Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients

Objectives-Capillary refill time is an important diagnostic adjunct in the acute resuscitation phase of the shocked child. This study assesses its rel ation to commonly measured haemodynamic parameters in the postresuscitation phase when the child has reached the intensive care unit, and compares thi s with core-peripheral temperature gap. Methods-Ninety standardised measurements of capillary refill time were made on 55 patients, who were divided into postcardiac surgery (n = 27), and ge neral (n = 28), most of whom had septic shock (n = 24). A normal capillary refill time was defined as less than or equal to 2 seconds. Measured haemod ynamic variables included: cardiac index, central venous pressure, systemic vascular resistance index, stroke volume index (SVI), and blood lactate. S eventy measurements were made on patients while being treated with inotrope s or vasodilators. Results-Capillary refill time and temperature gap both correlated poorly wi th all haemodynamic variables among postcardiac surgery children. For gener al patients, capillary refill time was related to SVI and lactate; temperat ure gap correlated poorly with all variables. General patients with a prolo nged capillary refill time had a lower median SVI (28 v 38 ml/m(2)) but not a higher lactate (1.7 v 1.1 mmol/l). A capillary refill time of greater th an or equal to 6 seconds had the best predictive value for a reduced SVI. Conclusion-Among ventilated, general intensive care patients, capillary ref ill time is related weakly to blood lactate and SVI. A normal value for cap illary refill time of less than or equal to 2 seconds has little predictive value and might be too conservative for this population; septic shock.