{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,3]],"date-time":"2026-04-03T08:45:05Z","timestamp":1775205905638,"version":"3.50.1"},"reference-count":28,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:sec>\n            <jats:title>Objectives<\/jats:title>\n            <jats:p>Early shock reversal is crucial to improve patient outcomes. Capillary refill time (CRT) is clinically important to identify and monitor shock in children but has issues with inconsistency. To minimize inconsistency, we evaluated a CRT monitoring system using an automated compression device. Our objective was to determine proper compression pressure in children.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods<\/jats:title>\n            <jats:p>Clinician force for CRT was collected during manual CRT measurement as a reference for automated compression in a previous study (12.9 N, 95% confidence interval, 12.5\u201313.4; n = 454). An automated compression device with a soft inflation bladder was fitted with a force sensor. We evaluated the effectiveness of the automated pressure to eliminate pulsatile blood flow from the distal phalange. Median and variance of CRT analysis at each pressure was compared.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results<\/jats:title>\n            <jats:p>A comparison of pressures at 300 to 500 mm Hg on a simulated finger yielded a force of 5 to 10 N, and these pressures were subsequently used for automated compression for CRT. Automated compression was tested in 44 subjects (median age, 33 months; interquartile range [IQR], 14\u201356 months). At interim analysis of 17 subjects, there was significant difference in the waveform with residual pulsatile blood flow (9\/50: 18% at 300 mm Hg, 5\/50:10% at 400 mm Hg, 0\/51: 0% at 500 mm Hg, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.008). With subsequent enrollment of 27 subjects at 400 and 500 mm Hg, none had residual pulsatile blood flow. There was no difference in the CRT: median 1.8 (IQR, 1.06\u20132.875) in 400 mm Hg vs median 1.87 (IQR, 1.25\u20132.8325) in 500 mm Hg, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.81. The variance of CRT was significantly larger in 400 mm Hg: 2.99 in 400 mm Hg vs. 1.35 in 500 mm Hg, <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02, Levene's test. Intraclass correlation coefficient for automated CRT was 0.56 at 400 mm Hg and 0.78 at 500 mm Hg.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>Using clinician CRT measurement data, we determined either 400 or 500 mm Hg is an appropriate pressure for automated CRT, although 500 mm Hg demonstrates superior consistency.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/pec.0000000000003183","type":"journal-article","created":{"date-parts":[[2024,6,14]],"date-time":"2024-06-14T19:00:30Z","timestamp":1718391630000},"page":"586-590","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Evaluation of Automated Finger Compression for Capillary Refill Time Measurement in Pediatrics"],"prefix":"10.1097","volume":"40","author":[{"given":"Amanda J.","family":"Nickel","sequence":"first","affiliation":[{"name":"Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shen","family":"Jiang","sequence":"additional","affiliation":[{"name":"Nihon Kohden Innovation Center, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalie","family":"Napolitano","sequence":"additional","affiliation":[{"name":"Department of Respiratory Care, Children's Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aaron","family":"Donoghue","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vinay M.","family":"Nadkarni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akira","family":"Nishisaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2024,6,14]]},"reference":[{"key":"bib1-20250504","doi-asserted-by":"crossref","first-page":"1035567","DOI":"10.3389\/fped.2022.1035567","article-title":"Capillary refill time in sepsis: a useful and easily accessible tool for evaluating perfusion in children","volume":"10","year":"2022","journal-title":"Front Pediatr"},{"key":"bib2-20250504","doi-asserted-by":"crossref","first-page":"1061","DOI":"10.1097\/CCM.0000000000002425","article-title":"American College of Critical Care Medicine Clinical Practice Parameters for hemodynamic support of pediatric and neonatal septic shock","volume":"45","year":"2017","journal-title":"Crit Care Med"},{"key":"bib3-20250504","doi-asserted-by":"crossref","first-page":"e52","DOI":"10.1097\/PCC.0000000000002198","article-title":"Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children","volume":"21","year":"2020","journal-title":"Pediatr Crit Care Med"},{"key":"bib4-20250504","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1001\/jama.2019.0071","article-title":"Effect of a resuscitation strategy targeting peripheral perfusion status vs serum lactate levels on 28-day mortality among patients with septic shock: the ANDROMEDA-SHOCK randomized clinical trial","volume":"321","year":"2019","journal-title":"JAMA"},{"key":"bib5-20250504","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1164\/rccm.201905-0968OC","article-title":"Effects of a resuscitation strategy targeting peripheral perfusion status versus serum lactate levels among patients with septic shock. 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