Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Unidad de Terapia Intensiva, Hospital Civil Fray Antonio Alcalde, Universidad de Guadalajara, Guadalajara, Jalisco.
Curr Opin Crit Care. 2023 Jun 1;29(3):208-214. doi: 10.1097/MCC.0000000000001038. Epub 2023 Apr 7.
The ANDROMEDA-SHOCK trial positioned capillary refill time (CRT) assessment as a novel resuscitation target for septic shock.The purpose of this article is to summarize pathophysiological determinants of CRT, review new technical developments on peripheral perfusion assessment, and explore recent evidence on the role of CRT monitoring in septic shock and other critical conditions.
A growing body of evidence supports the role of peripheral perfusion assessment as a warning and prognostic signal in a variety of clinical conditions among severely ill patients. Recent physiological studies demonstrated a rapid improvement of CRT after a single fluid bolus or a passive leg raising maneuver, a fact which may have diagnostic and therapeutic implications. Moreover, a couple of posthoc analyses of ANDROMEDA-SHOCK trial, reinforce that a normal CRT at the start of septic shock resuscitation, or its rapid normalization, thereafter may be associated with significant better outcomes.
Recent data confirm the relevance of peripheral perfusion assessment in septic shock and other conditions in critically ill patients. Future studies should confirm these findings, and test the potential contribution of technological devices to assess peripheral perfusion.
ANDROMEDA-SHOCK 试验将毛细血管再充盈时间（CRT）评估作为脓毒性休克的一种新的复苏目标。本文的目的是总结 CRT 的病理生理决定因素，回顾外周灌注评估的新技术进展，并探讨 CRT 监测在脓毒性休克和其他危急情况下的作用的最新证据。
越来越多的证据支持外周灌注评估作为严重疾病患者各种临床情况下的预警和预后信号。最近的生理学研究表明，单次液体冲击或被动抬腿后 CRT 迅速改善，这一事实可能具有诊断和治疗意义。此外，ANDROMEDA-SHOCK 试验的几项事后分析结果也证实，在脓毒性休克复苏开始时 CRT 正常，或随后迅速正常化，可能与显著更好的结局相关。
最近的数据证实了外周灌注评估在脓毒性休克和其他危重患者情况下的相关性。未来的研究应证实这些发现，并测试技术设备评估外周灌注的潜在贡献。
