Shock State

Assessment of capillary refill time (CRT) is a cornerstone of tissue perfusion monitoring in critically ill patients. CRT measurement is performed by applying brief and gentle pressure (for a few seconds) to a small area of skin until blanching occurs. CRT is defined as the time, in seconds, required for the skin surface to return to its initial color after release of pressure. Although CRT is a monitoring tool used on a daily basis in emergency departments and critical care units, its practical measurement modalities remain poorly standardized and time-consuming. Consequently, there is no consensus regarding the most reproducible bedside method for CRT assessment. Moreover, repeated CRT measurements during patient management are resource-intensive in terms of medical time and may raise issues related to healthcare staff availability. The perfusion index (PI) is a marker of tissue perfusion derived from a pulse oximetry sensor. This monitoring device is routinely used in all critically ill patients. It is placed on the finger and worn continuously, including during patient transport. Because PI measurement is automatic and continuous, establishing its correlation with CRT could allow for more precise tissue perfusion monitoring while reducing the time burden associated with bedside assessments in critically ill patients.

In this study of diagnostic accuracy, the investigators aim to validate a faster, simpler, and noninvasive test of fluid-responsiveness in critically ill children. This test is based on an assessment of the hemodynamic effects of a standardized abdominal compression, using electrical cardiometry. This would help physicians to identify more easily which patient could benefit from a volume expansion, thus avoiding a potentially useless or even dangerous fluid expansion that could lead to fluid overload. To this end, the diagnostic accuracy of electrical cardiometry-based stroke volume (SV) variation induced by a standardized abdominal compression to predict fluid responsiveness (define as a 15% increase in echocardiographically measured SV after volume expansion) will be measured.