A Normal Capillary Refill Time of ≤ 2 Seconds is Associated with Superior Vena Cava Oxygen Saturations of ≥ 70%

Objective To test the hypothesis that a normal capillary refill time (CRT) <= 2 seconds is associated with superior vena cava oxygen saturation (ScvO(2)) >= 70% in critically ill children. Study design Two-year, prospective study in a tertiary-level pediatric intensive care unit. Whenever ScvO(2) measurements were obtained, central (forehead/sternum) and peripheral (finger/toe) CRTs were concomitantly assessed. Results Central and peripheral CRTs <= 2 seconds were both associated with ScvO(2) >= 70% (P < .01). Sensitivity/specificity analyses revealed that central CRT <= 2 seconds demonstrated a sensitivity of 84.4%, specificity of 71.4%, positive predictive value of 93.1%, and negative predictive value of 50.0% in predicting ScvO(2) >= 70%. Peripheral CRT <= 2 seconds had a sensitivity of 71.9%, specificity of 85.7%, positive predictive value of 95.8%, and negative predictive value of 40.0% in predicting ScvO(2) >= 70%. Conclusions A normal CRT <= 2 seconds can be predictive of ScvO(2) >= 70%. Our study corroborates the recommendations of the Pediatric Advanced Life Support curricula targeting a normal CRT <= 2 seconds as a therapeutic endpoint for goal-directed shock resuscitation. This clinical target remains particularly relevant in community hospitals when the ability to obtain central venous catheter access may be limited and ScvO(2) data unavailable. (J Pediatr 2011; 158: 968-72).