Internal Medicine · 1 h ago
Review outlines mechanisms behind prolonged capillary refill in sepsis
A narrative review describes six physiological mechanisms that may prolong capillary refill time (CRT) in sepsis and septic shock. The authors distinguish mechanisms supported by physiology or observational associations from hypotheses lacking direct CRT-specific evidence, and recommend interpreting CRT alongside other hemodynamic and perfusion measures.
- CRT prolongation may reflect several coexisting mechanisms.
- Evidence strength differs across the proposed pathways.
- Interpret CRT alongside hemodynamic and other perfusion measures.
Capillary refill time (CRT) is used as a bedside resuscitation target in septic shock, but it reflects several processes rather than a single measure of perfusion. In this narrative review, the authors propose a framework of six non-mutually exclusive mechanisms that may prolong CRT, including reduced skin perfusion from sympathetic vasoconstriction, inadequate upstream blood flow, inflammatory microvascular injury, impaired vasomotor regulation, severe vasoplegia, and elevated venous or interstitial pressure.
The review notes that evidence varies across the proposed mechanisms. Physiological evidence and CRT-specific observational associations support some pathways, while a direct causal role for these mechanisms has not been established. The proposed contribution of venous and interstitial pressures is particularly hypothesis-generating because direct CRT-specific evidence is lacking.
The authors suggest interpreting CRT dynamically and in context, alongside preload responsiveness, cardiac output, arterial pressure, vasopressor exposure, skin temperature, mottling, venous congestion, and other perfusion markers. This is a narrative synthesis rather than a clinical trial; it organizes existing evidence and generates hypotheses, but does not establish that targeting CRT or testing responses to interventions identifies the underlying mechanism.
In practice
For clinicians assessing adults with sepsis or septic shock, the review supports treating prolonged CRT as a contextual sign of peripheral perfusion rather than evidence of one specific hemodynamic abnormality. CRT can be considered alongside cardiac output, arterial pressure, vasopressor exposure, skin temperature, mottling, venous congestion, and other perfusion markers. The article is a narrative synthesis, not a trial demonstrating improved outcomes from a CRT-guided strategy; proposed mechanisms have varying levels of support, and causal contributions remain unproven. It does not establish a new treatment or monitoring protocol.
AI-generated clinical interpretation · Not editor-reviewed
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Critical Care: Capillary refill time prolongation in sepsis and septic shock: supported and potential mechanisms from a pathophysiological perspective ↗This is an automated AI-condensed summary that has not yet been reviewed by an editor. Always consult the full item at the original source.