Capillary refill time: The missing link between macrocirculation and microcirculation in septic shock?
Open accessAbstract
ANDROMEDA-SHOCK was a multicenter, randomized controlled trial comparing capillary refill time (CRT)- versus lactate-targeted resuscitation in patients with early septic shock (1). The protocol mandated sequential steps starting with fluid challenges, followed by vasoactive-related interventions if necessary, until the target was reached. CRT-targeted resuscitation was associated with lower mortality (34.9% vs. 43.4%; P=0.06), beneficial effects on organ dysfunction, and less treatment intensity. A strong survival benefit was also supported by a recently published post-hoc Bayesian analysis (2).
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A rapid return of CRT to baseline suggests preserved hemodynamic coherence between macro- and microcirculations.
“A rapid return of CRT to baseline suggests preserved hemodynamic coherence between macro- and microcirculations [24].”
From Trends and Challenges in Noninvasive Hemodynamic Monitoring of Neonates Following Cardiac Surgery: A Narrative Review (2025) · cites this paper as [24]
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Hernández, G., Ospina-Tascón, G. A., Damiani, L. P., Estenssoro, E., Dubin, A., Hurtado, J., Friedman, G., Castro, R., Alegría, L., Teboul, J.-L., et al. (2019) · JAMA · doi:10.1001/jama.2019.0071 · Cited by 946 · see citing works
Self-citationThe ten pitfalls of lactate clearance in sepsis
Hernández, G., Bellomo, R., & Bakker, J. (2018) · Intensive Care Medicine · doi:10.1007/s00134-018-5213-x · Cited by 339 · see citing works
Self-citationZampieri, F. G., Damiani, L. P., Bakker, J., Ospina-Tascón, G. A., Castro, R., Cavalcanti, A. B., & Glenn Hernández, P. (2019) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201905-0968oc · Cited by 253 · see citing works
Self-citationLara, B., Enberg, L., Ortega, M., Leon, P., Kripper, C., Aguilera, P., Kattan, E., Castro, R., Bakker, J., & Hernandez, G. (2017) · PLOS ONE · doi:10.1371/journal.pone.0188548 · Cited by 167 · see citing works
Self-citationWhen to stop septic shock resuscitation: clues from a dynamic perfusion monitoring
Glenn Hernández, P., Luengo, C., Bruhn, A. R., Kattan, E., Friedman, G., Ospina-Tascón, G. A., Fuentealba, A., Castro, R., Regueira, T., Romero, C. M., et al. (2014) · Annals of Intensive Care · doi:10.1186/s13613-014-0030-z · Cited by 152 · see citing works
Self-citationGlenn Hernández, P., Pedreros, C., Veas, E., Bruhn, A. R., Romero, C. M., Rovegno, M., Neira, R., Bravo, S., Castro, R., Kattan, E., et al. (2011) · Journal of Critical Care · doi:10.1016/j.jcrc.2011.05.024 · Cited by 133 · see citing works
Self-citationBrunauer, A., Koköfer, A., Bataar, O., Gradwohl-Matis, I., Dankl, D., Bakker, J., & Dünser, M. W. (2016) · Journal of Critical Care · doi:10.1016/j.jcrc.2016.05.007 · Cited by 123 · see citing works
Self-citationThe holistic view on perfusion monitoring in septic shock
Glenn Hernández, P., Bruhn, A. R., Castro, R., & Regueira, T. (2012) · Current Opinion in Critical Care · doi:10.1097/mcc.0b013e3283532c08 · Cited by 97 · see citing works
Self-citationIs the macrocirculation really dissociated from the microcirculation in septic shock?
Hernández, G., & Teboul, J. (2016) · Intensive Care Medicine · doi:10.1007/s00134-016-4416-2 · Cited by 69 · see citing works
Self-citationPerspectives on perfusion monitoring in septic shock after the ANDROMEDA-SHOCK trial
Glenn Hernández, P., & Bakker, J. (2019) · Medicina Intensiva · doi:10.1016/j.medin.2019.09.009 · Cited by 11 · see citing works
Self-citationPerspectives on perfusion monitoring in septic shock after the ANDROMEDA-SHOCK trial
Glenn Hernández, P., & Bakker, J. (2019) · Medicina Intensiva (English Edition) · doi:10.1016/j.medine.2019.09.002 · Cited by 1 · see citing works
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Effective hemodynamic monitoring
Pinsky, M. R., Cecconi, M., Chew, M. S., De Backer, D., Douglas, I., Edwards, M., Hamzaoui, O., Hernandez, G., Martin, G., Monnet, X., et al. (2022) · Critical Care · doi:10.1186/s13054-022-04173-z · Cited by 167 · see citing works
Nedelcu, C., Ionescu, N. S., Bizubac, A. M., Filip, C., & Cirstoveanu, C. (2025) · Life · doi:10.3390/life15101621 · Cited by 2 · see citing works
- Authors
- Hernández, G., Castro, R., & Bakker, J.
- Affiliations
- Pontificia Universidad Católica de Chile (CL)
- Venue
- Journal of Thoracic Disease
- Publisher
- AME Publishing Company
- Published
- 2020-03
- Volume
- 12
- Issue
- 3
- Pages
- 1127-1129
- ISSN
- 2072-1439 (ISSN-L)
- 2077-6624
- PMC
- PMC7139032
- OpenAlex
- W3008749439
- Cited by
- 27
- References
- 11
- Citations by year
- 2026: 6 · 2025: 4 · 2024: 7 · 2023: 4 · 2022: 3 · 2021: 2 · 2020: 1
- FWCI
- 1.79
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of Thoracic Disease (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- EUR Research Repository (Erasmus University Rotterdam) (publishedVersion, other-oa)
- EUR Research Repository (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion, other-oa)
- RePub (Erasmus University Rotterdam) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Health Sciences › Medicine › Surgery › Hemodynamic Monitoring and Therapy
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Abdominal Surgery and Complications
- Keywords
- capillary refill time, septic shock, fluid resuscitation, macrocirculation, microcirculation, mortality, organ dysfunction
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