Capillary refill time paradoxically decreases in a blood loss shock model
Abstract Background This study aimed to investigate whether changes in capillary refill (CR) time precede macrovascular signs of deterioration in a human model of blood loss shock. The study was conducted at the Department of Emergency Medicine in Linköping, Sweden, and involved 42 healthy volunteer...
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SpringerOpen
2025-01-01
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| Series: | Intensive Care Medicine Experimental |
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| Online Access: | https://doi.org/10.1186/s40635-025-00714-2 |
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| author | Hugo Gustavsson Frida Meyer Sara Fahlander Birgitta Ölwegård Hanna Jonasson Rani Toll Joakim Henricson Daniel Wilhelms |
| author_facet | Hugo Gustavsson Frida Meyer Sara Fahlander Birgitta Ölwegård Hanna Jonasson Rani Toll Joakim Henricson Daniel Wilhelms |
| author_sort | Hugo Gustavsson |
| collection | DOAJ |
| description | Abstract Background This study aimed to investigate whether changes in capillary refill (CR) time precede macrovascular signs of deterioration in a human model of blood loss shock. The study was conducted at the Department of Emergency Medicine in Linköping, Sweden, and involved 42 healthy volunteers aged 18–45. Participants were randomized into two provocations of applied lower body negative pressure (LBNP): a stepwise escalation protocol and a direct application protocol, to simulate gradual and acute blood loss. The main outcome measure was CR time. Systolic, diastolic, and mean arterial pressures, heart rate, cardiac output, and systemic vascular resistance were measured continuously. CR time was assessed on the finger pulp using a standardized pressure and measured with a polarized reflectance imaging system. Results The provocation elicited pre-syncope reactions and clear decrease in blood pressure for all participants, yet two-thirds of the participants in both protocols reacted with shorter CR times at maximum provocation, and the overall median CR time decreased by 0.2 s (Wilcoxon W = − 395.0, range: − 6.3 to 3.2, IQR − 1.3 to 0.1, P = 0.0070). Participants with shorter CR times exhibited comparatively greater increases in systemic vascular resistance and a more pronounced decrease in cardiac output. Conclusions Our findings reveal that finger CR time paradoxically decreases in a majority of healthy volunteers in a lower body negative pressure model of blood loss, challenging traditional assumptions about the CR test’s reliability as a shock indicator in its present interpretation. |
| format | Article |
| id | doaj-art-5eade0db89af4ebfa1f867ab3f443ffb |
| institution | Kabale University |
| issn | 2197-425X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
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| series | Intensive Care Medicine Experimental |
| spelling | doaj-art-5eade0db89af4ebfa1f867ab3f443ffb2025-08-20T04:01:42ZengSpringerOpenIntensive Care Medicine Experimental2197-425X2025-01-0113111010.1186/s40635-025-00714-2Capillary refill time paradoxically decreases in a blood loss shock modelHugo Gustavsson0Frida Meyer1Sara Fahlander2Birgitta Ölwegård3Hanna Jonasson4Rani Toll5Joakim Henricson6Daniel Wilhelms7Department of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Biomedical Engineering, Linköping UniversityDepartment of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityDepartment of Emergency Medicine in Linköping, and Department of Biomedical and Clinical Sciences, Linköping UniversityAbstract Background This study aimed to investigate whether changes in capillary refill (CR) time precede macrovascular signs of deterioration in a human model of blood loss shock. The study was conducted at the Department of Emergency Medicine in Linköping, Sweden, and involved 42 healthy volunteers aged 18–45. Participants were randomized into two provocations of applied lower body negative pressure (LBNP): a stepwise escalation protocol and a direct application protocol, to simulate gradual and acute blood loss. The main outcome measure was CR time. Systolic, diastolic, and mean arterial pressures, heart rate, cardiac output, and systemic vascular resistance were measured continuously. CR time was assessed on the finger pulp using a standardized pressure and measured with a polarized reflectance imaging system. Results The provocation elicited pre-syncope reactions and clear decrease in blood pressure for all participants, yet two-thirds of the participants in both protocols reacted with shorter CR times at maximum provocation, and the overall median CR time decreased by 0.2 s (Wilcoxon W = − 395.0, range: − 6.3 to 3.2, IQR − 1.3 to 0.1, P = 0.0070). Participants with shorter CR times exhibited comparatively greater increases in systemic vascular resistance and a more pronounced decrease in cardiac output. Conclusions Our findings reveal that finger CR time paradoxically decreases in a majority of healthy volunteers in a lower body negative pressure model of blood loss, challenging traditional assumptions about the CR test’s reliability as a shock indicator in its present interpretation.https://doi.org/10.1186/s40635-025-00714-2Capillary refill timeCapillary refill testBlood loss shockLower body negative pressureMicrocirculation |
| spellingShingle | Hugo Gustavsson Frida Meyer Sara Fahlander Birgitta Ölwegård Hanna Jonasson Rani Toll Joakim Henricson Daniel Wilhelms Capillary refill time paradoxically decreases in a blood loss shock model Intensive Care Medicine Experimental Capillary refill time Capillary refill test Blood loss shock Lower body negative pressure Microcirculation |
| title | Capillary refill time paradoxically decreases in a blood loss shock model |
| title_full | Capillary refill time paradoxically decreases in a blood loss shock model |
| title_fullStr | Capillary refill time paradoxically decreases in a blood loss shock model |
| title_full_unstemmed | Capillary refill time paradoxically decreases in a blood loss shock model |
| title_short | Capillary refill time paradoxically decreases in a blood loss shock model |
| title_sort | capillary refill time paradoxically decreases in a blood loss shock model |
| topic | Capillary refill time Capillary refill test Blood loss shock Lower body negative pressure Microcirculation |
| url | https://doi.org/10.1186/s40635-025-00714-2 |
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