Cloutier Robert L, Bailey Jessica, Hansen Matthew, Le Mimi, Sheridan David
Department of Emergency Medicine Oregon Health and Science University, Portland, OR, United States of America.
Department of Emergency Medicine Oregon Health and Science University, Portland, OR, United States of America.
Am J Emerg Med. 2025 Aug;94:208-215. doi: 10.1016/j.ajem.2025.04.072. Epub 2025 May 1.
Sepsis remains a significant and difficult diagnosis in US Emergency Departments and Intensive Care Units.
The objective of this scoping review was to understand the state of the literature regarding the performance of Capillary Refill Time [CRT] as a method to assess circulatory dysfunction in sepsis.
This study followed PRISMA Guidelines for Scoping Reviews. Included studies used CRT as a physical exam finding 'measuring the time of return of color to a blanched nailbed' and was limited to Emergency Department and Intensive Care Unit settings. Our search used OVID Medline from 1946 through December of 2022 and resulted in 800 articles that led to 13 being included in the final analysis. Included studies were appraised using the Newcastle Ottawa Score.
Overall, the strength of the evidence across the 13 final studies was moderate. Studies suffered from numerous methodological shortcomings, and reproducibility in how they measured capillary refill.
Capillary refill has the potential to assist in the assessment of circulatory dysfunction in sepsis; however, emerging technologies making bedside measurement more reproducible and reliable must be further developed and studied in prospective randomized control trials powered to predict meaningful patient outcomes.
在美国急诊科和重症监护病房，脓毒症仍然是一个重要且难以诊断的病症。
本综述的目的是了解关于毛细血管再充盈时间（CRT）作为评估脓毒症循环功能障碍方法的文献现状。
本研究遵循PRISMA综述指南。纳入的研究将CRT用作体格检查结果，即“测量变白甲床恢复颜色的时间”，且仅限于急诊科和重症监护病房环境。我们的检索使用了1946年至2022年12月的OVID Medline数据库，共检索到800篇文章，最终13篇被纳入分析。使用纽卡斯尔渥太华量表对纳入的研究进行评估。
总体而言，13项最终研究的证据强度为中等。这些研究存在许多方法学上的缺陷，且在测量毛细血管再充盈方面缺乏可重复性。
毛细血管再充盈有可能辅助评估脓毒症中的循环功能障碍；然而，必须进一步开发新兴技术，使其在床边测量时更具可重复性和可靠性，并在前瞻性随机对照试验中进行研究，以预测有意义的患者预后。
