Original Article
A Normal Capillary Refill Time of ≤ 2 Seconds is Associated with Superior Vena Cava Oxygen Saturations of ≥ 70%

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Objective

To test the hypothesis that a normal capillary refill time (CRT) ≤ 2 seconds is associated with superior vena cava oxygen saturation (ScvO2) ≥ 70% in critically ill children.

Study design

Two-year, prospective study in a tertiary-level pediatric intensive care unit. Whenever ScvO2 measurements were obtained, central (forehead/sternum) and peripheral (finger/toe) CRTs were concomitantly assessed.

Results

Central and peripheral CRTs ≤ 2 seconds were both associated with ScvO2 ≥ 70% (P < .01). Sensitivity/specificity analyses revealed that central CRT ≤ 2 seconds demonstrated a sensitivity of 84.4%, specificity of 71.4%, positive predictive value of 93.1%, and negative predictive value of 50.0% in predicting ScvO2 ≥ 70%. Peripheral CRT ≤ 2 seconds had a sensitivity of 71.9%, specificity of 85.7%, positive predictive value of 95.8%, and negative predictive value of 40.0% in predicting ScvO2 ≥ 70%.

Conclusions

A normal CRT ≤ 2 seconds can be predictive of ScvO2 ≥ 70%. Our study corroborates the recommendations of the Pediatric Advanced Life Support curricula targeting a normal CRT ≤ 2 seconds as a therapeutic endpoint for goal-directed shock resuscitation. This clinical target remains particularly relevant in community hospitals when the ability to obtain central venous catheter access may be limited and ScvO2 data unavailable.

Section snippets

Methods

Institutional Review Board approval for this study was granted by the University of Michigan Health System’s Human Rights Committee. Any critically-ill child who was admitted to the pediatric intensive care unit (PICU) at C. S. Mott Children’s Hospital during the 2-year study period (May 2007 to May 2009) and required CVC placement for medical management (with the CVC tip located in the superior vena cava) was potentially eligible for the study. The diagnosis of sepsis or septic shock was not a

Results

Although consent/assent for study participation had been obtained for 78 children, because not all patients required VBG measurements during their PICU admission and many had CVCs placed into their femoral veins, data were limited to only 22 children. One additional patient was eliminated from study due to hypoxia at the time of data collection, leaving 21 patients available for analyses (Table I). A median of 2 (1 to 3) VBG measurements were obtained per patient, contributing to a total of 39

Discussion

The American Heart Association’s Subcommittee on Pediatric Resuscitation, through its PALS curricula, advocates the use of CRT to quickly assess perfusion in children.3 PALS teaches that prolonged CRT is an early clinical indicator of compensated shock that results from physiologic mechanisms that try to redirect blood flow from nonvital to vital organs as a means to preserve critical perfusion to the latter. Systemic vascular resistance is increased in order to maintain normal blood pressure

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The authors declare no conflicts of interest.

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