Tag: lactate

Upvote Story 4
In this article, we review physiologic principles of global oxygen delivery, and discuss the bedside approach to assessing the adequacy of oxygen delivery in critically ill patients. Although there have been technological advances in the assessment of oxygen delivery, we revisit and emphasize the importance of a ‘tried and true’ method – the physical examination. Also potentially important in the evaluation of oxygen delivery is... Read More | Comment
Upvote Story 7
Changes in lactate levels after ECMO implantation is an important tool to assess effective circulatory support and it is found superior to single lactate measurements as a prognostic sign of mortality in our study. Based on our results, an early insertion of ECMO before lactate gets high was suggested. Serial changes on lactate levels and calculation of its clearance may be superior to single lactate... Read More | Comment
Upvote Story 4
The use of bicarbonate is a source of eternal disagreement. Bicarbonate has a shameful history of being abused in situations where it’s unhelpful (e.g. cardiac arrest). This has impugned its reputation, giving it an aura of ignorance and failure. Consequently, bicarbonate is underutilized in some situations where it might actually help. This is an open-label multicenter RCT involving 389 patients within 48 hours of ICU... Read More | Comment
Upvote Story 8
A New York State requirement that all hospitals report compliance with protocols to treat severe sepsis and septic shock appears to improve care and reduce mortality from one of the most common causes of death in those who are critically ill, according to a new study published online in the American Thoracic Society’s American Journal of Respiratory and Critical Care Medicine. Patients who received the... Read More | Comment
Upvote Story 9
Thiamine administration within 24 hours of admission in patients presenting with septic shock was associated with improved lactate clearance and a reduction in 28-day mortality compared with matched controls. Patients who received IV thiamine supplementation within 24 hours of hospital admission were identified and compared with a matched cohort of patients not receiving thiamine. The primary objective was to determine if thiamine administration was associated... Read More | Comment
Upvote Story 8
Deleterious hemodynamic effects of severe lactic acidosis are largely suggested by experimental data, although not fully confirmed by human studies. Pending the effectiveness of an etiological treatment, there is no efficient and validated symptomatic therapy at hand to correct a life-threatening metabolic acidosis. Upcoming research in this field should be focused on the optimal strategy to treat severe metabolic acidosis, including symptomatic therapy. Alkalinization with... Read More | Comment
Upvote Story 8
The Surviving Sepsis Campaign recently released an update to the bundles of care it recommends for “sepsis” patients. You may have heard of the three-hour bundle, which essentially means that you do a bunch of stuff (lactate, cultures, antibiotics, fluids) within three hours of the patient declaring himself as having severe sepsis. If you don’t do all the stuff—say, for example, the patient got antibiotics... Read More | Comment
Upvote Story 5
This is the first extracorporeal cardiopulmonary resuscitation report to examine changes in Functional Status Scale from admission (baseline) to discharge as a measure of overall functional outcome. Half of surviving patients (19/38) had new morbidity, while 68% (26/38) had favorable outcomes. Lactate levels, duration of cardiopulmonary resuscitation, and duration of extracorporeal membrane oxygenation were not found to be risk factors for the development of new... Read More | Comment
Upvote Story 8
Septic shock is defined as sepsis with hypotension refractory to fluid challenge and requiring vasopressor support combined with an increase in arterial lactate reflecting impaired cellular energy metabolism and dysoxia. Te use of vasoactive drugs to restore mean arterial pressure (MAP) is strongly recommended by the Surviving Sepsis Campaign and the Task Force of the European Society of Intensive Care Medicine (ESICM) on circulatory shock... Read More | Comment
Upvote Story 10
Four thousand nine hundred one patients were admitted throughout the study period; 1,609 met criteria for metabolic acidosis and 145 had normal acid-base values. The association between at admission lactate, unmeasured anions, and chloride concentration with outcome was assessed by multivariate analysis in the whole cohort and in patients with metabolic acidosis. We also compared the mortality of patients with lactic, unmeasured anions, and hyperchloremic... Read More | Comment
Upvote Story 7
Consider using balanced fluids in your ED unless you are treating a patient at risk for cerebral edema, or a patient with a chloride responsive metabolic alkalosis, e.g. from gastric losses. Although the superiority of balanced fluids to NS is still debated, balanced solutions have many physiologic advantages. The commonly used balanced fluids, LR and Plasma-Lyte, do not contain supraphysiologic chloride and are buffered by... Read More | Comment
Upvote Story 14
It took all of one day for emergency physicians to organize opposition after an update to the Surviving Sepsis Campaign Bundle was released online. The day after the new version was released, Scott D. Weingart, MD, the editor-in-chief of EMCrit, and Josh Farkas, MD, the editor-in-chief of PulmCrit, posted a petition calling for its retraction. Their petition was signed by more than 4,000 people as... Read More | Comment
Upvote Story 19
The study by Churpek and colleagues was designed to evaluate both the frequency of urgent lactate measurements and their association with clinician interventions and mortality. An elevated lactate level means that a patient’s cells are not getting enough oxygen, sometimes as a result of inadequate blood flow. Septic patients who develop high lactate levels would benefit from urgent therapies, such as antibiotics, the study authors... Read More | Comment
Upvote Story 20
The critical care world is obsessed with fluid. Meanwhile, little attention has been given to the concepts of vasopressor responsiveness and vasopressor challenge. This is a missed opportunity, because vasopressor challenges may be done more safely and precisely than fluid challenges. To develop an approach to vasopressor responsiveness in septic shock, three concepts are helpful. The best way to determine epinephrine responsiveness may be to... Read More | Comment
Upvote Story 22
Clearance is the removal of a substance from blood, expressed as a volume (milliliters) over time (minutes). However, changes in lactate levels are the sum of ongoing production and removal from the blood by excretion (e.g., urine, sweat) and its metabolism (e.g., uptake by cells as a direct source of energy, conversion to glucose by the liver). To talk about “lactate clearance” when actually describing... Read More | Comment