Show simple item record

dc.contributor.authorFernández-Sarmiento J
dc.contributor.authorLamprea S
dc.contributor.authorBarrera S
dc.contributor.authorAcevedo L
dc.contributor.authorDuque C
dc.contributor.authorTrujillo M
dc.contributor.authorAguirre V
dc.contributor.authorJimenez C.
dc.date.accessioned2024-10-07T21:38:57Z
dc.date.available2024-10-07T21:38:57Z
dc.date.issued2024
dc.identifier.issn14712431
dc.identifier.otherhttps://www.scopus.com/inward/record.uri?eid=2-s2.0-85182645901&doi=10.1186%2fs12887-024-04524-5&partnerID=40&md5=4e80a79a3a1dbeda5b7346cfb005bbf9
dc.identifier.urihttp://hdl.handle.net/10818/61879
dc.description.abstractBackgrounds: In children with sepsis, circulatory shock and multi-organ failure remain major contributors to mortality. Prolonged capillary refill time (PCRT) is a clinical tool associated with disease severity and tissue hypoperfusion. Microcirculation assessment with videomicroscopy represents a promising candidate for assessing and improving hemodynamic management strategies in children with sepsis. Particularly when there is loss of coherence between the macro and microcirculation (hemodynamic incoherence). We sought to evaluate the association between PCRT and microcirculation changes in sepsis. Methods: This was a prospective cohort study in children hospitalized with sepsis. Microcirculation was measured using sublingual video microscopy (capillary density and flow and perfused boundary region [PBR]—a parameter inversely proportional to vascular endothelial glycocalyx thickness), phalangeal tissue perfusion, and endothelial activation and glycocalyx injury biomarkers. The primary outcome was the association between PCRT and microcirculation changes. Results: A total of 132 children with sepsis were included, with a median age of two years (IQR 0.6–12.2). PCRT was associated with increased glycocalyx degradation (PBR 2.21 vs. 2.08 microns; aOR 2.65, 95% CI 1.09–6.34; p = 0.02) and fewer 4–6 micron capillaries recruited (p = 0.03), with no changes in the percentage of capillary blood volume (p = 0.13). Patients with hemodynamic incoherence had more PBR abnormalities (78.4% vs. 60.8%; aOR 2.58, 95% CI 1.06–6.29; p = 0.03) and the persistence of these abnormalities after six hours was associated with higher mortality (16.5% vs. 6.1%; p < 0.01). Children with an elevated arterio-venous CO2 difference (DCO2) had an abnormal PBR (aOR 1.13, 95% CI 1.01–1.26; p = 0.03) and a lower density of small capillaries (p < 0.05). Prolonged capillary refill time predicted an abnormal PBR (AUROC 0.81, 95% CI 0.64–0.98; p = 0.03) and relative percentage of blood in the capillaries (AUROC 0.82, 95% CI 0.58–1.00; p = 0.03) on admission. A normal CRT at 24 h predicted a shorter hospital stay (aOR 0.96, 95% CI 0.94–0.99; p < 0.05). Conclusions: We found an association between PCRT and microcirculation changes in children with sepsis. These patients had fewer small capillaries recruited and more endothelial glycocalyx degradation. This leads to nonperfused capillaries, affecting oxygen delivery to the tissues. These disorders were associated with hemodynamic incoherence and worse clinical outcomes when the CRT continued to be abnormal 24 h after admission. © 2024, The Author(s).en
dc.formatapplication/pdfes_CO
dc.language.isoenges_CO
dc.publisherBMC Pediatricses_CO
dc.relation.ispartofseriesBMC Pediatrics Vol. 24 N° 1 art. 68
dc.rightsAttribution-NonCommercial-NoDerivatives 4.0 International*
dc.rights.urihttp://creativecommons.org/licenses/by-nc-nd/4.0/*
dc.sourceUniversidad de La Sabanaes_CO
dc.sourceIntellectum Repositorio Universidad de La Sabanaes_CO
dc.subject.otherEndotheliumen
dc.subject.otherFluid bolusen
dc.subject.otherMortalityen
dc.subject.otherResuscitationen
dc.subject.otherSeptic shocken
dc.titleThe association between prolonged capillary refill time and microcirculation changes in children with sepsisen
dc.typejournal articlees_CO
dc.type.hasVersionpublishedVersiones_CO
dc.rights.accessRightsopenAccesses_CO
dc.identifier.doi10.1186/s12887-024-04524-5


Files in this item

FilesSizeFormatView

There are no files associated with this item.

This item appears in the following Collection(s)

Show simple item record

Attribution-NonCommercial-NoDerivatives 4.0 InternationalExcept where otherwise noted, this item's license is described as Attribution-NonCommercial-NoDerivatives 4.0 International