Sheridan David C, Cloutier Robert L, Samatham Ravi, Hansen Matthew L
Department of Emergency Medicine, Oregon Health & Science University, Portland, OR, United States.
Promedix Inc., Portland, OR, United States.
Front Med (Lausanne). 2021 Jul 22;8:694241. doi: 10.3389/fmed.2021.694241. eCollection 2021.
Peripheral perfusion assessment is used routinely at the bedside by measuring the capillary refill time (CRT). Recent clinical trials have shown evidence to its ability to recognize conditions with decreased end organ perfusion as well as guiding therapeutic interventions in sepsis. However, the current standard of physician assessment at the bedside has shown large variability. New technology can improve the precision and repeatability of CRT affecting translation of previous high impact research. This was a prospective, observational study in the intensive care unit and emergency department at a quaternary care hospital using a non-invasive finger sensor for CRT. The device CRT was compared to the gold standard of trained research personnel assessment of CRT as well as to providers clinically caring for the patient. Pearson correlations coefficients were performed across 89 pairs of measurements. The Pearson correlation for the device CRT compared to research personnel CRT was 0.693. The Pearson correlation for the provider CRT compared to research personnel CRT was 0.359. New point-of-care technology shows great promise in the ability to improve peripheral perfusion assessment performed at the bedside in the emergency department triage and during active resuscitation. This standardized approach allows for better translation of prior research that is limited by the subjectivity of manual visual assessment of CRT.
通过测量毛细血管再充盈时间(CRT),外周灌注评估在床边被常规使用。最近的临床试验已证明其有能力识别终末器官灌注减少的情况,并在脓毒症中指导治疗干预。然而,目前床边医生评估的标准显示出很大的变异性。新技术可以提高CRT的精确性和可重复性,影响先前高影响力研究的转化。这是一项在一家四级护理医院的重症监护病房和急诊科进行的前瞻性观察性研究,使用非侵入性手指传感器测量CRT。将该设备测量的CRT与经过培训的研究人员评估CRT的金标准以及临床护理患者的医护人员进行比较。对89对测量值进行了Pearson相关系数分析。该设备测量的CRT与研究人员测量的CRT的Pearson相关系数为0.693。医护人员测量的CRT与研究人员测量的CRT的Pearson相关系数为0.359。新的床旁检测技术在改善急诊科分诊和积极复苏期间床边进行的外周灌注评估方面显示出巨大潜力。这种标准化方法有助于更好地转化先前受CRT手动视觉评估主观性限制的研究。