- Design
- Systematic review with frequentist and Bayesian meta-analysis of 7 RCTs
- Population
- 2408 adults with septic shock
- Primary outcome
- 28-day mortality
- Effect
- RR 0.87 (95% CI 0.76 to 1.01); Bayesian P(RR<1) 97.2%
This meta-analysis, published in September 2026, pooled seven randomised trials (2408 patients with septic shock) comparing resuscitation guided by peripheral perfusion, mainly capillary refill time, with standard care or lactate-guided resuscitation.
The pooled 28-day mortality risk ratio was 0.87 (95% CI 0.76 to 1.01), just short of significance, with no heterogeneity and moderate certainty. A Bayesian analysis put the probability of any benefit at 97.2%. The two largest, lowest-risk trials were each neutral.
Capillary refill is free, fast and repeatable, which matters in emergency departments without easy lactate testing. This analysis suggests guiding resuscitation by it is at least not worse than lactate, and may be better, but the size of any benefit is unknown.
- Measure capillary refill time repeatedly during septic shock resuscitation.
- Use a normalising refill time as a sign that perfusion is improving.
- Continue lactate measurement where available; the two are complementary.
- Avoid giving fluid just to chase a lactate when perfusion has normalised.
Why it matters
In settings without rapid lactate, a reliable bedside target changes how resuscitation is run.
Don't overread it
The main analysis did not reach significance; the largest trials were neutral.
The statistics, in plain English
A confidence interval reaching 1.01 means no effect cannot be ruled out. The Bayesian 97% figure is the probability that the true effect is any benefit at all, however small. I² of 0% means the trials agreed with each other.
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