1
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Ma ZY, Sun S, Wu SC, Lin L, Chen YX, Zhao D, Morgan SP. Pilot study on optimizing pressure for standardized capillary refill time measurement. Heliyon 2024; 10:e35716. [PMID: 39170323 PMCID: PMC11336845 DOI: 10.1016/j.heliyon.2024.e35716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Accepted: 08/01/2024] [Indexed: 08/23/2024] Open
Abstract
Purpose Capillary Refill Time (CRT) measurement has gained increasing attention in the field of sepsis and septic shock. Recognizing pressure as a fundamental determinant in CRT measurement is crucial for establishing a standardized CRT measurement procedure. In this preliminary study, we elucidated the optimal pressing strength for CRT measurement by analyzing the CRTs measured under varying pressures. Method Seventeen healthy individuals were enlisted to undergo CRT tests on their fingertips at various pressure levels. The applied force was initiated at 0.5N and incrementally increased by 0.5N until it reached 10.5N. An integrated Photoplethysmography (PPG) device was employed to capture fluctuations in light intensity. The CRT was automatically derived from the PPG signals via a specialized algorithm. The study included correlation assessment and reliability evaluation. Box plot and Bland-Altman plot were used to visualize the impact of pressure levels on CRTs. Results A dataset of 1414 CRTs across 21 pressures showed significant differences (Kruskal-Wallis test, p < 0.0001), highlighting the impact of pressure on CRT. CRT values between 4.5N and 10.5N pressures varied less, with an Intraclass Correlation Coefficient (ICC) of 0.499 indicating moderate consistency. Notably, CRTs at 10N and 10.5N pressures revealed a high ICC of 0.790, suggesting strong agreement. Conclusion A pressure range of 4.5N-10.5N is recommended for stable CRT measurements, with 10.0N-10.5N providing optimal consistency and reliability.
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Affiliation(s)
- Zi-Yu Ma
- Faculty of Environment and Life, Beijing University of Technology, China, No. 100 Pingleyuan, Chaoyang District, Beijing, 100124, China
| | - Shen Sun
- Faculty of Environment and Life, Beijing University of Technology, China, No. 100 Pingleyuan, Chaoyang District, Beijing, 100124, China
| | - Shui-Cai Wu
- Faculty of Environment and Life, Beijing University of Technology, China, No. 100 Pingleyuan, Chaoyang District, Beijing, 100124, China
| | - Lan Lin
- Faculty of Environment and Life, Beijing University of Technology, China, No. 100 Pingleyuan, Chaoyang District, Beijing, 100124, China
| | - Yi-Xiong Chen
- Beijing Science and Technology Project Manager Management Corporation Ltd, Beijing, China
| | - Dong Zhao
- Department of Endocrinology, Beijing LuHe Hospital, Capital Medical University, Beijing, China
| | - Stephen P. Morgan
- Optics and Photonics Research Group, University of Nottingham, Nottingham, UK
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2
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Nagasawa T, Iwata K, Bachour RPDS, Ogawa-Ochiai K, Tsumura N, Cardoso GC. Quantitative Capillary Refill Time with image-based finger force estimation. Med Eng Phys 2024; 127:104168. [PMID: 38692764 DOI: 10.1016/j.medengphy.2024.104168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 02/28/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
Skin color observation provides a simple and non-invasive method to estimate the health status of patients. Capillary Refill Time (CRT) is widely used as an indicator of pathophysiological conditions, especially in emergency patients. While the measurement of CRT is easy to perform, its evaluation is highly subjective. This study proposes a method to aid quantified CRT measurement using an RGB camera. The procedure consists in applying finger compression to the forearm, and the CRT is calculated based on the skin color change after the pressure release. We estimate compression applied by a finger from its fingernail color change during compression. Our study shows a step towards camera-based quantitative CRT for untrained individuals.
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Affiliation(s)
- Takumi Nagasawa
- Department of Imaging Science, Graduate School of Science and Engineering, Chiba University, Chiba, 263-8522, Japan
| | - Kazuki Iwata
- Department of Imaging Science, Graduate School of Science and Engineering, Chiba University, Chiba, 263-8522, Japan.
| | | | - Keiko Ogawa-Ochiai
- Kampo Clinical Center, Hiroshima University Hospital, Hiroshima, 734-8551, Japan
| | - Norimichi Tsumura
- Department of Imaging Sciences, Graduate School of Engineering, Chiba University, Chiba, 263-8522, Japan
| | - George C Cardoso
- Physics Department, FFCLRP, University of Sao Paulo, 14040-901, Brazil
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3
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Bachour RPDS, Dias EL, Cardoso GC. Skin-color-independent robust assessment of capillary refill time. JOURNAL OF BIOPHOTONICS 2023; 16:e202300063. [PMID: 37485975 DOI: 10.1002/jbio.202300063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/25/2023] [Accepted: 07/19/2023] [Indexed: 07/25/2023]
Abstract
Capillary Refill Time (CRT) assesses peripheral perfusion in resource-limited settings. However, the repeatability and reproducibility of CRT measurements are limited for individuals with darker skin. This paper presents quantitative CRT measurements demonstrating good performance and repeatability across all Fitzpatrick skin phototypes. The study involved 22 volunteers and utilized controlled compression at 7 kPa, an RGB video camera, and cocircular polarized white LED light. CRT was determined by calculating the time constant of an exponential regression applied to the mean pixel intensity of the green (G) channel. An adaptive algorithm identifies the optimal regression region for noise reduction, and flags inappropriate readings. The results indicate that 80% of the CRT readings fell within a 20% range of the expected CRT value. The repetition standard deviation was 17%. These findings suggest the potential for developing reliable and reproducible quantitative CRT methods for robust measurements in patient triage, monitoring, and telehealth applications.
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Affiliation(s)
| | - Eduardo Lopes Dias
- Department of Physics, FFCLRP, University of São Paulo, São Paulo, Brazil
| | - George C Cardoso
- Department of Physics, FFCLRP, University of São Paulo, São Paulo, Brazil
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4
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Merdji H, Curtiaud A, Aheto A, Studer A, Harjola VP, Monnier A, Duarte K, Girerd N, Kibler M, Ait-Oufella H, Helms J, Mebazaa A, Levy B, Kimmoun A, Meziani F. Performance of Early Capillary Refill Time Measurement on Outcomes in Cardiogenic Shock: An Observational, Prospective Multicentric Study. Am J Respir Crit Care Med 2022. [DOI: 10.1164/rccm.202204-0687oc 10.1164/rccm.202204-0687oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- Hamid Merdji
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Strasbourg, France
| | - Anais Curtiaud
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Antoine Aheto
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Antoine Studer
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Veli-Pekka Harjola
- Emergency Medicine, University of Helsinki, Helsinki, Finland
- Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Alexandra Monnier
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
| | - Kevin Duarte
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433; Medical Intensive Care Unit Brabois, France
| | - Nicolas Girerd
- Centre d'Investigations Cliniques Plurithématique, INSERM 1433; Medical Intensive Care Unit Brabois, France
| | - Marion Kibler
- Division of Cardiovascular Medicine, Strasbourg University Hospital, Strasbourg, France
| | - Hafid Ait-Oufella
- Intensive Care Unit, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM U970, Cardiovascular Research Center, Université de Paris, Paris, France
| | - Julie Helms
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Strasbourg, France
| | - Alexandre Mebazaa
- Department of Anaesthesiology, Burn and Critical Care, Saint Louis-Lariboisière University Hospitals, Assistance Publique-Hôpitaux de Paris, Paris, France
- INSERM UMR-S 942, Cardiovascular Markers in Stress Conditions, Fédération Hospitalo-Universitaire Promice, University of Paris, Paris, France
| | - Bruno Levy
- INSERM U1116, Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux, Centre Hospitalier Régional Universitaire de Nancy, France; and
| | - Antoine Kimmoun
- INSERM U1116, Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux, Centre Hospitalier Régional Universitaire de Nancy, France; and
| | - Ferhat Meziani
- Université de Strasbourg, Faculté de Médecine; Hôpitaux universitaires de Strasbourg, Nouvel Hôpital Civil, Service de Médecine Intensive-Réanimation, Strasbourg, France
- INSERM (French National Institute of Health and Medical Research), Unité Mixte de Recherche (UMR) 1260, Regenerative Nanomedicine, Strasbourg, France
- Clinical Research in Intensive Care and Sepsis Trial Group for Global Evaluation and Research in Sepsis French Clinical Research Infrastructure Network, France
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5
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Gillespie J, Hansen M, Samatham R, Baker SD, Filer S, Sheridan DC. Capillary Refill Technology to Enhance the Accuracy of Peripheral Perfusion Evaluation in Sepsis. J Intensive Care Med 2022; 37:1159-1164. [DOI: 10.1177/08850666221087685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Monitoring of capillary refill time (CRT) is a common bedside assessment used to ascertain peripheral perfusion in a patient for a vast array of conditions. The literature has shown that a change in CRT can be used to recognize life-threatening conditions that cause decreased perfusion, such as sepsis, and aid in resuscitation. The current practice for calculating CRT invites subjectivity and produces a highly variable result. Innovative technology may be able to standardize this process and provide a reliable and accurate value for use in diagnostics and treatment. This study aimed to assess a new technology (DCR by ProMedix Inc.) for rapid, bedside, and noninvasive detection of CRT. Methods: This was a secondary analysis of a prospective observational study evaluating the accuracy of new technology towards CRT-guided diagnosis of sepsis. It was carried out in the adult emergency departments (ED) of an academic tertiary care medical center. Patients seeking care in the ED were determined eligible if they were > 18 years in age and exhibited chief complaints suggestive of possible sepsis. The CRT produced by the technology was compared to the gold standard manual waveform assessment. Results: 218 consecutive subject enrollments were included and multiple measurements were made on each patient. Data with irregular waveforms were excluded. A total of 692 waveforms were evaluated for CRT values by a pair of trained PhD biomedical engineers. The average age of the cohort was 50.62 and 51.4% female. Results showed a Pearson correlation coefficient of 0.91 for the device CRT compared to the CRT gold standard. The Pearson correlation coefficient for the two independent engineering review of the waveform data was 0.98. This device produces accurate, consistent results and eliminates the subjectivity of CRT measurements that is in practice currently.
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Affiliation(s)
- Jordan Gillespie
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Matthew Hansen
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Ravi Samatham
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - David C. Sheridan
- Department of Emergency Medicine, Oregon Health & Science University, Portland, Oregon, USA
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6
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Shinozaki M, Shimizu R, Saito D, Nakada TA, Nakaguchi T. Portable measurement device to quantitatively measure capillary refilling time. ARTIFICIAL LIFE AND ROBOTICS 2022. [DOI: 10.1007/s10015-021-00723-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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7
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Measurement of capillary refill time with a handheld prototype device: a comparative validation study in healthy volunteers. J Clin Monit Comput 2021; 36:1271-1278. [PMID: 34550528 DOI: 10.1007/s10877-021-00757-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 09/08/2021] [Indexed: 10/20/2022]
Abstract
Validity and reproducibility of clinical capillary refill time (CRT) measurement depend on many factors in daily routine practice. We conducted a prospective validation study of an automatized handheld prototype device providing standardized CRT assessment (DiCART™) in 20 healthy volunteers. Three different methods of CRT measurement were compared before and during dynamic circulatory changes induced by venous and arterial occlusion tests at both upper and lower limb levels: CRTCLIN corresponding to basic clinical assessment and considered as the reference method; CRTVIDEO corresponding to off-line videos reviewed by investigators recorded by DiCART™; and CRTDiCART corresponding to on-line videos analysed by a built-in proprietary mathematical algorithm included in DiCART™. Five subjects were excluded because of a DiCART™ dysfunction. ROCAUC to detect arterial occlusion test changes at the upper limb level were 1.00 (95%CI 1.00; 1.00), 0.96 (95%CI 0.88; 1.00), and 0.92 (95%CI 0.79; 1.00) for CRTCLIN, CRTVIDEO, and CRTDiCART, respectively. Precision of CRTCLIN and CRTVIDEO were significantly better than CRTDiCART (0.18 and 0.20 vs. 0.28; P < 0.05). Percentages of error were 76% and 87% for CRTVIDEO and CRTDiCART, respectively. DiCART™ had an excellent discrimination to detect major changes in CRT induced by arterial ischemia. However, the perfectible precision, the poor agreement with clinical assessment and numerous device dysfunctions give leads to the development of a further version of the prototype before promoting its use in clinical practice.Trial registration clinicaltrial.gov. Identifier: NCT04538612.
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8
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Ballaji HK, Correia R, Liu C, Korposh S, Hayes-Gill BR, Musgrove A, Morgan SP. Optical Fibre Sensor for Capillary Refill Time and Contact Pressure Measurements under the Foot. SENSORS 2021; 21:s21186072. [PMID: 34577279 PMCID: PMC8470683 DOI: 10.3390/s21186072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/11/2021] [Accepted: 08/20/2021] [Indexed: 12/16/2022]
Abstract
Capillary refill time (CRT) refers to the time taken for body tissue to regain its colour after an applied blanching pressure is released. Usually, pressure is manually applied and not measured. Upon release of pressure, simple mental counting is typically used to estimate how long it takes for the skin to regain its colour. However, this method is subjective and can provide inaccurate readings due to human error. CRT is often used to assess shock and hydration but also has the potential to assess peripheral arterial disease which can result in tissue breakdown, foot ulcers and ultimately amputation, especially in people with diabetes. The aim of this study was to design an optical fibre sensor to simultaneously detect blood volume changes and the contact pressure applied to the foot. The CRT probe combines two sensors: a plastic optical fibre (POF) based on photoplethysmography (PPG) to measure blood volume changes and a fibre Bragg grating to measure skin contact pressure. The results from 10 healthy volunteers demonstrate that the blanching pressure on the subject’s first metatarsal head of the foot was 100.8 ± 4.8 kPa (mean and standard deviation), the average CRT was 1.37 ± 0.46 s and the time to achieve a stable blood volume was 4.77 ± 1.57 s. For individual volunteers, the fastest CRT measured was 0.82 ± 0.11 and the slowest 1.94 ± 0.49 s. The combined sensor and curve fitting process has the potential to provide increased reliability and accuracy for CRT measurement of the foot in diabetic foot ulcer clinics and in the community.
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Affiliation(s)
- Hattan K. Ballaji
- Optics and Photonics Group, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (H.K.B.); (R.C.); (C.L.); (S.K.); (B.R.H.-G.)
- Computer Engineering Department, College of Computers and Information System, Umm Al-Qura University, Makkah 24381, Saudi Arabia
| | - Ricardo Correia
- Optics and Photonics Group, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (H.K.B.); (R.C.); (C.L.); (S.K.); (B.R.H.-G.)
| | - Chong Liu
- Optics and Photonics Group, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (H.K.B.); (R.C.); (C.L.); (S.K.); (B.R.H.-G.)
| | - Serhiy Korposh
- Optics and Photonics Group, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (H.K.B.); (R.C.); (C.L.); (S.K.); (B.R.H.-G.)
| | - Barrie R. Hayes-Gill
- Optics and Photonics Group, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (H.K.B.); (R.C.); (C.L.); (S.K.); (B.R.H.-G.)
| | - Alison Musgrove
- Nottingham University Hospitals NHS Trust, Nottingham NG5 1PB, UK;
| | - Stephen P. Morgan
- Optics and Photonics Group, Faculty of Engineering, University of Nottingham, Nottingham NG7 2RD, UK; (H.K.B.); (R.C.); (C.L.); (S.K.); (B.R.H.-G.)
- Correspondence:
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9
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Falotico JM, Shinozaki K, Saeki K, Becker LB. Advances in the Approaches Using Peripheral Perfusion for Monitoring Hemodynamic Status. Front Med (Lausanne) 2020; 7:614326. [PMID: 33365323 PMCID: PMC7750533 DOI: 10.3389/fmed.2020.614326] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/16/2020] [Indexed: 12/27/2022] Open
Abstract
Measures of peripheral perfusion can be used to assess the hemodynamic status of critically ill patients. By monitoring peripheral perfusion status, clinicians can promptly initiate life-saving therapy and reduce the likelihood of shock-associated death. Historically, abnormal perfusion has been indicated by the observation of pale, cold, and clammy skin with increased capillary refill time. The utility of these assessments has been debated given that clinicians may vary in their clinical interpretation of body temperature and refill time. Considering these constraints, current sepsis bundles suggest the need to revise resuscitation guidelines. New technologies have been developed to calculate capillary refill time in the hopes of identifying a new gold standard for clinical care. These devices measure either light reflected at the surface of the fingertip (reflected light), or light transmitted through the inside of the fingertip (transmitted light). These new technologies may enable clinicians to monitor peripheral perfusion status more accurately and may increase the potential for ubiquitous hemodynamic monitoring across different clinical settings. This review will summarize the different methods available for peripheral perfusion monitoring and will discuss the advantages and disadvantages of each approach.
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Affiliation(s)
- Julianne M Falotico
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, United States
| | - Koichiro Shinozaki
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, United States.,The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States.,Nihon Kohden Innovation Center, Cambridge, MA, United States
| | - Lance B Becker
- Department of Emergency Medicine, North Shore University Hospital, Northwell Health, Manhasset, NY, United States.,The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
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10
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Shinozaki K, Jacobson LS, Saeki K, Kobayashi N, Weisner S, Falotico JM, Li T, Kim J, Lampe JW, Becker LB. The standardized method and clinical experience may improve the reliability of visually assessed capillary refill time. Am J Emerg Med 2020; 44:284-290. [DOI: 10.1016/j.ajem.2020.04.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 03/16/2020] [Accepted: 04/03/2020] [Indexed: 01/09/2023] Open
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11
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Liu C, Correia R, Ballaji H, Korposh S, Hayes-Gill B, Morgan S. Optical Fibre Sensor for Simultaneous Measurement of Capillary Refill Time and Contact Pressure. SENSORS 2020; 20:s20051388. [PMID: 32138378 PMCID: PMC7085692 DOI: 10.3390/s20051388] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 02/27/2020] [Accepted: 03/01/2020] [Indexed: 11/19/2022]
Abstract
The widely applied capillary refill time (CRT) measurement is currently performed by manually applying pressure and using a stopwatch to record the time taken for the skin to recover its normal colour after a blanching pressure is applied. This method is highly subjective and observer-dependent. This paper presents a new, integrated optical sensor probe, combining monitoring of the capillary refilling process with the blanching pressure applied. The sensor consists of an optical fibre-based reflectance photoplethysmography (PPG) sensor to measure the reflected light signal, as well as a fibre Bragg grating (FBG) to measure the applied blanching pressure and to indicate the time when pressure is released. This sensor was applied to calculate the CRT (1.38 ± 0.66 s) of 10 healthy adult volunteers with (55.2 ± 21.8 kPa) blanching pressures. The form of the capillary refilling data was investigated by fitting using an exponential regression model (R2 > 0.96). The integrated probe has the potential to improve the reliability of CRT measurements by standardising the optimum duration and magnitude of the pressure.
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12
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Shinozaki K, Saeki K, Jacobson LS, Falotico JM, Li T, Hirahara H, Horie K, Kobayashi N, Weisner S, Lampe JW, Becker LB. Evaluation of accuracy of capillary refill index with pneumatic fingertip compression. J Clin Monit Comput 2020; 35:135-145. [PMID: 31916222 DOI: 10.1007/s10877-019-00454-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 12/26/2019] [Indexed: 01/09/2023]
Abstract
Capillary refill time (CRT) is a method of measuring a patient's peripheral perfusion status through a visual assessment performed by a clinician. We developed a new method of measuring CRT using standard pulse oximetry sensor, which was designated capillary refill index (CRI). We evaluated the accuracy of CRI in comparison to CRT image analysis. Thirty healthy adult volunteers were recruited for a derivation study and 30 patients in the emergency department (ED) were for validation. Our high fidelity mechanical device compresses and releases the fingertip to measure changes in blood volume using infrared-light (940 nm). CRT was calculated by image analysis software using recorded fingertip videos. CRI and CRT were measured at: room temperature (ROOM TEMP), 15 °C cold water (COLD), and 38 °C warm water (REWARM). Intra-rater reliability, Bland-Altman plots, and correlation coefficients were used to evaluate the accuracy of the novel CRI method. CRI (4.9 [95% CI 4.5-5.3] s) and CRT (4.0 [3.6-4.3]) in the COLD group were higher than the ROOM TEMP and REWARM groups. High intra-rater reliability was observed in both measurements (0.97 [0.95-0.98] and 0.98 [0.97-0.99], respectively). The Bland-Altman plots suggested a systematic bias: CRI was consistently higher than CRT (difference: + 1.01 s). There was a strong correlation between CRI and CRT (r = 0.89, p < 0.001). ED patients had higher CRI (3.91 [5.05-2.75]) and CRT (2.21 [3.19-1.23]) than those of healthy volunteers at room temperature. The same difference and correlation patterns were verified in the ED setting. CRI was as reliable as CRT by image analysis. The values of CRI was approximately 1 s higher than CRT.
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Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr., Manhasset, NY, 11030, USA. .,Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, NY, USA.
| | - Kota Saeki
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | - Lee S Jacobson
- Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Julianne M Falotico
- Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Timmy Li
- Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, NY, USA
| | | | | | | | | | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr., Manhasset, NY, 11030, USA.,ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr., Manhasset, NY, 11030, USA.,Department of Emergency Medicine, Northshore University Hospital, Northwell Health, Manhasset, NY, USA
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13
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Jacquet-Lagrèze M, Bouhamri N, Portran P, Schweizer R, Baudin F, Lilot M, Fornier W, Fellahi JL. Capillary refill time variation induced by passive leg raising predicts capillary refill time response to volume expansion. Crit Care 2019; 23:281. [PMID: 31420052 PMCID: PMC6697974 DOI: 10.1186/s13054-019-2560-0] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND A peripheral perfusion-targeted resuscitation during early septic shock has shown encouraging results. Capillary refill time, which has a prognostic value, was used. Adding accuracy and predictability on capillary refill time (CRT) measurement, if feasible, would benefit to peripheral perfusion-targeted resuscitation. We assessed whether a reduction of capillary refill time during passive leg raising (ΔCRT-PLR) predicted volume-induced peripheral perfusion improvement defined as a significant decrease of capillary refill time following volume expansion. METHODS Thirty-four patients with acute circulatory failure were selected. Haemodynamic variables, metabolic variables (PCO2gap), and four capillary refill time measurements were recorded before and during a passive leg raising test and after a 500-mL volume expansion over 20 min. Receiver operating characteristic curves were built, and areas under the curves were calculated (ROCAUC). Confidence intervals (CI) were performed using a bootstrap analysis. We recorded mortality at day 90. RESULTS The least significant change in the capillary refill time was 25% [95% CI, 18-30]. We defined CRT responders as patients showing a reduction of at least 25% of capillary refill time after volume expansion. A decrease of 27% in ΔCRT-PLR predicted peripheral perfusion improvement with a sensitivity of 87% [95% CI, 73-100] and a specificity of 100% [95% CI, 74-100]. The ROCAUC of ΔCRT-PLR was 0.94 [95% CI, 0.87-1.0]. The ROCAUC of baseline capillary refill time was 0.73 [95% CI, 0.54-0.90] and of baseline PCO2gap was 0.79 [0.61-0.93]. Capillary refill time was significantly longer in non-survivors than in survivors at day 90. CONCLUSION ΔCRT-PLR predicted peripheral perfusion response following volume expansion. This simple low-cost and non-invasive diagnostic method could be used in peripheral perfusion-targeted resuscitation protocols. TRIAL REGISTRATION CPP Lyon Sud-Est II ANSM: 2014-A01034-43 Clinicaltrial.gov, NCT02248025 , registered 13th of September 2014.
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Affiliation(s)
- Matthias Jacquet-Lagrèze
- Département d’Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008 Lyon, France
| | - Nourredine Bouhamri
- Département d’Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Philippe Portran
- Département d’Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008 Lyon, France
| | - Rémi Schweizer
- Département d’Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008 Lyon, France
| | - Florent Baudin
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008 Lyon, France
- Département de Réanimation Pédiatrique, Centre Hospitalier Femme mère enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
| | - Marc Lilot
- Département d’Anesthésie Pédiatrique, Centre Hospitalier Femme Mère Enfant, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Centre Lyonnais d’Enseignement par Simulation en Santé, SAMSEI, Université Claude Bernard Lyon 1, Lyon, France
- Health Services and Performance Research Lab (EA 7425 HESPER), Université Claude Bernard Lyon 1, Lyon, France
- EPICIME-CIC 1407 de Lyon, Inserm, Hospices Civils de Lyon, F-69677 Bron, France
| | - William Fornier
- Département d’Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008 Lyon, France
| | - Jean-Luc Fellahi
- Département d’Anesthésie Réanimation, Centre Hospitalier Louis Pradel, Hospices Civils de Lyon, 59 Boulevard Pinel, 69500 Bron, France
- Université Claude-Bernard, Lyon 1, Campus Lyon Santé Est, 8 avenue Rockefeller, 69008 Lyon, France
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14
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Toll John R, Henricson J, Anderson CD, Björk Wilhelms D. Man versus machine: comparison of naked-eye estimation and quantified capillary refill. Emerg Med J 2019; 36:465-471. [PMID: 31308133 PMCID: PMC6678056 DOI: 10.1136/emermed-2018-207948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 04/26/2019] [Accepted: 05/30/2019] [Indexed: 11/15/2022]
Abstract
Background Capillary refill (CR) time is traditionally assessed by ‘naked-eye’ inspection of the return to original colour of a tissue after blanching pressure. Few studies have addressed intra-observer reliability or used objective quantification techniques to assess time to original colour. This study compares naked-eye assessment with quantified CR (qCR) time using polarisation spectroscopy and examines intra-observer and interobserver agreements in using the naked eye. Method A film of 18 CR tests (shown in a random fixed order) performed in healthy adults was assessed by a convenience sample of 14 doctors, 15 nurses and 19 secretaries (Department of Emergency Medicine, Linköping University, September to November 2017), who were asked to estimate the time to return to colour and characterise it as ‘fast’, ‘normal’ or ‘slow’. The qCR times and corresponding naked-eye time assessments were compared using the Kruskal-Wallis test. Three videos were shown twice without observers’ knowledge to measure intra-observer repeatability. Intra-observer categorical assessments were compared using Cohen’s Kappa analysis. Interobserver repeatability was measured and depicted with multiple-observer Bland-Altman plotting. Differences in naked-eye estimation between professions were analysed using ANOVA. Results Naked-eye assessed CR time and qCR time differ substantially, and agreement for the categorical assessments (naked-eye assessment vs qCR classification) was poor (Cohen’s kappa 0.27). Bland-Altman intra-observer repeatability ranged from 6% to 60%. Interobserver agreement was low as shown by the Bland-Altman plotting with a 95% limit of agreement with the mean of ±1.98 s for doctors, ±1.6 s for nurses and ±1.75 s for secretaries. The difference in CR time estimation (in seconds) between professions was not significant. Conclusions Our study suggests that naked-eye-assessed CR time shows poor reproducibility, even by the same observers, and differs from an objective measure of CR time.
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Affiliation(s)
- Rani Toll John
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Östergötland, Sweden.,Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden
| | - Joakim Henricson
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden.,Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Chris D Anderson
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Östergötland, Sweden.,Department of Dermatology and Venerology, Heart and Medicine Centre, Region Östergötland, Linköping, Sweden
| | - Daniel Björk Wilhelms
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, Linköping, Sweden.,Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Linköping, Sweden
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15
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John RT, Henricson J, Nilsson GE, Wilhelms D, Anderson CD. Reflectance spectroscopy: to shed new light on the capillary refill test. JOURNAL OF BIOPHOTONICS 2018; 11:e201700043. [PMID: 28544641 DOI: 10.1002/jbio.201700043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 04/25/2017] [Accepted: 05/09/2017] [Indexed: 06/07/2023]
Abstract
To use Bioengineering methodology is used to achieve, at five anatomical sites, a detailed, quantitative assessment of the return of blood content to the blanched area, during the Capillary Refill (CR) test. An observational, non-randomized, experimental study on 23 healthy subjects (14 females) was performed in our climate controlled skin physiology laboratory. Our main outcome measures were based on the chronological assessment and quantification of red blood cell concentration (RBC) after the release of blanching pressure in the CR test, using Tissue Viability Imaging (TiVi), a digital photographic technique based on polarisation spectroscopy. TiVi enabled collection of detailed data on skin RBC concentration during the CR test. The results were shown as curves with skin blood concentration (TiVi-value) on the y-axis and the time on the x-axis. Quantitative CR responses showed site and temperature variability. We also suggest possible objective endpoint values from the capillary refill curve. Detailed data on skin RBC concentration during the CR test is easily obtained and allows objective determination of end points not possible to achieve by naked eye assessment. These findings have the potential to place the utility of the CR test in a clinical setting in a new light. Picture: Regular photograph and TiVi Image showing CR test and corresponding graph for the CR response.
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Affiliation(s)
- Rani Toll John
- Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University and Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland, 58185, Linköping, Sweden
| | - Joakim Henricson
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Dermatology and Venerology, Heart and Medicine Center, Region Östergötland
| | - Gert E Nilsson
- WheelsBridge AB, Lövsbergsv 13, 589 37 Linköping, Sweden
| | - Daniel Wilhelms
- Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University, Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland
| | - Chris D Anderson
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Department of Dermatology and Venerology, Heart and Medicine Center, Region Östergötland
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16
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Henricson J, Toll John R, Anderson CD, Björk Wilhelms D. Diffuse Reflectance Spectroscopy: Getting the Capillary Refill Test Under One's Thumb. J Vis Exp 2017. [PMID: 29286408 DOI: 10.3791/56737] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The capillary refill test was introduced in 1947 to help estimate circulatory status in critically ill patients. Guidelines commonly state that refill should occur within 2 s after releasing 5 s of firm pressure (e.g., by the physician's finger) in the normal healthy supine patient. A slower refill time indicates poor skin perfusion, which can be caused by conditions including sepsis, blood loss, hypoperfusion, and hypothermia. Since its introduction, the clinical usefulness of the test has been debated. Advocates point out its feasibility and simplicity and claim that it can indicate changes in vascular status earlier than changes in vital signs such as heart rate. Critics, on the other hand, stress that the lack of standardization in how the test is performed and the highly subjective nature of the naked eye assessment, as well as the test's susceptibility to ambient factors, markedly lowers the clinical value. The aim of the present work is to describe in detail the course of the refill event and to suggest potentially more objective and exact endpoint values for the capillary refill test using diffuse polarization spectroscopy.
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Affiliation(s)
- Joakim Henricson
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland; Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University;
| | - Rani Toll John
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland; Division of Neuro and Inflammation Science, Department of Clinical and Experimental Medicine, Linköping University
| | - Chris D Anderson
- Division of Cell Biology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University; Department of Dermatology and Venerology, Heart and Medicine Center, Region Östergötland
| | - Daniel Björk Wilhelms
- Department of Emergency Medicine, Local Health Care Services in Central Östergötland, Region Östergötland; Division of Drug Research, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University
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Investigation of the feasibility of non-invasive optical sensors for the quantitative assessment of dehydration. Med Eng Phys 2017; 48:181-187. [PMID: 28734875 DOI: 10.1016/j.medengphy.2017.06.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 03/07/2017] [Accepted: 06/20/2017] [Indexed: 11/21/2022]
Abstract
This study explores the feasibility of prospectively assessing infant dehydration using four non-invasive, optical sensors based on the quantitative and objective measurement of various clinical markers of dehydration. The sensors were investigated to objectively and unobtrusively assess the hydration state of an infant based on the quantification of capillary refill time (CRT), skin recoil time (SRT), skin temperature profile (STP) and skin tissue hydration by means of infrared spectrometry (ISP). To evaluate the performance of the sensors a clinical study was conducted on a cohort of 10 infants (aged 6-36 months) with acute gastroenteritis. High sensitivity and specificity were exhibited by the sensors, in particular the STP and SRT sensors, when combined into a fusion regression model (sensitivity: 0.90, specificity: 0.78). The SRT and STP sensors and the fusion model all outperformed the commonly used "gold standard" clinical dehydration scales including the Gorelick scale (sensitivity: 0.56, specificity: 0.56), CDS scale (sensitivity: 1.0, specificity: 0.2) and WHO scale (sensitivity: 0.13, specificity: 0.79). These results suggest that objective and quantitative assessment of infant dehydration may be possible using the sensors investigated. However, further evaluation of the sensors on a larger sample population is needed before deploying them in a clinical setting.
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