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Erschienen in: Critical Care 1/2019

Open Access 01.12.2019 | Letter

Optimal pressing strength and time for capillary refilling time

verfasst von: Rui Kawaguchi, Taka-aki Nakada, Taku Oshima, Masayoshi Shinozaki, Toshiya Nakaguchi, Hideaki Haneishi, Shigeto Oda

Erschienen in: Critical Care | Ausgabe 1/2019

Substantial investigations on the microcirculation have highlighted the importance of the capillary refilling time (CRT), which is widely used in clinical settings [13]. However, CRT measurement conditions, including pressing strength and time, are inconsistent (e.g., pressing strength: light, moderate, or firm; pressing time: 3 s, 5 s, or until the capillary bed visually blanches) [25]. CRT is conventionally measured visually after manual compression, which limits the accuracy of measurement and precludes the precise determination of how long and strong the nail bed should be pressed. Therefore, we developed a novel device which can be adjusted for pressing strength and time to precisely measure CRT using an electric actuator and strength and color sensors.
CRT was measured in age- and sex-matched healthy adults (n = 31) using the developed device under conditions of pressing strength of 1, 3, 5, and 7 N, and a pressing time 1, 2, 3, 4, 5, and 6 s (Additional file 1: Methods and supplemental data).
There was a significant difference in CRT for pressing strength but not for pressing time (two-way analysis of variance (ANOVA): strength P < 0.001, time P = 0.97) (Fig. 1). There were significant differences in CRT between pressing strengths of 1 and 3 N (P < 0.01) but no significant differences among 3, 5, and 7 N (P = 0.16). Thus, 3–7 N appears to be the optimal strength range for CRT measurement. A strength of 3 N is that which is needed to lift an object weighing 300 g (e.g., two smartphones) using fingers; the examinees would feel a 300-g load on their fingers. To identify sufficient pressing time, we further analyzed the plots of the readings from the color sensor during nail bed compression. The measured values change rapidly in the initial part of compression (rapid phase) until the inflection point, where the slope of color change reduces (slow phase) (Fig. 2a). The longest period of the rapid phase was 1.999 s among all the study subjects (minimum 0.1022 s, 95% 1.149 s) (Fig. 2b). The pressure release during the rapid phase may destabilize this measurement. Thus, a pressing time of 2 s is a good threshold to obtain stable CRT measurements for all subjects.
In the study aimed at identifying the standard pressing strength and CRT, pressing the nail bed with 3–7 N for 2 s appears to be optimal. Further development of portable CRT measurement devices fulfilling these conditions may contribute to achieving precise CRT measurements to monitor the microcirculation in clinical settings.

Acknowledgement

We thank Mr. Yutaka Furukawa, Mr. Minami Nagano, Ms. Eriko Miyazaki, Ms. Shino Tateishi, and Ms. Ayako Teratani for helping with data collection.

Funding

This work was supported by AMED (#JPhe1502001). The funder had no role in the study design, experiments, collection, analyses, interpretation of data, writing of the manuscript, or decision to submit the manuscript for publication.

Availability of data and materials

The datasets used and/or analyzed during our study are available from the corresponding author upon reasonable request.
The study participants were informed of the experiment and agreements were obtained via consent form before the measurements. All procedures in this study were approved by the Ethical Review Board of the Chiba University Graduate School of Medicine.
Written informed consent for the publication was obtained.

Competing interests

The authors declare that they have no competing interests. Chiba University has filed a provisional patent application covering aspects of this manuscript. TN, TN, HH, and SO are listed as inventors.

Publisher’s Note

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Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://​creativecommons.​org/​licenses/​by/​4.​0/​), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://​creativecommons.​org/​publicdomain/​zero/​1.​0/​) applies to the data made available in this article, unless otherwise stated.
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Metadaten
Titel
Optimal pressing strength and time for capillary refilling time
verfasst von
Rui Kawaguchi
Taka-aki Nakada
Taku Oshima
Masayoshi Shinozaki
Toshiya Nakaguchi
Hideaki Haneishi
Shigeto Oda
Publikationsdatum
01.12.2019
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 1/2019
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-018-2295-3

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