A normal capillary refill time of ≤ 2 seconds is associated with superior vena cava oxygen saturations of ≥ 70%.
OBJECTIVE
To test the hypothesis that a normal capillary refill time (CRT) ≤ 2 seconds is associated with superior vena cava oxygen saturation (ScvO₂) ≥ 70% in critically ill children.


METHODS
Two-year, prospective study in a tertiary-level pediatric intensive care unit. Whenever ScvO₂ measurements were obtained, central (forehead/sternum) and peripheral (finger/toe) CRTs were concomitantly assessed.


RESULTS
Central and peripheral CRTs ≤ 2 seconds were both associated with ScvO₂ ≥ 70% (P < .01). Sensitivity/specificity analyses revealed that central CRT ≤ 2 seconds demonstrated a sensitivity of 84.4%, specificity of 71.4%, positive predictive value of 93.1%, and negative predictive value of 50.0% in predicting ScvO₂ ≥ 70%. Peripheral CRT ≤ 2 seconds had a sensitivity of 71.9%, specificity of 85.7%, positive predictive value of 95.8%, and negative predictive value of 40.0% in predicting ScvO₂ ≥ 70%.


CONCLUSIONS
A normal CRT ≤ 2 seconds can be predictive of ScvO₂ ≥ 70%. Our study corroborates the recommendations of the Pediatric Advanced Life Support curricula targeting a normal CRT ≤ 2 seconds as a therapeutic endpoint for goal-directed shock resuscitation. This clinical target remains particularly relevant in community hospitals when the ability to obtain central venous catheter access may be limited and ScvO₂ data unavailable.
Department of Pediatrics and Communicable Diseases, University of Michigan Medical School, C.S. Mott Children's Hospital, Ann Arbor, MI, USA.
Patricia L
PL
Raimer
Yong Y
YY
Han
Monica S
MS
Weber
Gail M
GM
Annich
Joseph R
JR
Custer
D001784:Blood Gas Analysis; D002196:Capillaries / Q000473:pathology*; D057785:Catheters; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010100:Oxygen / Q000737:chemistry / Q000378:metabolism*; D010101:Oxygen Consumption; D010372:Pediatrics; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D014683:Vena Cava, Superior / Q000473:pathology*
D010100:Oxygen