Using Capillary Refill Time to Guide Sepsis Resuscitation

We don't know the best markers to assess adequate resuscitation of patients with sepsis. Although the Surviving Sepsis guidelines endorse using lactate clearance as guidance, it is a weak recommendation with low-quality evidence (NEJM JW Emerg Med Jun 2018 and Intensive Care Med 2018; 44:925). Current Centers for Medicare & Medicaid Services sepsis reporting (i.e., SEP-1) requires measuring lactate and repeating assessment if lactate is >2 mmol/L.

Investigators from South America randomized 424 patients with early septic shock to resuscitation guided by peripheral perfusion evaluation at 30-minute intervals (using capillary refill time [CRT])^* or by lactate level measured every 2 hours. Patient care was protocolized for stepwise intervention…