Department of Critical Care Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China; Department of Critical Care Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, Hubei, China.
Nursing Department, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou 310016, China.
Intensive Crit Care Nurs. 2024 Oct;84:103743. doi: 10.1016/j.iccn.2024.103743. Epub 2024 Jun 18.
Capillary refill time (CRT) is defined as the time taken for color to return to an external capillary bed after pressure is applied to cause blanching. Recent studies demonstrated the benefits of CRT in guiding fluid therapy for sepsis. However, lack of consistency among physicians in how to perform and interpret CRT has led to a low interobserver agreement for this assessment tool, which prevents its availability in sepsis clinical settings.
To give physicians a concise overview of CRT and explore recent evidence on its reliability and value in the management of sepsis.
A narrative review.
This narrative review summarizes the factors affecting CRT values, for example, age, sex, temperature, light, observation techniques, work experience, training level and differences in CRT measurement methods. The methods of reducing the variability of CRT are synthesized. Based on studies with highly reproducible CRT measurements and an excellent inter-rater concordance, we recommend the standardized CRT assessment method. The threshold of normal CRT values is discussed. The application of CRT in different phases of sepsis management is summarized.
Recent data confirm the value of CRT in critically ill patients. CRT should be detected by trained physicians using standardized methods and reducing the effect of ambient-related factors. Its association with severe infection, microcirculation, tissue perfusion response, organ dysfunction and adverse outcomes makes this approach a very attractive tool in sepsis. Further studies should confirm its value in the management of sepsis.
As a simple assessment, CRT deserves more attention even though it has not been widely applied at the bedside. CRT could provide nursing staff with patient's microcirculatory status, which may help to develop individualized nursing plans and improve the patient's care quality and treatment outcomes.
毛细血管再充盈时间（CRT）定义为在施加压力导致苍白后，颜色恢复到外部毛细血管床所需的时间。最近的研究表明 CRT 在指导脓毒症的液体治疗方面具有益处。然而，由于医生在如何进行和解释 CRT 方面缺乏一致性，导致该评估工具的观察者间一致性较低，这阻碍了其在脓毒症临床环境中的应用。
为医生提供 CRT 的简要概述，并探讨 CRT 在脓毒症管理中的可靠性和价值的最新证据。
叙述性综述。
本叙述性综述总结了影响 CRT 值的因素，例如年龄、性别、温度、光线、观察技术、工作经验、培训水平和 CRT 测量方法的差异。综合了减少 CRT 可变性的方法。基于具有高度可重复性 CRT 测量值和极好的观察者间一致性的研究，我们建议采用标准化 CRT 评估方法。讨论了正常 CRT 值的阈值。总结了 CRT 在脓毒症管理不同阶段的应用。
最近的数据证实了 CRT 在危重症患者中的价值。CRT 应由经过培训的医生使用标准化方法进行检测，并减少环境相关因素的影响。其与严重感染、微循环、组织灌注反应、器官功能障碍和不良结局的相关性使得这种方法在脓毒症中成为一种非常有吸引力的工具。进一步的研究应证实其在脓毒症管理中的价值。
作为一种简单的评估方法，即使 CRT 尚未在床边广泛应用，它也值得更多关注。CRT 可以为护理人员提供患者的微循环状态，这可能有助于制定个性化的护理计划，提高患者的护理质量和治疗结果。
