UMEM Educational Pearls

Category: Critical Care

Title: Capillary Refill vs. Lactate in Septic Shock

Keywords: capillary refill, lactate, sepsis (PubMed Search)

Posted: 5/14/2019 by Mark Sutherland
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  • ANDROMEDA-SHOCK compared using capillary refill time versus lactate clearance as a guide for resuscitation in septic shock patients
  • The cap refill group showed better SOFA scores at 72 hours, and a trend to lower mortality
  • In the study, cap refill was performed by pressing a glass microscope slide to the ventral surface of the second finger distal phalanx, holding until blanched for 10 seconds, and releasing.  Cap refill > 3 seconds was considered abnormal.

 

Bottom Line: Consider using capillary refill as an alternate (or complimentary) endpoint to lactate clearance when resuscitating your septic shock patients.

 

References

Hernández G, Ospina-Tascón GA, Damiani LP, et al. Effect of a Resuscitation Strategy Targeting Peripheral Perfusion Status vs Serum Lactate Levels on 28-Day Mortality Among Patients With Septic Shock: The ANDROMEDA-SHOCK Randomized Clinical Trial. JAMA. 2019;321(7):654–664. doi:10.1001/jama.2019.0071

Andromeda-shock - Capillary Refill Vs. Lactate.  Clay Smith - https://journalfeed.org/article-a-day/2019/andromeda-shock-rct-perfusion-vs-lactate