Wesołek Fabian, Putowski Zbigniew, Staniszewska Wiktoria, Latacz Robert, Krzych Łukasz J
Students' Scientific Society, Department of Acute Medicine, School of Medicine in Zabrze, Medical University of Silesia, 40-055 Katowice, Poland.
Center for Intensive and Perioperative Care, Jagiellonian University Medical College, 31-008 Krakow, Poland.
J Clin Med. 2024 Sep 28;13(19):5782. doi: 10.3390/jcm13195782.
In critically ill patients, achieving a mean arterial pressure (MAP) of 65 mmHg is a recommended resuscitation goal to ensure proper tissue oxygenation. Unfortunately, some patients do not benefit from providing such a value, suggesting that other indices are needed for better hemodynamic assessment. Capillary refill time (CRT) has emerged as an established marker for peripheral perfusion and a therapeutic target in critical illness, but its relationship with other exponents of hypoperfusion during vasopressor support after resuscitation period still warrants further research. This study aimed to investigate whether in critically ill patients after initial resuscitation, CRT would provide information independent of other, readily accessible hemodynamic variables. Critically ill patients who were mechanically ventilated after the resuscitation period and receiving vasopressors were prospectively studied between December 2022 and June 2023. Vasopressor support was measured using norepinephrine equivalent doses (NEDs). CRT, MAP and NED were assessed simultaneously and analyzed using Spearman's rank correlation. A total of 92 patients were included and 210 combined MAP-CRT-NED-Lactate records were obtained. There was no correlation between CRT and MAP (R = -0.1, = 0.14) or lactate (R = 0.11, = 0.13), but there was a positive weak correlation between CRT and NED (R = 0.25, = 0.0005). In patients with hypotension, in 83% of cases (15/18), CRT was within normal range, despite different doses of catecholamines. When assessing patients with high catecholamine doses, in 58% cases (11/19), CRT was normal and MAP was usually above 65 mmHg. Capillary refill time provides additional hemodynamic information that is not highly related with the values of mean arterial pressure, lactate level and vasopressor doses. It could be incorporated into routine physical examination in critically ill patients who are beyond initial resuscitation.
在危重症患者中，将平均动脉压（MAP）维持在65 mmHg是推荐的复苏目标，以确保组织获得充足的氧合。遗憾的是，部分患者并未从维持这一数值中获益，这表明需要其他指标来进行更有效的血流动力学评估。毛细血管再充盈时间（CRT）已成为评估外周灌注的既定指标及危重症治疗的目标，但复苏期后在血管活性药物支持期间，其与其他灌注不足指标之间的关系仍有待进一步研究。本研究旨在探讨在初始复苏后的危重症患者中，CRT是否能提供独立于其他易于获取的血流动力学变量的信息。对2022年12月至2023年6月期间复苏期后接受机械通气且使用血管活性药物的危重症患者进行前瞻性研究。使用去甲肾上腺素等效剂量（NEDs）来衡量血管活性药物支持情况。同时评估CRT、MAP和NED，并采用Spearman秩相关分析。共纳入92例患者，获得210组MAP-CRT-NED-乳酸记录。CRT与MAP（R = -0.1，P = 0.14）或乳酸（R = 0.11，P = 0.13）之间无相关性，但CRT与NED之间存在弱正相关（R = 0.25，P = 0.0005）。在低血压患者中，83%的病例（15/18）CRT在正常范围内，尽管使用了不同剂量的儿茶酚胺。在评估高剂量儿茶酚胺治疗的患者时，58%的病例（11/19）CRT正常，且MAP通常高于65 mmHg。毛细血管再充盈时间提供了额外的血流动力学信息，与平均动脉压、乳酸水平和血管活性药物剂量的值相关性不高。它可纳入初始复苏后的危重症患者的常规体格检查中。
