From the Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA.
Nihon Kohden Innovation Center, Boston, MA.
Pediatr Emerg Care. 2024 Aug 1;40(8):586-590. doi: 10.1097/PEC.0000000000003183. Epub 2024 Jun 14.
Early shock reversal is crucial to improve patient outcomes. Capillary refill time (CRT) is clinically important to identify and monitor shock in children but has issues with inconsistency. To minimize inconsistency, we evaluated a CRT monitoring system using an automated compression device. Our objective was to determine proper compression pressure in children.
Clinician force for CRT was collected during manual CRT measurement as a reference for automated compression in a previous study (12.9 N, 95% confidence interval, 12.5-13.4; n = 454). An automated compression device with a soft inflation bladder was fitted with a force sensor. We evaluated the effectiveness of the automated pressure to eliminate pulsatile blood flow from the distal phalange. Median and variance of CRT analysis at each pressure was compared.
A comparison of pressures at 300 to 500 mm Hg on a simulated finger yielded a force of 5 to 10 N, and these pressures were subsequently used for automated compression for CRT. Automated compression was tested in 44 subjects (median age, 33 months; interquartile range [IQR], 14-56 months). At interim analysis of 17 subjects, there was significant difference in the waveform with residual pulsatile blood flow (9/50: 18% at 300 mm Hg, 5/50:10% at 400 mm Hg, 0/51: 0% at 500 mm Hg, P = 0.008). With subsequent enrollment of 27 subjects at 400 and 500 mm Hg, none had residual pulsatile blood flow. There was no difference in the CRT: median 1.8 (IQR, 1.06-2.875) in 400 mm Hg vs median 1.87 (IQR, 1.25-2.8325) in 500 mm Hg, P = 0.81. The variance of CRT was significantly larger in 400 mm Hg: 2.99 in 400 mm Hg vs. 1.35 in 500 mm Hg, P = 0.02, Levene's test. Intraclass correlation coefficient for automated CRT was 0.56 at 400 mm Hg and 0.78 at 500 mm Hg.
Using clinician CRT measurement data, we determined either 400 or 500 mm Hg is an appropriate pressure for automated CRT, although 500 mm Hg demonstrates superior consistency.
早期休克逆转对于改善患者预后至关重要。毛细血管再充盈时间（CRT）对于识别和监测儿童休克具有重要的临床意义，但存在不一致的问题。为了最大程度地减少这种不一致，我们使用自动加压设备评估了一种 CRT 监测系统。我们的目的是确定儿童的适当加压值。
在先前的研究中，我们在手动 CRT 测量过程中收集了医生施加的 CRT 力，作为自动加压的参考（12.9 N，95%置信区间，12.5-13.4；n=454）。带有软充气囊的自动加压设备配备了力传感器。我们评估了该自动加压设备消除远端指节搏动性血流的效果。比较了每个压力下 CRT 分析的中位数和方差。
在模拟手指上从 300 至 500 mm Hg 进行压力比较，得出力值为 5 至 10 N，随后在自动 CRT 加压中使用这些压力。在 44 名受试者（中位年龄，33 个月；四分位距[IQR]，14-56 个月）中测试了自动加压。在 17 名受试者的中期分析中，具有残余搏动性血流的波形存在显著差异（9/50：300 mm Hg 时为 18%，400 mm Hg 时为 5/50：10%，500 mm Hg 时为 0/51：0%，P=0.008）。随后在 400 和 500 mm Hg 时招募了 27 名受试者，均无残余搏动性血流。400 mm Hg 时 CRT 的中位数为 1.8（IQR，1.06-2.875），500 mm Hg 时 CRT 的中位数为 1.87（IQR，1.25-2.8325），P=0.81。400 mm Hg 时 CRT 的方差明显更大：400 mm Hg 时为 2.99，500 mm Hg 时为 1.35，P=0.02，Levene 检验。400 mm Hg 时自动 CRT 的组内相关系数为 0.56，500 mm Hg 时为 0.78。
使用医生 CRT 测量数据，我们确定 400 或 500 mm Hg 是自动 CRT 的适当压力，尽管 500 mm Hg 表现出更高的一致性。
