Integrating Multimodal Peripheral Perfusion Assessment in Critical Care

A 2025 pilot study found multimodal peripheral perfusion metrics to be strongly interrelated, with capillary refill time (CRT) showing the best prediction for ICU mortality—supporting CRT as an immediate bedside prognostic signal that can inform early resuscitation decisions.

This was a prospective, single-center cohort of 55 adult ICU patients. Investigators measured six bedside perfusion parameters and evaluated primary endpoints including ICU mortality and correlations with conventional hemodynamic markers. Measurements were simultaneous and standardized early during ICU admission, which strengthens the internal consistency of the reported associations.

The team evaluated Peripheral Perfusion Index (PPI), mottling score, capillary refill time (CRT), central-to-peripheral temperature gradient (ΔT), skin blood flow at basal temperature (SBFBT), and forearm regional tissue oxygenation (rSO2). PPI, SBFBT and ΔT were strongly interrelated, while rSO2 showed no significant associations. CRT demonstrated the highest prognostic accuracy for ICU mortality. Mottling score and SBFBT/PPI trailed CRT, supporting CRT as the most discriminant bedside marker in this cohort.

In early resuscitation, multimodal peripheral perfusion assessment can augment macrocirculatory data by providing rapid physiologic information—helpful when deciding vasopressor escalation, reassessing likely fluid responsiveness, or intensifying monitoring. Serial perfusion trends in the first hour—most notably CRT—offer immediate prognostic context that may shift priorities toward earlier hemodynamic support or closer observation.