Capillary Refill Research Articles

Effect of norepinephrine on the vascular waterfall and tissue perfusion in vasoplegic hypotensive patients: a prospective, observational, applied physiology study in cardiac surgery

BackgroundNorepinephrine is a commonly used drug for treating vasoplegic acute circulatory failure in ICU. The prediction of norepinephrine macro- and micro-circulatory response is complicated by its uneven receptors’ distribution between the arterial and the venous structures, and by the presence of a physiological vascular waterfall (VW) that disconnects the arterial and the venous circulation in two pressure systems. The objectives of this study were to describe the VW in patients with arterial hypotension due to vasodilatory circulatory shock, and its behavior according to its response to norepinephrine infusion.MethodsA prospective, observational, bi-centric study has included adult patients, for whom the physician decided to initiate norepinephrine during the six first hours following admission to the ICU after cardiac surgery, and unresponsive to a fluid challenge. The mean systemic pressure (MSP) and the critical closing pressure (CCP) were measured at inclusion and after norepinephrine infusion.ResultsThirty patients were included. Norepinephrine increased arterial pressure and total peripheral resistances in all cohort. The cohort was dichotomized as VW responders (patients with a change of VW over the least significant change (≥ 93% increase in VW)), and as VW non-responders. In 19 (63%) of the 30 patients, VW increased from 3.47 [− 14.43;7.71] mmHg to 43.6 [25.8;48.1] mmHg, p < 0.001) with norepinephrine infusion, being classified as VW responders. The VW responders improved cardiac index (from 1.8 (0.6) L min−1 m−2 to 2.2 (0.5) L min−1 m−2, p = 0.002), capillary refill time (from to 4.2 (1.1) s to 3.1 (1) s, p = 0.006), and pCO2 gap (from 9 [7;10] mmHg to 6 [4;8] mmHg, p = 0.04). No baseline parameters were able to predict the VW response to norepinephrine. In comparison, VW non-responders did not significantly change the VW (from 5 [-5;16] mmHg to -2 [-12;15] mmHg, p = 0.17), cardiac index (from 1.6 (0.3) L min−1 m−2 to 1.8 (0.4) L min−1 m−2, p = 0.09) and capillary refill time (from 4.1 (1) s to 3.7 (1.4), p = 0.44).ConclusionsIn post-cardiac surgery patients with vasoplegic arterial hypotension, the vascular waterfall is low. Norepinephrine did not systematically restore the vascular waterfall. Increase of the vascular waterfall was associated with an improvement of laboratory and clinical parameters of tissue perfusion.

Remote photoplethysmography and automated capillary refill time technique for microcirculation assessment in septic shock patients

Remote photoplethysmography and automated capillary refill time technique for microcirculation assessment in septic shock patients

Early Diagnosis of Acute Myocarditis or Dilated Cardiomyopathy in Children Younger Than 2 Years.

Diagnosis of acute myocarditis or dilated cardiomyopathy (DCM) on initial presentation is difficult in children younger than 2 years because most present with complaints suggestive of a respiratory infection. The objective of this study is to determine whether signs, symptoms, and diagnostic studies excluding those of heart failure, done routinely in the emergency department could distinguish children younger than 2 years with acute myocarditis or DCM from those with respiratory illnesses. Sixty-four infants' charts, 32 cases and 32 controls, were reviewed from January 1, 2009, through December 31, 2020. Controls were matched to cases with respect to age, reason, and time of admission. Signs, symptoms, and blood gases were reviewed. The median age is 6.5 (0.5-22) months in both groups. Infants presenting with signs of heart failure including murmurs ( P = 0.002), prolonged capillary refill ( P = 0.024), cool, mottled extremities ( P = 0.002), poor perfusion ( P = 0.001), or hepatomegaly ( P < 0.001) were more likely to be diagnosed with acute myocarditis or DCM when compared with the control group with respiratory disease. Infants with fever ( P = 0.017), nasal congestion ( P < 0.001), rhinorrhea ( P < 0.001), cough ( P < 0.001), and wheezing ( P < 0.001) were more likely to have a respiratory illness than acute myocarditis or DCM. The presence of a lower p co2 (30 [14-116] vs 40 [31-59] mm Hg, P < 0.001), lower bicarbonate (16.7 [6.3-23.4] vs 21.7 [16-28.4], P < 0.001), or an oxygen saturation > 95% ( P = 0.004) was observed in infants with acute myocarditis or DCM compared with those with respiratory illness. By multivariable analysis, infants with tachycardia in the absence of fever, metabolic acidosis, and an oxygen saturation > 95% were more likely to have acute myocarditis or DCM than those without this disease. Children younger than 2 years presenting to the emergency department with tachycardia and no fever, metabolic acidosis, and a high oxygen saturation should be investigated for acute myocarditis or DCM.

Skin-color-independent robust assessment of capillary refill time.

Capillary Refill Time (CRT) assesses peripheral perfusion in resource-limited settings. However, the repeatability and reproducibility of CRT measurements are limited for individuals with darker skin. This paper presents quantitative CRT measurements demonstrating good performance and repeatability across all Fitzpatrick skin phototypes. The study involved 22 volunteers and utilized controlled compression at 7 kPa, an RGB video camera, and cocircular polarized white LED light. CRT was determined by calculating the time constant of an exponential regression applied to the mean pixel intensity of the green (G) channel. An adaptive algorithm identifies the optimal regression region for noise reduction, and flags inappropriate readings. The results indicate that 80% of the CRT readings fell within a 20% range of the expected CRT value. The repetition standard deviation was 17%. These findings suggest the potential for developing reliable and reproducible quantitative CRT methods for robust measurements in patient triage, monitoring, and telehealth applications.

Development of the national Dutch PEWS: the challenge against heterogeneity and implementation difficulties of PEWS in the Netherlands

BackgroundFor the early recognition of deteriorating patients several Pediatric Early Warning Score (PEWS) systems have been developed with the assumption that early detection can prevent further deterioration. Although PEWS are widely being used in hospitals in the Netherlands, there is no national consensus on which score to use and how to embed the score into a PEWS system. This resulted in a substantial heterogeneity of PEWS systems, of which many are unvalidated or self-designed. The primary objective of this study was to develop a pragmatic consensus-based PEWS system that can be utilized in all Dutch hospitals (University Medical Centers, teaching hospitals, and general hospitals).MethodsThis study is an iterative mixed-methods study. The methods from the Core Outcome Measures in Effectiveness Trials (COMET) initiative were used and consisted of two Delphi rounds, two inventories set out to all Dutch hospitals and a focus group session with parents. The study was guided by five expert meetings with different stakeholders and a final consensus meeting that resulted in a core PEWS set.ResultsThe first Delphi round was completed by 292 healthcare professionals, consisting of pediatric nurses and physicians. In the second Delphi round 217 healthcare professionals participated. Eventually, the core PEWS set was been developed comprising of the parameters work of breathing, respiratory rate, oxygen therapy, heart rate and capillary refill time, and AVPU (Alert, Verbal, Pain, and Unresponsive). In addition, risk stratification was added to the core set with standardized risk factors consisting of [1] worried signs from healthcare professionals and parents and [2] high-risk treatment, with the option to add applicable local defined risk factors. Lastly, the three categories of risk stratification were defined (standard, medium, and high risk) in combination with standardized actions of the professionals for each category.ConclusionThis study demonstrates a way to end a country’s struggle with PEWS heterogeneity by co-designing a national Dutch PEWS system. Currently, the power of the system is being investigated in a large multi-center study in the Netherlands.

Development and internal validation of a Neonatal Healthcare-associated infectiOn Prediction score (NeoHoP score) for very low birthweight infants in low-resource settings: a retrospective case–control study

Background and objectivesEarly diagnosis of neonatal infection is essential to prevent serious complications and to avoid unnecessary use of antibiotics. The prevalence of healthcare-associated infections (HAIs) among very low birthweight...

Machine Learning Analysis of Association of Capillary Refill Time With In-Hospital Mortality in Cardiogenic Shock Patients

Machine Learning Analysis of Association of Capillary Refill Time With In-Hospital Mortality in Cardiogenic Shock Patients

TREATMENT OF GIARDIASIS IN DOMESTIC CATS

Giardiasis is a disease caused by Giardia sp. a protozoan which infects the small intestine causing non-specific diarrhea in humans and other mammals. This article aims to help readers find out the causes of giardiasis in cats, and how to treat cases of giardiasis in cats. A 1-year-old queen named Qaqa that weighs 2.15 kg had suffered diarrhea for a month. Previously, the cat had been given an antidiarrheal drug called Guanistrep which helped in reducing the frequency of diarrhea but after finishing the drug, the diarrhea recurred. Clinical examination showed the cat experience inflammation on the anus, slow capillary refill time (CRT), and increased body temperature but there was no indication that the cat was dehydrated. Examination of the feces found the presence of the protozoa Giardia sp. The Hematological examination of the cat indicates leukocytosis, monocytosis, and granulocytosis. The cat was diagnosed with Giardiasis. The therapy given is the administration of Metronidazole, Nutria Gel Plus, and Guanistrep which all were given orally. Two weeks after the administration of the medication, the frequency of the cat's defecation decreased and the feces had a solid consistency. To avoid Giardia sp. infection, owners need to be educated on how to properly care for their cat’s by providing drinking water with mineral water and limiting the interaction with wild animals, as well as maintaining the cleanliness of the cat's residence, especially where the cat eats and drinks.

Ultrasonographic measurement of caudal vena cava to aorta ratio during fluid resuscitation of dogs with spontaneous circulatory shock.

To describe the change in the caudal vena cava to aorta ratio (CVC:Ao) ratio during fluid resuscitation of circulatory shock in dogs and compare these results with those of the physical examination and blood lactate. Perfusion parameters and blood lactate were recorded at admission. An abdominal point-of-care ultrasound protocol was performed, during which the caudal vena cava to aorta ratio was measured on the spleno-renal view. Measurements were performed within 5 minutes before and after a 10 mL/kg crystalloid fluid bolus. Investigators were not blinded to therapeutic interventions. Twenty-nine dogs with physical signs of circulatory shock were enrolled. Caudal vena cava to aorta ratios were below reference interval in 28 of 29 dogs. After bolus administration, median caudal vena cava diameter increased by 0.14 cm (0.69 to 0.83 cm) and median aorta diameter increased by 0.03 cm (0.87 to 0.90 cm) and caudal vena cava to aorta ratio returned to within reference range in 65% of dogs (13/29). Bolus administration was associated with an increase in median caudal vena cava to aorta ratio of 0.10 (95% CI:0.05 to 0.16, P=0.0005). Blood lactate did not change significantly. Heart rate and capillary refill time decreased significantly after fluid bolus (heart rate: estimate=-19 bpm, 95% CI:-30 to -8, P=0.002; capillary refill time: estimate=-1.0 s, 95% CI:-1.3 to -0.7, P < 0.0001). In this population of dogs with circulatory shock, the caudal vena cava to aorta ratio significantly increased after a fluid bolus. Future studies that implement blinding of the outcome assessors are warranted to confirm these findings.

Clinical evaluation of peripheral tissue perfusion as a predictor of mortality in sepsis and septic shock in the intensive care unit: Systematic review and meta-analysis

ObjectiveTo determine the diagnostic performance of the clinical evaluation of peripheral tissue perfusion in the prediction of mortality. DesignSystematic review and meta-analysis. SettingIntensive care unit. Patients and participantsPatients with sepsis and septic shock. InterventionsStudies of patients with sepsis and/or septic shock that associated clinical monitoring of tissue perfusion with mortality were included. A systematic review was performed by searching the PubMed/MEDLINE, Cochrane Library, SCOPUS, and OVID databases. Main variables of interestThe risk of bias was assessed with the QUADAS-2 tool. Sensitivity and specificity were calculated to evaluate the predictive accuracy for mortality. Review Manager software version 5.4 was used to draw the forest plot graphs, and Stata version 15.1 was used to build the hierarchical summary receiver operating characteristic model. ResultsThirteen studies were included, with a total of 1667 patients and 17 analyses. Two articles evaluated the temperature gradient, four evaluated the capillary refill time, and seven evaluated the mottling in the skin. In most studies, the outcome was mortality at 14 or 28 days. The pooled sensitivity of the included studies was 70%, specificity 75.9% (95% CI, 61.6%–86.2%), diagnostic odds ratio 7.41 (95% CI, 3.91–14.04), and positive and negative likelihood ratios 2.91 (95% CI, 1.80–4.72) and 0.39 (95% CI, 0.30–0.51), respectively. ConclusionsClinical evaluation of tissue perfusion at the bedside is a useful tool, with moderate sensitivity and specificity, to identify patients with a higher risk of death among those with sepsis and septic shock. RegistrationPROSPERO CRD42019134351.

Vitamin D-dependent Rickets Type II

The work aimed to present one case with vitamin D-dependent rickets type II, treated at Nasser Hospital – in the Gaza Strip. The patient was 3 years old with a body weight of 8.5 kg and a height of 90 CM. Skin color was cyanotic, but skin moisture was dry. Body temperature was 39 C from axillary; Turgor was warm and rough. The texture of vascularity was ecchymosis. The patient was on NGT and ETT and had alopecia in their hair. His Nails color was pale but was clubbing in shape. Deformity in the head and face; his eyes are symmetrical, but he is blind with corneal opacities bilateral, about ears are symmetrical auricles and gross hearing acuity. Mouth mucous membrane was moist but had ulcers and infection; teeth were missing, and tongues cyanotic and cracked. He has dysphagia, dyspepsia and hoarseness of voice. Full range of motion of the neck. Carotid pulsation rate 160 b/min symmetrical and bounding, cervical lymph nodes are enlarged and tender. Respiratory rate 40 b/min, barrel chest and abnormal breathing pattern. The patient complained of productive cough, on percussion, lung sound was dullness, but in auscultation, bilateral wheezy; apical heart rate was 140 b/min regular and strong. His blood pressure was 130/83 mm Hg. Capillary refill was 3 seconds. Normal heart sounds. The abdomen was soft and relaxed but distended. A genitalia was normal, About range of motion was limited and flaccid motor response.M. Aker 3 years old of cons. marriage 1st cousin, the second order of birth; the chief complaint was Rickets Type 2, which is badly responding to vit D. The Personal history of this disease was discovered when he was two months old with a history of sibling died at the age of 4 years (his sister), at birth. The patient was normal without any symptoms, and at the age of two months, he started the symptoms; 1st one was hair loss with fragile bone. With investigation, there is Vit D deficiency, so calcium supplement and Vit D were given; at the age of one year, the condition worsened, and bones were more fragile with bowing of legs, so doctors advised increasing the dose of Vit D and calcium with calciless treatment, but the immune system suppressed, and he got a lot of chest infections, so hospital admission many times with intravenous antibiotics, sometimes he was intubated on Mechanical ventilation in pediatric (I c u ), on 2 years, he was Oxygen-dependent then later he developed Respiratory Failure, at 3 year pt. was complaining severe chest infection and was intubated on Mechanical ventilation; unfortunately the child died at the age of 3 years.

Perfusion index in newborns with CHD without clinical signs of hypoperfusion and heart failure: comparison with healthy newborns.

Peripheral perfusion index has been proposed as a possible method for detecting circulatory impairment. We aimed to determine the normal range of peripheral perfusion index in healthy newborns and compare it with that of newborns with CHD. Right-hand saturation and right-hand peripheral perfusion index levels were recorded, and physical examination and echocardiography were performed in newborns who were 0-28 days old and whom were evaluated in our paediatric cardiology outpatient clinic. The saturation and peripheral perfusion index levels of newborns with normal heart anatomy and function were compared with those of newborns with CHD. Out of 358 newborns (238 mature and 75 premature) enrolled in the study, 39 had CHD (20 mild CHD, 13 moderate CHD, and 6 severe CHD), of which 29 had CHD with left-to-right shunting, 5 had obstructive CHD, and 5 had cyanotic CHD. No newborn had clinical signs of hypoperfusion or heart failure, such as prolonged capillary refill, weakened pulses, or coldness of extremities. Peripheral perfusion index level was median (interquartile range) 1.7 (0.6) in healthy newborns, 1.8 (0.7) in newborns with mild CHD, and 1.8 (0.4) in newborns with moderate and severe CHD, and there was no significant difference between the groups regarding peripheral perfusion index level. Peripheral perfusion index remains unchanged in newborns with CHD without the clinical signs of hypoperfusion or heart failure. Larger studies with repeated peripheral perfusion index measurements can determine how valuable this method will be in the follow-up of newborns with CHD.

Critical Digital Ischemia Secondary to Ulnar Artery Thrombosis in Suspected Antiphospholipid Syndrome

Antiphospholipid syndrome (APS) is known to cause critical limb ischemia leading to limb loss or death from arterial occlusion. We reported a 45-year-old woman with critical digital ischemia and was suspected secondary to APS. This woman presented to the Emergency Department (ED) for the third time because of recurrent pain and numbness in the fingertips of her left hand with bluish discoloration of the left little finger. Her ulnar artery became faint on palpation, and her left fifth finger was cool, cyanotic, with prolonged capillary refill time (CRT) and unrecognised signal in SpO2. Angiography and ultrasound showed proximal thrombosis of the ulnar artery. Thrombectomy was performed twice because graft thrombosis had occurred during the first operation. The rheumatology team treated her as APS and administered antiplatelet drugs. We hope this case report will raise awareness among emergency physicians for early recognition and provide optimal treatment.

Penerapan Perawatan Kaki Dan Kuku Terhadap Peningkatan Sirkulasi Perifer Pada Penderita Critical Limb Ischemia (CLI)

Background . Critical limb ischemia (CLI) is the most severe stages disease vessels blood chronic , oriented CLI management on effort to anticipate doing amputation by pushing a severe infection happens on wound and healing the wound easier. One wrong possible intervention done to increase peripheral circulation and prevent the occurance of amputation consequence on severe infection is circulation maintenance. Purpose Describe feet application and nail care _ enhancement of peripheral circulation to fill a need safety of patients with Critical Limb Ischemia (CLI) . Method : This is a descriptive study uses a study case approach with a Nursing process approach . Subject of the study was one participant . Results the client felt painful on the feet , it started by feeling numb and cold on her left toes, then purple spots and several days later the spots were changed to be black and widespread to her calf . cold acral, nursing diagnosis enforced impaired peripheral tissue perfusion. Nursing Intervention: feet and nail care, Evaluation: decreased pain scale, increased muscle strength, changed in acral temperature and no changed in capillary refill. Conclusion : Giving circulation maintenance on client Mrs. S with CLI (Critical Limb Ischemia) for 5 days management was effective because on the fifth day client said painful on her left lower extremity decreased so that she could move , and client said she felt comfortable and relax after washing and cleaning her feet using warm water , soap , body lotion and cuting her toenails.&#x0D; Keywords : CLI, foot care , peripheral circulation, pain

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

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

Selective Application of Blood Glucose Monitoring After Free Flap Surgery: Potential Indications in Real-World Practice.

For free-flap monitoring, physical examination still serves as the criterion standard. Blood glucose measurement (BGM) has been suggested to be useful in identifying flap perfusion status. Nonetheless, its routine use may not be cost-effective in real-world settings. This study aimed to share the experiences of using BGM for flap monitoring and suggest its potential indications. Of cases of free flap reconstruction conducted between March 2017 and May 2021, those using BGM for flap monitoring were reviewed. Blood glucose measurement was selectively conducted for the following specific situations, which included encountering a flap showing a reddish discoloration and/or rapid capillary refilling time in the immediate postoperative period, monitoring discolored flaps after conducting a salvage operation, and conducting bloodletting therapy for salvaging congestive flaps. The clinical course and outcomes were evaluated. Of a total of 203 cases, 35 used BGM for flap monitoring in addition to clinical examination. In 29 cases, BGM was performed to distinguish early hyperemia from true venous insufficiency. All flaps showed BGM greater than 60 mg/dL with a mean value of 115.42, suggesting early hyperemia, and had uneventful postoperative courses. In 3 cases with already discolored flaps after a salvage operation, BGM was conducted 4 times serially every 3 hours and showed a mean value of 81.6 mg/dL with increasing trends. The flaps recovered completely. In the other 3 cases requiring bloodletting therapy, BGM was conducted an average of 11 times at a median interval of 7 hours. The bloodletting therapy was terminated with reference to the value of BGM when it showed greater than 60 mg/dL while the therapy was on hold. All flaps were successfully salvaged except one showing partial necrosis. Blood glucose measurement may be helpful in assessing flap perfusion and decision making in certain clinical situations and may be useful as an ancillary tool for flap monitoring. Selective application of BGM may contribute to achieving optimal outcomes.

Risk Factors for Dengue Shock Syndrome in Children Admitted in Federal Govt. Polyclinic Hospital (FGPC) Islamabad

Objective: To determine the risk factors for dengue shock syndrome in children admitted in Federal Govt. Polyclinic Hospital (FGPC) Islamabad. Methodology: A cross sectional study, conducted at Pediatric department of FGPC hospital from August 2019 to October 2019, included 102 children of less than 12 years of age. All the children with acute febrile illness, who tested positive for NS1 antigen visiting the outpatient and emergency department, admitted in Pediatric department were considered eligible for enrollment in the study. Demographic and clinical characteristics were reported and correlated with disease prognosis and clinical outcomes. Results: Out of 102 patients, 13 (12.7%) developed dengue shock syndrome (DSS). Patients with capillary refill time of more than 3 seconds were found to be 2.44 times more likely to develop dengue shock syndrome (OR=2.44, 95% CI 1.47 – 4.03, p&lt;0.001). Similarly, patients with thrombocytopenia (platelet count less than 150x103 cells) and leukopenia (TLC less than 4000x103 cells) were found to be at increased risk of developing dengue shock syndrome as compared to others (OR=1.28, 95% CI 1.12 – 1.48, p=0.001 and OR=1.6, 95% CI 1.12 – 5.21, p=0.01 respectively). Out of 13(12.7%) patients with DSS 1 patient (7.7%) died but no mortality observed in DHF. Conclusion: Increased capillary refill time, thrombocytopenia, and leukopenia were found to be significant predictors of DSS in children with dengue fever. Early identification of these risk factors can help in timely management and potentially reduce morbidity and mortality associated with DSS.

EVALUATION OF SICK (SIGNS OF INFLAMATION THAT CAN KILL) SCORE IN PREDICTING MORTALITY AND DURATION OF STAY OF PATIENTS IN PICU IN RURAL TERTIARY CARE CENTRE

Background: Mortality in critically ill children occurs in first 24 hour of admission. Therefore, immediate assessment of children at admission with a rapid clinical score is required. Early identification and proper triage of patients, allocation of available resources based on severity of illness is essential for effective management of critical illness. In this study SICK SCORE is used to predict mortality at admission. Methods: This is a prospective observational study of 100 patients over a period of two years at a rural tertiary center. The assessment using SICK SCORE was done on arrival prior to initiation of treatment for children admitted in PICU. A SICK SCORE variable (temperature, heart rate, respiratory rate, systolic blood pressure, saturation, capillary refill time, sensorium by AVPU scale) was measured using standard guidelines. Each variable is scored 0 to 1, higher the score higher is the prediction of mortality. Results: The study included 100 children admitted in PICU, children between 1 month to 17yr were included in this study, there were 10 deaths (all three had SICK SCORE&gt;6, with 70% sensitivity and specificity 5 %) during study period of 2 years. The mortality risk and duration of stay was found to be increasing with increase in SICK score. Conclusion: Substantially increased rate of mortality and lengthy duration of hospital stay was observed among SICK children who had higher sick score at admission. Hence, we conclude, SICK score is extremely useful in predicting mortality and lengthy stay on admission to hospital and it is also simple and cost-effective scoring system for triaging in resource limited settings.

Reliability and reproducibility of the DICART device to assess capillary refill time: a bench and in-silico study.

Capillary refill time (CRT) is an important indicator of peripheral perfusion with a strong prognostic value, but it is sensitive to environmental factors and numerous measurement methods are reported in the litterature. DiCARTECH has developed a device that assesses CRT. We sought to investigate the robustness of the device and the reproducibility of the algorithm in a bench and in-silico study. We used the video acquired from a previous clinical study on healthy volunteers. For the bench study, the measurement process was performed by a robotic system piloted by a computer that analyzed 250 times nine previously acquired videos. For the in-silico study, we used 222 videos to test the algorithm's robustness. We created 30 videos from each video with a large blind spot and used the "color jitter" function to create a hundred videos from each video. In the bench study, the coefficient of variation was 11% (95%CI: 9-13). The correlation with human-measured CRT was good (R2 = 0.91, P < 0.001). In the in-silico study, for the blind spotted video, the coefficient of variation was 13% (95%CI: 10-17). For the color-jitter modified video the coefficient of variation was 62% (95%CI: 55-70). We confirmed the ability of the DiCART™ II device to perform multiple measurements without mechanical or electronic dysfunction. The precision and reproducibility of the algorithm are compatible with the assessment of clinical small changes in CRT.

Capillary Refill Time and Serum Lactate as Predictors of Mortality and Postoperative Extracorporeal Membrane Oxygenation Requirement in Congenital Heart Surgery.

Multiple tissue perfusion markers are described to guide therapy in critically ill pediatric patients undergoing congenital heart surgery. Given the advantages of capillary refill time, our goal is to determine its predictive capacity for mortality and postoperative extracorporeal oxygenation requirements in congenital heart surgery and compare it to serum lactate. We conducted a prospective cohort observational study in a single high-complexity university hospital. Serum lactate and capillary refill time were measured at five predetermined time points: preoperative, immediate postoperative, 6, 12, and 24 h after the surgery. Prolonged immediate postoperative, 6 h, and 12 h capillary refill time measurements turned out to be independent risk factors for both outcomes. The capillary refill time area under the curve ranged between 0.70 and 0.80, while the serum lactate resulted between 0.79 and 0.92 for both outcomes. Both tissue perfusion markers resulted in mortality and extracorporeal oxygenation requirement predictors. Given the advantages of capillary refill time over serum lactate, a monitoring strategy including these two perfusion markers should be considered for congenital heart surgeries.