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Capillary refill time

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https://www.readbyqxmd.com/read/29782357/reversible-microvascular-hyporeactivity-to-acetylcholine-during-diabetic-ketoacidosis
#1
Jérémie Joffre, Simon Bourcier, Geoffroy Hariri, Arnaud-Felix Miailhe, Naike Bigé, Guillaume Dumas, Vincent Dubée, Pierre-Yves Boelle, Idriss Abdallah, Jean-Luc Baudel, Bertrand Guidet, Eric Maury, Hafid Ait-Oufella
OBJECTIVES: Metabolic acidosis is commonly observed in critically ill patients. Experimental studies suggested that acidosis by itself could impair vascular function, but this has been poorly investigated in human. DESIGN: Prospective observational study. SETTING: Medical ICU in a tertiary teaching hospital. PATIENTS: To assess the relationship between metabolic acidosis severity and microvascular reactivity, we included adult diabetic patients admitted in ICU for ketoacidosis...
May 18, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29716488/a-two-centre-observational-study-of-simultaneous-pulse-oximetry-and-arterial-oxygen-saturation-recordings-in-intensive-care-unit-patients
#2
S J Ebmeier, M Barker, M Bacon, R C Beasley, R Bellomo, C Knee Chong, G M Eastwood, J Gilchrist, H Kagaya, J Pilcher, S K Reddy, E Ridgeon, N Sarma, S Spragas, A Tanaka, M Tweedie, M Weatherall, P J Young
The influence of variables that might affect the accuracy of pulse oximetry (SpO<sub>2</sub>) recordings in critically ill patients is not well established. We sought to describe the relationship between paired SpO<sub>2</sub>/SaO<sub>2</sub> (oxygen saturation via arterial blood gas analysis) in adult intensive care unit (ICU) patients and to describe the diagnostic performance of SpO<sub>2</sub> in detecting low SaO<sub>2</sub> and PaO<sub>2</sub>...
May 2018: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/29687277/early-goal-directed-therapy-using-a-physiological-holistic-view-the-andromeda-shock-a-randomized-controlled-trial
#3
Glenn Hernández, Alexandre Biasi Cavalcanti, Gustavo Ospina-Tascón, Fernando Godinho Zampieri, Arnaldo Dubin, F Javier Hurtado, Gilberto Friedman, Ricardo Castro, Leyla Alegría, Maurizio Cecconi, Jean-Louis Teboul, Jan Bakker
BACKGROUND: Septic shock is a highly lethal condition. Early recognition of tissue hypoperfusion and its reversion are key factors for limiting progression to multiple organ dysfunction and death. Lactate-targeted resuscitation is the gold-standard under current guidelines, although it has several pitfalls including that non-hypoxic sources of lactate might predominate in an unknown proportion of patients. Peripheral perfusion-targeted resuscitation might provide a real-time response to increases in flow that could lead to a more timely decision to stop resuscitation, thus avoiding fluid overload and the risks of over-resuscitation...
April 23, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/29675404/neonatal-hemodynamics-from-developmental-physiology-to-comprehensive-monitoring
#4
REVIEW
Sabine L Vrancken, Arno F van Heijst, Willem P de Boode
Maintenance of neonatal circulatory homeostasis is a real challenge, due to the complex physiology during postnatal transition and the inherent immaturity of the cardiovascular system and other relevant organs. It is known that abnormal cardiovascular function during the neonatal period is associated with increased risk of severe morbidity and mortality. Understanding the functional and structural characteristics of the neonatal circulation is, therefore, essential, as therapeutic hemodynamic interventions should be based on the assumed underlying (patho)physiology...
2018: Frontiers in Pediatrics
https://www.readbyqxmd.com/read/29628707/predictive-factors-determining-outcomes-in-pulseless-limb-in-paediatric-supracondylar-fractures-of-humerus
#5
Hemant Chaturvedi, Vikram Khanna, Rakesh Bhargava, Raju Vaishya
Introduction: Amongst all the complications associated with paediatric supracondylar humerus fractures, significant vascular injury is reported in only 1% cases, of which, less than 1% develop Volkmann's ischemic contracture. This study evaluates factors, like delay in presentation of the injury, limb perfusion and pulse, in determining functional outcome in a supracondylar humerus fractures with pulseless limb. Materials & methods: Twenty-one paediatric patients with a pulseless supracondylar humerus fracture presenting from 2012 to 2014 were included...
March 2018: Journal of Clinical Orthopaedics and Trauma
https://www.readbyqxmd.com/read/29624011/comparison-of-the-cardiovascular-and-respiratory-effects-and-sevoflurane-requirement-in-dogs-premedicated-with-two-doses-of-medetomidine-and-butorphanol-undergoing-surgical-sterilization
#6
D Juodzente, A Macas, B Karveliene, S Petkevicius, V Riskeviciene
The aim of this study was to compare the cardiovascular and respiratory effects and sevoflurane requirement in dogs premedicated with two doses of medetomidine and butorphanol undergoing surgical sterilization. The dogs were randomly assigned to two different groups: group 1 received a lower dose of medetomidine (0.014 mg/kg) and butorphanol (0.14 mg/kg) and group 2 received a higher dose of medetomidine (0.024 mg/kg) and butorphanol (0.24 mg/kg). Anesthesia was induced with intravenous propofol and maintained with sevoflurane 2% in pure oxygen...
March 2018: Polish Journal of Veterinary Sciences
https://www.readbyqxmd.com/read/29589502/comparison-between-a-multicentre-collaborative-closed-loop-audit-assessing-management-of-supracondylar-fractures-and-the-british-orthopaedic-association-standard-for-trauma-11-boast-11-guidelines
#7
MULTICENTER STUDY
R Goodall, H Claireaux, J Hill, E Wilson, F Monsell, Boast Collaborative, P Tarassoli
Aims Supracondylar fractures are the most frequently occurring paediatric fractures about the elbow and may be associated with a neurovascular injury. The British Orthopaedic Association Standards for Trauma 11 (BOAST 11) guidelines describe best practice for supracondylar fracture management. This study aimed to assess whether emergency departments in the United Kingdom adhere to BOAST 11 standard 1: a documented assessment, performed on presentation, must include the status of the radial pulse, digital capillary refill time, and the individual function of the radial, median (including the anterior interosseous), and ulnar nerves...
March 1, 2018: Bone & Joint Journal
https://www.readbyqxmd.com/read/29553951/monitoring-peripheral-perfusion-and-microcirculation
#8
Arnaldo Dubin, Elizabeth Henriquez, Glenn Hernández
PURPOSE OF REVIEW: Microcirculatory alterations play a major role in the pathogenesis of shock. Monitoring tissue perfusion might be a relevant goal for shock resuscitation. The goal of this review was to revise the evidence supporting the monitoring of peripheral perfusion and microcirculation as goals of resuscitation. For this purpose, we mainly focused on skin perfusion and sublingual microcirculation. RECENT FINDINGS: Although there are controversies about the reproducibility of capillary refill time in monitoring peripheral perfusion, it is a sound physiological variable and suitable for the ICU settings...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29438568/haemodynamic-assessment-and-support-in-sepsis-and-septic-shock-in-resource-limited-settings
#9
David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W Dünser, Arjen M Dondorp, Marcus J Schultz
Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking. Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind...
November 1, 2017: Transactions of the Royal Society of Tropical Medicine and Hygiene
https://www.readbyqxmd.com/read/29417244/secondary-raynaud-s-phenomenon-and-skin-necrosis-of-toes-in-the-paraplegic-patient-with-hypertension
#10
Yong Jig Lee, Kisoo Park
We present two cases of paraplegic patients who developed secondary Raynaud's phenomenon. A 43-year-old man with paraplegia presented with dark purple discoloration and skin defects on his left second and third toes and complained of a cold sensation in both feet for a period of 1 year. He had been taking diuretics for 4 years. The capillary refilling time for both affected toes was delayed. His antihypertensive drug was changed to a calcium channel blocker under suspicion of Raynaud's phenomenon aggravated by hydrochlorothiazide, and the capillary refilling time normalized within 3 days...
February 7, 2018: Drug Safety—Case Reports
https://www.readbyqxmd.com/read/29384267/a-cool-response-the-influence-of-ambient-temperature-on-capillary-refill-time
#11
Rani Toll John, Joakim Henricson, Johan Junker, Carl-Oscar Jonson, Gert E Nilsson, Daniel Wilhelms, Chris D Anderson
OBJECTIVE: To describe the effect of low ambient temperature on skin temperature and capillary refill (CR) time in forehead, sternum and finger pulp. METHODS: An observational, nonrandomized experimental study on 15 healthy subjects (6 females) in a cold room (8°C). Outcome measures were skin temperature and quantified CR test after application of a standardized blanching pressure (9 N/cm2 ) using digital photographic polarization spectroscopy to generate CR times...
January 31, 2018: Journal of Biophotonics
https://www.readbyqxmd.com/read/29317214/case-series-use-of-glyceryl-trinitrate-patches-to-improve-peripheral-circulation-in-children-with-severe-neurodisability
#12
Frances Morrison, Jack Fairhurst, Charlie Fairhurst
AIM: Evaluation of topical Glyceryl trinitrate as a therapeutic option to improve peripheral circulation in 16 children with severe complex neurodisability, poor capillary return and signs of vascular insufficiency, including discomfort. METHODS: If insufficient improvement in capillary return was obtained using conservative measures, a 5 mg GTN patch was placed each day on the front of the tibia of each leg. Children were reviewed clinically for up to 12 months of treatment...
December 31, 2017: European Journal of Paediatric Neurology: EJPN
https://www.readbyqxmd.com/read/29286408/diffuse-reflectance-spectroscopy-getting-the-capillary-refill-test-under-one-s-thumb
#13
Joakim Henricson, Rani Toll John, Chris D Anderson, Daniel Björk Wilhelms
The capillary refill test was introduced in 1947 to help estimate circulatory status in critically ill patients. Guidelines commonly state that refill should occur within 2 s after releasing 5 s of firm pressure (e.g., by the physician's finger) in the normal healthy supine patient. A slower refill time indicates poor skin perfusion, which can be caused by conditions including sepsis, blood loss, hypoperfusion, and hypothermia. Since its introduction, the clinical usefulness of the test has been debated. Advocates point out its feasibility and simplicity and claim that it can indicate changes in vascular status earlier than changes in vital signs such as heart rate...
December 2, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/29276289/a-case-of-metronidazole-injection-infiltration-without-sequelae
#14
Andrew M North, Justin M Yee
Purpose: This report describes a case of metronidazole injection infiltration which contrasts the sole other case report in the literature at this time, as the patient described herein experienced mild signs and symptoms with prompt resolution and no significant sequelae. Summary: The patient experienced metronidazole injection infiltration during administration open to gravity via an 18-gauge peripheral catheter in the left brachial vein. The site was examined at bedside within approximately 30 minutes of the incident and was noted to be slightly edematous, erythemic, and painful in terms of a 5...
September 2017: Hospital Pharmacy
https://www.readbyqxmd.com/read/29206763/association-of-clinical-hypoperfusion-variables-with-lactate-clearance-and-hospital-mortality
#15
Jessica Londoño, César Niño, James Díaz, Carlos Morales, Jimmy León, Elisa Bernal, Cesar Vargas, Leonardo Mejía, Carolina Hincapié, Johana Ascuntar, Alba León, Fabián Jaimes
BACKGROUND: lactate has shown utility in assessing the prognosis of patients admitted to the hospital with confirmed or suspected shock. Some findings of the physical examination might replace it as screening tool. We asked to determine the correlation and association between clinical perfusion parameters and lactate at the time of admission; the correlation between the change in clinical parameters and lactate clearance after 6 and 24 hours of resuscitation and; the association between clinical parameters, lactate and mortality...
December 4, 2017: Shock
https://www.readbyqxmd.com/read/29176794/capillary-refill-time-during-fluid-resuscitation-in-patients-with-sepsis-related-hyperlactatemia-at-the-emergency-department-is-related-to-mortality
#16
Barbara Lara, Luis Enberg, Marcos Ortega, Paula Leon, Cristobal Kripper, Pablo Aguilera, Eduardo Kattan, Ricardo Castro, Jan Bakker, Glenn Hernandez
INTRODUCTION: Acute circulatory dysfunction in patients with sepsis can evolve rapidly into a progressive stage associated with high mortality. Early recognition and adequate resuscitation could improve outcome. However, since the spectrum of clinical presentation is quite variable, signs of hypoperfusion are frequently unrecognized in patients just admitted to the emergency department (ED). Hyperlactatemia is considered a key parameter to disclose tissue hypoxia but it is not universally available and getting timely results can be challenging in low resource settings...
2017: PloS One
https://www.readbyqxmd.com/read/29158684/right-and-left-ventricular-function-in-hospitalized-children-with-respiratory-syncytial-virus-infection
#17
Thorsten Horter, Britt Nakstad, Omid Ashtari, Anne Lee Solevåg
Background: Extrapulmonary manifestations including cardiac dysfunction have been demonstrated in children with respiratory syncytial virus (RSV) infection requiring intensive care. The aim of this study was to examine cardiac function in hospitalized children with moderate RSV infection admitted to a regular pediatric ward. Methods: We used echocardiography to determine cardiac output, and right and left ventricular function in 26 patients (aged 2 weeks to 24 months) with RSV infection...
2017: Infection and Drug Resistance
https://www.readbyqxmd.com/read/29119808/early-warning-and-track-and-trigger-systems-for-newborn-infants-a-review
#18
Nicolay Mortensen, Johan Henrik Augustsson, Jorunn Ulriksen, Unni Tveit Hinna, Georg M Schmölzer, Anne Lee Solevåg
Tools for clinical assessment and escalation of observation and treatment are insufficiently established in the newborn population. We aimed to provide an overview over early warning- and track and trigger systems for newborn infants and performed a nonsystematic review based on a search in Medline and Cinahl until November 2015. Search terms included 'infant, newborn', 'early warning score', and 'track and trigger'. Experts in the field were contacted for identification of unpublished systems. Outcome measures included reference values for physiological parameters including respiratory rate and heart rate, and ways of quantifying the extent of deviations from the reference...
March 2017: Journal of Child Health Care: for Professionals Working with Children in the Hospital and Community
https://www.readbyqxmd.com/read/29103849/the-effect-of-skin-pigmentation-on-determination-of-limb-ischemia
#19
Elizabeth M Polfer, Ryan M Zimmerman, Eshetu Tefera, Ryan D Katz, James P Higgins, Kenneth R Means
PURPOSE: Timely identification of tissue ischemia is critical, both in the traumatized limb and following free tissue transfer. The purpose of this study was to determine if skin pigmentation affects the ability to detect limb ischemia. METHODS: We conducted a study of healthy controls exposed to limb ischemia. The subjects were classified based on skin pigmentation using a defined skin type assessment tool, a visual color scale, and self-description of race. Participants were randomized by limb and tourniquet status; surgeons were blinded to both...
January 2018: Journal of Hand Surgery
https://www.readbyqxmd.com/read/28966921/echocardiographic-evaluation-of-hemodynamics-in-neonates-and-children
#20
REVIEW
Yogen Singh
Hemodynamic instability and inadequate cardiac performance are common in critically ill children. The clinical assessment of hemodynamic status is reliant upon physical examination supported by the clinical signs such as heart rate, blood pressure, capillary refill time, and measurement of the urine output and serum lactate. Unfortunately, all of these parameters are surrogate markers of cardiovascular well-being and they provide limited direct information regarding the adequacy of blood flow and tissue perfusion...
2017: Frontiers in Pediatrics
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