A prolonged capillary refill is predictor of low central venous oxygen saturation

Introduction: Educational programs in pediatric life support endorse a capillary refill time > 2 s as an indicator of shock. In the emergency room, a barrier to the implementation of an early goal directed therapy, aiming at central venous oxygen saturation (ScvO(2)) >= 70% is the insertion of central venous catheter (CVC). Objective: To establish the predictive value of capillary refill time > 2 s to detect ScvO(2) < 70% in children admitted to Intensive Care Units. Patients and Method: Prospective study. We included 48 children admitted in the first 24 hours in ICU with superior vena cava CVC. Simultaneously, we measured ScvO(2) and capillary refill time in the heel of upper extremity or toe. Results: There were 75 paired measurements ScvO(2) (75,9 +/- 8,4%) and capillary refill capillary (1,9 +/- 1,0 s). We found an inverse correlation between capillary refill time and ScvO(2) (r - 0,58). The ROC curve analysis revealed an excellent ability for the capillary fill time > 2 s to predict ScvO(2) < 70% (AUC 0,94) (95% CI 0,87-0,98). Conclusions: A prolonged capillary refill time > 2 s, is a predictor of ScvO(2) < 70% in children admitted to ICU, which supports the current recommendations. This finding may be relevant in emergency units where the use of CVC is limited and ScvO(2) is not available.