Capillary refill and core-peripheral temperature gap as indicators of haemodynamic status in paediatric intensive care patients
Open accessAbstract
OBJECTIVES: Capillary refill time is an important diagnostic adjunct in the acute resuscitation phase of the shocked child. This study assesses its relation to commonly measured haemodynamic parameters in the postresuscitation phase when the child has reached the intensive care unit, and compares this 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 general (n = 28), most of whom had septic shock (n = 24). A normal capillary refill time was defined as < or = 2 seconds. Measured haemodynamic variables included: cardiac index, central venous pressure, systemic vascular resistance index, stroke volume index (SVI), and blood lactate. Seventy measurements were made on patients while being treated with inotropes or vasodilators. RESULTS: Capillary refill time and temperature gap both correlated poorly with all haemodynamic variables among post-cardiac surgery children. For general patients, capillary refill time was related to SVI and lactate; temperature gap correlated poorly with all variables. General patients with a prolonged capillary refill time had a lower median SVI (28 v 38 ml/m2) but not a higher lactate (1.7 v 1.1 mmol/l). A capillary refill time of > or = 6 seconds had the best predictive value for a reduced SVI. CONCLUSION: Among ventilated, general intensive care patients, capillary refill time is related weakly to blood lactate and SVI. A normal value for capillary refill time of < or = 2 seconds has little predictive value and might be too conservative for this population; septic shock.
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Other studies did not find any statistically significant associations between CPTd and hemodynamic parameters.
“Nonetheless, other studies did not find any statistically significant associations [28,29].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [29]
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“In the general pediatric intensive care unit population, only a severely prolonged capillary refill time correlates with the stroke volume index and lactate concentration; however, this correlation is relatively weak [38].”
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BackgroundFluid Bolus Therapy in Pediatric Sepsis: Current Knowledge and Future Direction
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“In children with septic shock in intensive care it relates weakly to stroke volume index (52) but commonly relied upon to determine the responsiveness to FBT.”
BackgroundTransfusion Decision Making in Pediatric Critical Illness
Markham, C., Small, S., Hovmand, P., & Doctor, A. (2017) · The Pediatric clinics of North America · doi:10.1016/j.pcl.2017.06.003 · Cited by 17 · see citing works
Santhanam, I., Pai, M., Kasturi, K., & Radhamani, M. (2002) · Pediatric Critical Care Medicine · doi:10.1097/00130478-200210000-00006 · Cited by 21 · see citing works
“However, other studies suggest that it correlates poorly with hemodynamic variables such as stroke volume index, cardiac index, systemic vascular resistance index, central venous pressure, and lactate (22, 23).”
BackgroundCardiovascular Compromise in the Newborn Infant
Seri, I., & Markovitz, B. P. (2011) · Avery's Diseases of the Newborn · doi:10.1016/b978-1-4377-0134-0.10051-4 · Cited by 18 · see citing works
Methylene Blue for Refractory Shock in Children: A Systematic Review and Survey Practice Analysis
Luna, A. O., Johnson, R., Funaro, M. C., Canarie, M. F., & Pierce, R. W. (2020) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002295 · Cited by 21 · see citing works
Noninvasive monitoring of peripheral perfusion
Lima, A. A. P., & Bakker, J. (2007) · Springer eBooks · doi:10.1007/3-540-37363-2_26 · Cited by 17 · see citing works
Definition of Normal Blood Pressure Range: The Elusive Target
Engle, W. D. (2008) · Elsevier eBooks · doi:10.1016/b978-1-4160-3162-8.10003-x · Cited by 17 · see citing works
Pediatric sepsis and septic shock management in resource-limited settings
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Inotropes for preterm babies during the transition period after birth: friend or foe?
Rabe, H., & Rojas-Anaya, H. (2017) · Archives of Disease in Childhood Fetal & Neonatal · doi:10.1136/archdischild-2016-311709 · Cited by 16 · see citing works
Ussat, M., Vogtmann, C., Gebauer, C. M., Pulzer, F., Thome, U. H., & Knüpfer, M. M. (2015) · Early Human Development · doi:10.1016/j.earlhumdev.2015.09.007 · Cited by 15 · see citing works
“Circulatory — cpTD N 2 °C, CRT N 2 s [16,17], increased heart rate N 10% above individual base-line, bradycardia with pulse b 100 bpm (for at least 20 s), change of skin colour (pallor, “grey” skin) and blood pressure; 2.”
BackgroundThe Cardiovascular System in Severe Sepsis: Insight From a Cardiovascular Simulator
Bronicki, R. A., Tume, S., Flores, S., Loomba, R., Borges, N. M., Penny, D., & Burkhoff, D. (2022) · Pediatric Critical Care Medicine · doi:10.1097/pcc.0000000000002945 · Cited by 14 · see citing works
A Review of Biomarkers and Physiomarkers in Pediatric Sepsis
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Definition of Normal Blood Pressure Range
Engle, W. D. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-2763-0.00003-2 · Cited by 14 · see citing works
Diagnosing and treating attentional difficulties: a nationwide survey
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Cardiovascular Compromise in the Newborn Infant
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“Tibby and colleagues (2) evaluated this same question in 1999 using a sample of sick patients in the pediatric intensive care unit who were being treated with inotropes and/or fluids.”
BackgroundPediatric Sepsis and Septic Shock Management in Resource-Limited Settings
Musa, N. L., Murthy, S., Kissoon, N. “., Lodha, R., & Ranjit, S. (2019) · Springer eBooks · doi:10.1007/978-3-030-03143-5_10 · Cited by 10 · see citing works
Standardized capillary refill time and relation to clinical parameters in hospitalized dogs
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Low cardiac output syndrome in children
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Rossi, A. F., Checchia, P. A., Lopez, L., Seiden, H., & Burke, R. P. (2012) · World Journal for Pediatric and Congenital Heart Surgery · doi:10.1177/2150135111433472 · Cited by 8 · see citing works
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Clinical Presentations of Neonatal Shock: The VLBW Infant during the First Postnatal Day
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Multimodal Assessment of Systemic Blood Flow in Infants
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“inflammatory skin conditions [3,13,14] and to evaluate treatment response [15] or assist for treatment planning [12].”
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“Hypothermia during CPB n (%) 7 (17) 2 (12) 5 (20) NS”
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Noninvasive monitoring of peripheral perfusion
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Sepsis Management in Resource-Limited Settings
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Paediatric capillary refill times
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“, fever or hypothermia) (Schriger and Baraff, 1988; Gorelick et al., 1993; Strozik et al., 1997; Tibby et al., 1999) and the difference in normal values dependingonwhich site”
BackgroundMethodInfluentialClinical Presentations of Neonatal Shock
Kluckow, M. R., & Seri, I. (2012) · Elsevier eBooks · doi:10.1016/b978-1-4377-2763-0.00012-3 · Cited by 4 · see citing works
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Is regional paediatric surveillance useful? Experience in Wales
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“31 Either T IH getting higher or T AI getting lower after injection indicated that the temperature of the infected knee was relatively higher than before being infected.”
BackgroundShock séptico en pediatría II: Enfoque actual en el diagnóstico y tratamiento
Alejandro Donoso, F., Daniela Arriagada, S., Pablo Cruces, R., & Díaz, F. (2013) · Revista chilena de pediatría · doi:10.4067/s0370-41062013000600003 · Cited by 3 · see citing works
- Authors
- Tibby, S. M., Hatherill, M., & Murdoch, I. A.
- Affiliations
- Guy's Hospital (GB)
- Venue
- Archives of Disease in Childhood
- Publisher
- BMJ
- Published
- 1999-02-01
- Volume
- 80
- Issue
- 2
- Pages
- 163-166
- ISSN
- 0003-9888 (ISSN-L)
- 1468-2044
- PMC
- PMC1717816
- OpenAlex
- W2161631123
- Cited by
- 152
- References
- 24
- Citations by year
- 2025: 3 · 2024: 5 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 5 · 2019: 9 · 2018: 9 · 2017: 5 · 2016: 7 · 2015: 2 · 2014: 9 · 2013: 9 · 2012: 10
- FWCI
- 2.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Archives of Disease in Childhood (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Emergency Medicine › Cardiac Arrest and Resuscitation
- Keywords
- capillary refill time, hemodynamic status, pediatric intensive care, septic shock, stroke volume index, blood lactate, post-cardiac surgery, inotropic agents, vasodilators, central venous pressure, systemic vascular resistance index, cardiac index
- MeSH terms
- Body Temperature Regulation, Capillary Resistance, Child, Child, Preschool, Cardiac Surgical Procedures, Hemodynamics, Humans, Infant, Pediatrics, Postoperative Complications, Predictive Value of Tests, Regional Blood Flow, Shock, Septic, Skin, Stroke Volume, Intensive Care Units, Pediatric, Lactic Acid
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