Capillary refill time: the missing link between macrocirculation and microcirculation in septic shock?

ANDROMEDA-SHOCK was a multicenter, randomized controlled trial comparing capillary refill time (CRT)- versus lactate-targeted resuscitation in patients with early septic shock (1). The protocol mandated sequential steps starting with fluid challenges, followed by vasoactive-related interventions if necessary, until the target was reached. CRT-targeted resuscitation was associated with lower mortality (34.9% vs. 43.4%; P=0.06), beneficial effects on organ dysfunction, and less treatment intensity. A strong survival benefit was also supported by a recently published post-hoc Bayesian analysis (2).