Gillespie Jordan, Hansen Matthew, Samatham Ravi, Baker Steven D, Filer Scott, Sheridan David C
Department of Emergency Medicine, 6684Oregon Health & Science University, Portland, Oregon, USA.
ProMedix Inc., Portland, Oregon, USA.
J Intensive Care Med. 2022 Sep;37(9):1159-1164. doi: 10.1177/08850666221087685. Epub 2022 Mar 21.
Monitoring of capillary refill time (CRT) is a common bedside assessment used to ascertain peripheral perfusion in a patient for a vast array of conditions. The literature has shown that a change in CRT can be used to recognize life-threatening conditions that cause decreased perfusion, such as sepsis, and aid in resuscitation. The current practice for calculating CRT invites subjectivity and produces a highly variable result. Innovative technology may be able to standardize this process and provide a reliable and accurate value for use in diagnostics and treatment. This study aimed to assess a new technology (DCR by ProMedix Inc.) for rapid, bedside, and noninvasive detection of CRT. This was a secondary analysis of a prospective observational study evaluating the accuracy of new technology towards CRT-guided diagnosis of sepsis. It was carried out in the adult emergency departments (ED) of an academic tertiary care medical center. Patients seeking care in the ED were determined eligible if they were > 18 years in age and exhibited chief complaints suggestive of possible sepsis. The CRT produced by the technology was compared to the gold standard manual waveform assessment. 218 consecutive subject enrollments were included and multiple measurements were made on each patient. Data with irregular waveforms were excluded. A total of 692 waveforms were evaluated for CRT values by a pair of trained PhD biomedical engineers. The average age of the cohort was 50.62 and 51.4% female. Results showed a Pearson correlation coefficient of 0.91 for the device CRT compared to the CRT gold standard. The Pearson correlation coefficient for the two independent engineering review of the waveform data was 0.98. This device produces accurate, consistent results and eliminates the subjectivity of CRT measurements that is in practice currently.
监测毛细血管再充盈时间（CRT）是一种常见的床旁评估方法，用于确定患有各种病症的患者的外周灌注情况。文献表明，CRT的变化可用于识别导致灌注减少的危及生命的病症，如败血症，并有助于复苏。目前计算CRT的方法存在主观性，结果差异很大。创新技术或许能够使这一过程标准化，并为诊断和治疗提供可靠准确的值。本研究旨在评估一种用于快速、床旁和无创检测CRT的新技术（ProMedix公司的动态CRT）。这是一项前瞻性观察性研究的二次分析，该研究评估了新技术对CRT指导的败血症诊断的准确性。研究在一家学术性三级医疗中心的成人急诊科进行。如果急诊科的患者年龄大于18岁且有提示可能患有败血症的主要症状，则被确定为符合条件。将该技术产生的CRT与金标准手动波形评估进行比较。纳入了连续218名受试者，并对每位患者进行了多次测量。排除波形不规则的数据。由一对训练有素的博士生物医学工程师对总共692个波形的CRT值进行了评估。该队列的平均年龄为50.62岁，女性占51.4%。结果显示，与CRT金标准相比，该设备CRT的皮尔逊相关系数为0.91。对波形数据进行的两次独立工程审查的皮尔逊相关系数为0.98。该设备产生准确、一致的结果，并消除了目前实际应用中CRT测量的主观性。
