Thursday, February 28, 2019


PulmCCM - February 23, 2019 - By Jon-Emile S. Kenny
..."Within the 2016 Surviving Sepsis Guidelines lies the following recommendation: ‘normalize lactate in patients with elevated lactate levels as a marker of tissue hypo-perfusion.’ This, however, is graded as a weak recommendation, low quality of evidence. Interestingly, buried within the text, the guideline authors declare – correctly – that ‘serum lactate is not a direct measure of tissue perfusion.’ Could there exist a better indicator of tissue starvation in septic shock?
Almost 40 years ago, Champion introduced the idea of monitoring capillary refill time [CRT] for shock resuscitation. This low-tech metric fell out of favour during the zenith of invasive monitoring and oxygen delivery optimization in the 1980s and ‘90s. However, recent data have shown that CRT: 1. is potentially a more responsive resuscitation sign in sepsis than biochemical guides, 2. spares excessive intravenous fluids and their inherent harms and 3. predicts mortality in septic patients in the ED.
Given the above, the ANDROMEDA-SHOCK trial was released last week at the 48th Critical Care Congress and the caterwauling was recorded immediately across multiple time zones. Do we dare worship this false idol? This Golden Calf called ‘capillary refill time?’..."