Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA.
Nihon Kohden Innovation Center, Boston, MA.
Crit Care Med. 2020 Oct;48(10):e927-e933. doi: 10.1097/CCM.0000000000004506.
Capillary refill time is a noninvasive method to assess tissue perfusion to determine shock status. Capillary refill time is defined as the time required to regain skin color after blanching pressure is applied. Although common methods to measure capillary refill time depend on clinicians' visual assessment, a new approach using a pulse oximeter waveform analysis exists, referred to as full finger reperfusion time. We aim to evaluate reproducibility and validity of the novel full finger reperfusion time measurement using clinicians' visual capillary refill time assessment as a reference standard.
Prospective observational study.
PICUs and operating suites at a large academic children's hospital.
Ninety-nine children 1-12 years old with various skin color tones.
Each child had 10 measurements, including five full finger reperfusion time and five clinician capillary refill time, alternating second and third digits.
Eighteen children had prolonged capillary refill time (> 2 s) and four children with capillary refill time greater than 3 seconds. Four-hundred eighty-five data pairs were analyzed. Intraclass correlation coefficient of full finger reperfusion time within each patient was 0.76 (95% CI, 0.68-0.83), demonstrating good reproducibility. Correlation coefficient between full finger reperfusion time and clinician capillary refill time was moderate: r = 0.37 (p < 0.0001; 95% CI, 0.29-0.44) for the pairs and r = 0.52 (p < 0.0001; 95% CI, 0.36-0.65) for patient average. Bland-Altman plot showed a consistent difference between full finger reperfusion time and clinician capillary refill time (full finger reperfusion time 1.14 s longer). Weak association was found between force and full finger reperfusion time (β = -0.033 ± 0.016; 95% CI, -0.065 to -0.0016; p = 0.04), finger thickness (β = -0.20 ± 0.089; 95% CI, -0.37 to -0.19; p = 0.03), except for color tone (p = 0.31). Finger temperature was associated with full finger reperfusion time (β = -0.18 ± 0.041; 95% CI, -0.26 to -0.0999; p < 0.0001).
Full finger reperfusion time demonstrated good reproducibility. Full finger reperfusion time showed moderate correlation with clinician capillary refill time. Full finger reperfusion time was 1.14 seconds longer than capillary refill time. Future studies should focus on the clinical value of full finger reperfusion time as a monitoring device for hemodynamics in critically ill children.
毛细血管再充盈时间是一种评估组织灌注以确定休克状态的非侵入性方法。毛细血管再充盈时间定义为施加压迫使皮肤变白后恢复肤色所需的时间。虽然常用的测量毛细血管再充盈时间的方法依赖于临床医生的视觉评估，但存在一种使用脉搏血氧仪波形分析的新方法，称为全手指再灌注时间。我们旨在评估使用临床医生视觉毛细血管再充盈时间评估作为参考标准的新型全手指再灌注时间测量的可重复性和有效性。
前瞻性观察研究。
一家大型学术儿童医院的 PICU 和手术室。
99 名 1-12 岁不同肤色的儿童。
每个孩子有 10 次测量，包括 5 次全手指再灌注时间和 5 次临床医生毛细血管再充盈时间，交替第二和第三指。
18 名儿童有较长的毛细血管再充盈时间（>2 秒），4 名儿童的毛细血管再充盈时间大于 3 秒。分析了 485 对数据。每位患者的全手指再充盈时间的组内相关性系数为 0.76（95%CI，0.68-0.83），表明具有良好的可重复性。全手指再灌注时间与临床医生毛细血管再充盈时间之间的相关系数为中度：配对的 r = 0.37（p <0.0001；95%CI，0.29-0.44），患者平均值的 r = 0.52（p <0.0001；95%CI，0.36-0.65）。Bland-Altman 图显示全手指再灌注时间和临床医生毛细血管再充盈时间之间存在一致的差异（全手指再灌注时间长 1.14 秒）。发现力与全手指再灌注时间之间存在弱关联（β=-0.033±0.016；95%CI，-0.065 至-0.0016；p=0.04），手指厚度（β=-0.20±0.089；95%CI，-0.37 至-0.19；p=0.03），但颜色色调除外（p=0.31）。手指温度与全手指再灌注时间相关（β=-0.18±0.041；95%CI，-0.26 至-0.0999；p<0.0001）。
全手指再充盈时间表现出良好的可重复性。全手指再灌注时间与临床医生毛细血管再充盈时间呈中度相关。全手指再灌注时间比毛细血管再充盈时间长 1.14 秒。未来的研究应集中于全手指再灌注时间作为危重症儿童血流动力学监测设备的临床价值。
