Using Capillary Refill Time to Manage Resuscitation in Septic Shock

Lactate levels are an imperfect measure of peripheral perfusion in patients with shock. In 2019, investigators found that resuscitation (using fluids, vasopressors, inotropes, etc.) based on capillary refill (“cap-refill”) time improved some outcomes in patients with septic shock, compared with lactate-guided resuscitation. Now, in a similar but larger, international, unblinded study, the investigators randomized ≈1500 adults within 4 hours of septic shock presentation to receive either cap-refill–guided resuscitation (see Figure 1) or usual care (resuscitation typically guided by lactate and other clinical parameters).

The personalized algorithm for cap-refill–guided resuscitation was complex.* The study used a “win-ratio” methodolog…