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Fage N, Moretto F, Rosalba D, Shi R, Lai C, Teboul JL, Monnet X. Effect on capillary refill time of volume expansion and increase of the norepinephrine dose in patients with septic shock. Crit Care 2023; 27:429. [PMID: 37932812 PMCID: PMC10629142 DOI: 10.1186/s13054-023-04714-0] [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: 05/31/2023] [Accepted: 10/27/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND Capillary refill time (CRT) has been suggested as a variable to follow during the course of septic shock. We systematically investigated the effects on CRT of volume expansion and norepinephrine. METHODS In 69 septic shock patients, we recorded mean arterial pressure (MAP), cardiac index (CI), and 5 consecutive CRT measurements (video method, standardized pressure applied on the fingertip) before and after a 500-mL saline infusion in 33 patients and before and after an increase of the norepinephrine dose in 36 different patients. Fluid responders were defined by an increase in CI ≥ 15%, and norepinephrine responders by an increase in MAP ≥ 15%. RESULTS The least significant change of CRT was 23%, so that changes in CRT were considered significant if larger than 23%. With volume expansion, CRT remained unchanged on average in patients with baseline CRT < 3 s (n = 7) and in all but one patient with baseline CRT ≥ 3 s in whom fluid increased CI < 15% (n = 13 "fluid non-responders"). In fluid responders with baseline CRT ≥ 3 s (n = 13), CRT decreased in 8 patients and remained unchanged in the others, exhibiting a dissociation between CI and CRT responses. The proportion of patients included > 24 h after starting norepinephrine was higher in patients with such a dissociation than in the other ones (60% vs. 0%, respectively). Norepinephrine did not change CRT significantly (except in one patient) if baseline CRT was ≥ 3 s and the increase in MAP < 15% (n = 6). In norepinephrine responders with prolonged baseline CRT (n = 11), it increased in 4 patients and remained unchanged in the other ones, which exhibited a dissociation between MAP and CRT responses. CONCLUSIONS In septic shock patients with prolonged CRT, CRT very rarely improves with treatment when volume expansion increases cardiac output < 15% and increasing norepinephrine increases MAP < 15%. When the effects of fluid infusion on cardiac output and of norepinephrine on MAP are significant, the response of CRT is variable, as it decreases in some patients and remains stable in others which exhibit a dissociation between changes in macrohemodynamic variables and in CRT. In this regard, CRT behaves as a marker of microcirculation. TRIAL REGISTRATION ClinicalTrial.gov (NCT04870892). Registered January15, 2021. Ethics committee approval CE SRLF 21-25.
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Affiliation(s)
- Nicolas Fage
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France.
- Department of Medical Intensive Care, University Hospital of Angers, Angers, France.
- MITOVASC Laboratory UMR INSERM (French National Institute of Health and Medical Research), 1083-CNRS 6015, University of Angers, Angers, France.
| | - Francesca Moretto
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Daniela Rosalba
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Rui Shi
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Christopher Lai
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Jean-Louis Teboul
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
| | - Xavier Monnet
- Service de Médecine Intensive-Réanimation, Hôpital de Bicêtre, DMU CORREVE, Inserm UMR S_999, FHU SEPSIS, Groupe de Recherche Clinique CARMAS, Université Paris-Saclay, AP-HP, Le Kremlin-Bicêtre, France
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Park W, Yiu C, Liu Y, Wong TH, Huang X, Zhou J, Li J, Yao K, Huang Y, Li H, Li J, Jiao Y, Shi R, Yu X. High Channel Temperature Mapping Electronics in a Thin, Soft, Wireless Format for Non-Invasive Body Thermal Analysis. BIOSENSORS 2021; 11:bios11110435. [PMID: 34821651 PMCID: PMC8615861 DOI: 10.3390/bios11110435] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/29/2021] [Accepted: 10/29/2021] [Indexed: 11/16/2022]
Abstract
Hemodynamic status has been perceived as an important diagnostic value as fundamental physiological health conditions, including decisive signs of fatal diseases like arteriosclerosis, can be diagnosed by monitoring it. Currently, the conventional hemodynamic monitoring methods highly rely on imaging techniques requiring inconveniently large numbers of operation procedures and equipment for mapping and with a high risk of radiation exposure. Herein, an ultra-thin, noninvasive, and flexible electronic skin (e-skin) hemodynamic monitoring system based on the thermal properties of blood vessels underneath the epidermis that can be portably attached to the skin for operation is introduced. Through a series of thermal sensors, the temperatures of each subsection of the arrayed sensors are observed in real-time, and the measurements are transmitted and displayed on the screen of an external device wirelessly through a Bluetooth module using a graphical user interface (GUI). The degrees of the thermal property of subsections are indicated with a spectrum of colors that specify the hemodynamic status of the target vessel. In addition, as the sensors are installed on a soft substrate, they can operate under twisting and bending without any malfunction. These characteristics of e-skin sensors exhibit great potential in wearable and portable diagnostics including point-of-care (POC) devices.
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Affiliation(s)
- Wooyoung Park
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Chunki Yiu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Yiming Liu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Tsz Hung Wong
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Xingcan Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Jingkun Zhou
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Jian Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Kuanming Yao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Ya Huang
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Hu Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Jiyu Li
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
| | - Yanli Jiao
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Rui Shi
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
| | - Xinge Yu
- Department of Biomedical Engineering, City University of Hong Kong, Hong Kong 999077, China; (W.P.); (C.Y.); (Y.L.); (T.H.W.); (X.H.); (J.Z.); (J.L.); (K.Y.); (Y.H.); (H.L.); (J.L.); (Y.J.); (R.S.)
- Hong Kong Center for Cerebra-Cardiovascular Health Engineering, Hong Kong Science Park, New Territories, Hong Kong 999077, China
- Correspondence:
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[Dealing with the bleeding patient, being effective with (almost) nothing]. REVUE DE L'INFIRMIÈRE 2021; 70:19-20. [PMID: 34446228 DOI: 10.1016/j.revinf.2021.06.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
The practice of pre-hospital care, whether you are a professional rescuer, a nurse, a doctor or a simple citizen, sometimes exposes you to the management of a patient who presents an acute hemorrhage. The prognosis is quickly life-threatening if the safety, assessment, life-saving gestures and activation of the rescue chain are not carried out. A basic, inexpensive first aid kit can further reduce morbidity and mortality. Training first responders in life-saving techniques is a public health issue.
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