Division of Critical Care, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.
Pediatr Crit Care Med. 2012 Mar;13(2):136-40. doi: 10.1097/PCC.0b013e318220afdc.
Many pediatric healthcare providers believe that capillary refill time is a measure of perfusion and cardiac output in children. Despite its widespread use, there are no studies examining the relationship of capillary refill time to cardiac output in noncritically ill children. This study examined the inter-rater reliability of capillary refill time and its relationship to hemoglobin and with cardiac output in pediatric patients undergoing cardiac catheterization.
Prospective observational study.
Tertiary care pediatric hospital.
A total of 58 children, ages 0.3-17 yrs, with congenital heart disease undergoing cardiac catheterization.
Two clinicians performed two measurements of capillary refill time in a standardized fashion on 58 children undergoing cardiac catheterization. Cardiac output was determined by the Fick method within 15 mins of the first assessment of capillary refill time (time 1).
Capillary refill time and cardiac output measurements were obtained in 44 children, and 108 paired measurements of capillary refill time were obtained to assess inter-rater reliability. The mean capillary refill time was 1.2 secs (±0.5 secs), and the mean cardiac output was 3.6 L/min/m (2.2-5.7 L/min/m). The inter-rater intraclass correlation coefficient was 0.12 (time 1) (95% confidence interval -0.15 to +0.37) and was 0.32 (95% confidence interval 0.058-0.54) at the end of the catheterization (time 2). A significant association was noted between average capillary refill time at time 1 and hemoglobin, with higher hemoglobin correlating with longer capillary refill time (p = .015). There was no significant correlation between the average capillary refill time taken at the time of cardiac output measurement (time 1) and measured cardiac output (r = .331, 95% confidence interval for r, .066-.552).
We found that the inter-rater reliability of capillary refill time was poor and variable under controlled conditions and capillary refill time was not correlated with cardiac output in anesthetized nonacutely ill pediatric patients undergoing cardiac catheterization. Caution should be used in inferring cardiac output from capillary refill time measurements alone.
许多儿科医疗保健提供者认为毛细血管再充盈时间是衡量儿童灌注和心输出量的指标。尽管它被广泛应用，但目前还没有研究检查毛细血管再充盈时间与非危重病儿童心输出量之间的关系。本研究检查了在接受心导管检查的儿科患者中毛细血管再充盈时间的观察者间可靠性及其与血红蛋白的关系，并与心输出量相关。
前瞻性观察性研究。
三级儿童保健医院。
共有 58 名年龄在 0.3-17 岁之间患有先天性心脏病的患者接受心导管检查。
两位临床医生以标准化的方式对 58 名接受心导管检查的患者进行了两次毛细血管再充盈时间测量。心输出量通过 Fick 法在第一次毛细血管再充盈时间评估后 15 分钟内确定（时间 1）。
在 44 名儿童中获得了毛细血管再充盈时间和心输出量测量值，并获得了 108 对毛细血管再充盈时间的配对测量值，以评估观察者间的可靠性。平均毛细血管再充盈时间为 1.2 秒（±0.5 秒），平均心输出量为 3.6 L/min/m（2.2-5.7 L/min/m）。时间 1 的观察者间组内相关系数为 0.12（95%置信区间为-0.15 至+0.37），在导管插入术结束时（时间 2）为 0.32（95%置信区间为 0.058-0.54）。在时间 1 时，平均毛细血管再充盈时间与血红蛋白之间存在显著相关性，血红蛋白越高，毛细血管再充盈时间越长（p =.015）。在测量心输出量时（时间 1）的平均毛细血管再充盈时间与测量的心输出量之间没有显著相关性（r =.331，95%置信区间为 r，.066-.552）。
我们发现，在控制条件下，毛细血管再充盈时间的观察者间可靠性较差且可变，并且在接受麻醉的非急性危重病儿科患者中，毛细血管再充盈时间与心输出量不相关。从单独的毛细血管再充盈时间测量值推断心输出量时应谨慎。
