(3):269–276.CrossRefGoogle ScholarPubMed
Sheridan, DC, Baker, SD, Kayser, SA, Jones, D, Hansen, ML. Variability of capillary refill time among physician measurements. J Emerg Med. 2017;53(5):51–57.CrossRefGoogle ScholarPubMed
Lara, B, Enberg, L, Ortega, M, et al. Capillary refill time during fluid resuscitation in patients with sepsis-related hyperlactatemia at the emergency department is related to mortality. PloS One. 2017;12(11):e0188548.CrossRefGoogle ScholarPubMed
Sebat, C, Vandegrift, MA, Oldroyd, S, Kramer, A, Sebat, F. Capillary refill time as part of an early warning score for rapid response team activation is an independent predictor of outcomes. Resuscitation. 2020;153:105–110.CrossRefGoogle ScholarPubMed
Ait-Oufella, H, Bige, N, Boelle, PY, et al. Capillary refill time exploration during septic shock. Intensive Care Med. 2014;40(7):958–964.CrossRefGoogle ScholarPubMed
Hernández, G, Ospina-Tascón, GA, Damiani, LP, et al. Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: The ANDROMEDA-SHOCK randomized clinical trial. JAMA. 2019;321(7):654–664.CrossRefGoogle ScholarPubMed
Pickard, A, Karlen, W, Ansermino, JM. Capillary refill time: is it still a useful clinical sign? Anesth Analg. 2011;113(1):120–123.CrossRefGoogle Scholar