- Lilian Loso
- Summer 2026
Faculty instructor: Kelsey Pascoe, PhD, RN
Abstract
The purpose of this project is to evaluate capillary refill time (CRT) as a prognostic indicator in the early management of septic shock. A literature review was conducted using the CINAHL Complete, PubMed, WSU Science Library, and ProQuest databases. The search strategy included the terms sepsis, septic shock, capillary refill time, and management to identify relevant research studies, clinical practice guidelines, and meta-analyses. In addition, stakeholder interviews with nurses and healthcare providers and educational resources on septic shock management were reviewed to support implementation planning. Septic shock is a life-threatening complication of infection characterized by profound circulatory, cellular, and metabolic dysfunction and is associated with persistently high mortality. Current management emphasizes early recognition, prompt administration of appropriate antimicrobial therapy, source control, fluid resuscitation, and vasopressor support (Plata-Menchaca et al., 2026). Timely fluid resuscitation remains essential for stabilizing sepsis-induced tissue hypoperfusion (Peake et al., 2026). Although serum lactate measurement is routinely used to assess disease severity and guide resuscitation and has been associated with reduced mortality and organ dysfunction (El-Sayed et al., 2024), laboratory testing may not be readily available in all healthcare settings. Evidence from the ANDROMEDA-SHOCK trial demonstrated that CRT-guided resuscitation was associated with faster recovery of organ dysfunction, lower fluid administration, and an increased likelihood of survival compared with lactate-guided resuscitation (Gebhart, 2025). The subsequent ANDROMEDA-SHOCK-2 trial further demonstrated that personalized hemodynamic resuscitation targeting CRT was superior to usual care in patients with early septic shock (Hernandez et al., 2025). As a low-cost, noninvasive bedside assessment, CRT can be performed rapidly and repeatedly during resuscitation. Current evidence suggests that targeting CRT normalization may facilitate earlier discontinuation of active resuscitation, reduce the risk of over-resuscitation, and improve clinical outcomes compared with lactate-guided strategies (Hernandez et al., 2025). These findings support the integration of CRT-guided resuscitation into routine septic shock management through the development of standardized protocols, clinician education, and ongoing evaluation of patient outcomes (Huang et al., 2024).
Keywords: septic shock, capillary refill time, resuscitation