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Background <p>The vasopressor test (VPT) has been proposed to evaluate changes in tissue perfusion in response to a transient, vasopressor-induced increase in mean arterial blood pressure (MAP). However, the physiological determinants of this response remain unclear.</p> Objectives <p>To (1) evaluate capillary refill time (CRT) response to standardized VPT, (2) explore the associations between CRT and splanchnic vascular Doppler indices, and (3) identify baseline hemodynamic predictors of CRT improvement.</p> Methods <p>In this prospective multicenter study, 32 septic shock patients with persistent hypoperfusion and preload unresponsiveness underwent a VPT, increasing MAP from 65 to 85 mmHg. CRT responders were defined as those with a decrease of ≥ 1&#xa0;s. Visceral Doppler resistive indices were measured to assess regional perfusion. Baseline hemodynamic variables were evaluated as predictors of CRT improvement. Logistic regression and mixed-effects models examined the associations between CRT, stroke volume, and baseline hemodynamics.</p> Results <p>Eleven patients (34%) showed CRT improvement ≥ 1&#xa0;s during VPT, whereas 3 (9%) worsened and 18 (57%) had no meaningful change. Changes in CRT were not associated with renal, hepatic, or splenic Doppler resistive indices. Baseline mean systemic filling pressure (Pmsf) was lower in CRT responders (13 [10–16] vs. 18 [17–21] mmHg, <i>p</i> = 0.0002) and remained independently associated with CRT improvement (β = −0.469, <i>p</i> = 0.035). Mixed-effects models showed an inverse association between Δ stroke volume and ΔCRT (β = −0.043, <i>p</i> = 0.021).</p> Conclusions <p>Improvement in CRT during VPT identified patients with preserved peripheral perfusion recruitability. Lower baseline Pmsf was consistently associated with CRT responsiveness. The lack of correlation with visceral indices underscores the heterogeneity of regional perfusion responses.</p>

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Dynamic changes in capillary refill time during a vasopressor test in septic shock patients: a physiological pilot study

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年5月13日

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  • Emilio Daniel Valenzuela,
  • Pablo Mercado,
  • Vanessa Oviedo,
  • Macarena Amthauer,
  • Roberto Contreras,
  • David Carpio,
  • Alejandra González,
  • Luigi Gabrielli,
  • Michel Slama,
  • Jan Bakker,
  • Ricardo Castro,
  • Arnaldo Dubin

摘要

Background

The vasopressor test (VPT) has been proposed to evaluate changes in tissue perfusion in response to a transient, vasopressor-induced increase in mean arterial blood pressure (MAP). However, the physiological determinants of this response remain unclear.

Objectives

To (1) evaluate capillary refill time (CRT) response to standardized VPT, (2) explore the associations between CRT and splanchnic vascular Doppler indices, and (3) identify baseline hemodynamic predictors of CRT improvement.

Methods

In this prospective multicenter study, 32 septic shock patients with persistent hypoperfusion and preload unresponsiveness underwent a VPT, increasing MAP from 65 to 85 mmHg. CRT responders were defined as those with a decrease of ≥ 1 s. Visceral Doppler resistive indices were measured to assess regional perfusion. Baseline hemodynamic variables were evaluated as predictors of CRT improvement. Logistic regression and mixed-effects models examined the associations between CRT, stroke volume, and baseline hemodynamics.

Results

Eleven patients (34%) showed CRT improvement ≥ 1 s during VPT, whereas 3 (9%) worsened and 18 (57%) had no meaningful change. Changes in CRT were not associated with renal, hepatic, or splenic Doppler resistive indices. Baseline mean systemic filling pressure (Pmsf) was lower in CRT responders (13 [10–16] vs. 18 [17–21] mmHg, p = 0.0002) and remained independently associated with CRT improvement (β = −0.469, p = 0.035). Mixed-effects models showed an inverse association between Δ stroke volume and ΔCRT (β = −0.043, p = 0.021).

Conclusions

Improvement in CRT during VPT identified patients with preserved peripheral perfusion recruitability. Lower baseline Pmsf was consistently associated with CRT responsiveness. The lack of correlation with visceral indices underscores the heterogeneity of regional perfusion responses.