Tag: lactate
Roadblock: AFib with RVR
In this paper we focus on strategies to bypass the most common pitfalls in our treatment algorithm when treating patients who present to the ED in atrial fibrillation with RVR. We all know the few medications in our toolbox... read more
CRT-targeted Fluid Resuscitation vs. Lactate-targeted in Septic Shock
Capillary refill time (CRT)-targeted fluid resuscitation in septic shock was not superior to a lactate-targeted one on early fluid administration or fluid balances. However, it was associated with comparable effects on regional... read more
Arterial pH with Hemodynamic Response Association to Vasopressin in Patients with Septic Shock
Compared with higher arterial pH, patients with septic shock and low arterial pH had lower odds of vasopressin response and higher catecholamine doses after vasopressin initiation. Similar to other vasopressors, the clinical... read more
Respiratory Drive in Sepsis and Septic Shock Patients: Modulation by High-flow Nasal Cannula
Patients with sepsis and septic shock of extrapulmonary origin present elevated respiratory drive and effort, which can be effectively reduced by high-flow nasal cannula. 25 nonintubated patients with extrapulmonary sepsis... read more
Outcome After Intubation for Septic Shock with Respiratory Distress and Hemodynamic Compromise
Intubation within 24 h of sepsis was not associated with hospital mortality but resulted in fewer 28-day hospital-free days. Although intubation remains a high-risk procedure, we did not identify an increased risk in mortality... read more
Pre-hospital suPAR, Lactate and CRP Measurements for Decision-making
Pre-hospital suPAR measurements alone or combined with C-reactive protein (CRP) and/or lactate measurements could not predict the ED discharge or hospital admission of 109 non-urgent EMS patients with non-specific chief complaints... read more
Lactated Ringers is Safe in Hyperkalemia, and is Superior to NS
The myth that LR should be avoided in hyperkalemia is not only incorrect, it is probably backwards. For a hyperkalemic patient in renal failure, Lactated Ringers (LR) should be preferred over normal saline (NS). LR has been... read more
Lactate = LactHATE
Like many others who attended SMACC earlier this year I returned home dazed and confused about the significance of lactate in the septic patient. So like any good (aspiring to be) evidence-based medicine practitioner,... read more
Cytokine Adsorption Effect on Survival and Circulatory Stabilization in Patients Receiving ECPR
Even after the introduction of extracorporeal cardiopulmonary resuscitation (ECPR), survival after cardiac arrest remains poor. Excess release of vasoactive cytokines may be a reason for cardiovascular instability and death... read more
Validation of a Point-of-Care Capillary Lactate Measuring Device
Lactate Pro 2 had good agreement with the reference method using arterial blood but poorer agreement using venous blood. Our results show the potential for overestimation of the lactate values in haemodynamically compromised... read more
What’s Working for COVID-19 Patients in the Epicenter
Our large tertiary care ED in Queens, NY, usually sees more than 100,000 adults a year. As we write this, we have 850 COVID-19-likely or -positive patients (several hundred above our bed capacity just one month ago), more... read more
Epinephrine Challenge in Sepsis: An Empiric Approach to Catecholamines
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... read more
Serum Lactate Level and Mortality in Metformin-associated Lactic Acidosis Requiring RRT
This study suggests that predialysis level of serum lactate level is an important marker of mortality in MALA patients requiring renal replacement therapy (RRT) with a linear dose-response relationship. To better evaluate... read more
Lactate and Stepwise Lactate Kinetics Used to Guide Resuscitation
Lactate is an important parameter for monitoring tissue perfusion at present. Lactate kinetics are particularly important to evaluate the response of ICU patients. Therefore, lactate can be the starting point for resuscitation,... read more
Optimizing Therapy of Bloodstream Infection Due to Extended-spectrum β-lactamase-producing Enterobacteriaceae
Carbapenems should be used in patients with serious infections; alternatives could be used individually, particularly for definitive treatment of patients with milder presentations. Meropenem and imipenem are the drugs... read more
Assessment of Microcirculation in Cardiogenic Shock
The parameter most frequently used to detect tissue malperfusion is serum lactate. Novel, noninvasive methods to quantify microvascular perfusion have the potential to guide treatment in terms of optimizing organ perfusion... read more
Risk Factors Associated with 30-day Mortality for Out-of-Center ECMO Support
Out-of-hospital extracorporeal membrane oxygenation (ECMO) implantation and ECMO transport have become a growing field useful for emergent treatment of heart or lung failure with increasing number of centers launching such... read more
Early Goal-directed Therapy Using a Physiological Holistic View
If peripheral perfusion-targeted resuscitation improves 28-day mortality, this could lead to simplified algorithms, assessing almost in real-time the reperfusion process, and pursuing more physiologically sound objectives.... read more
Sex-specific Differences in Survival After Out-of-hospital Cardiac Arrest
This nationwide, population-based observational study in Japan included 386,535 adult patients aged ≥ 18 years with out-of-hospital cardiac arrest (OHCA). In all these patients, resuscitation was attempted by EMS personnel... read more
Terlipressin for Septic Shock Patients
Catecholamines are commonly used in septic shock but face limitations of their hypo-responsiveness and adverse events due to high dose. Terlipressin is a synthetic vasopressin analog with greater selectivity for the V1-receptor.... read more
Ideas for Future Intensive Care
Progress toward determining the true worth of ongoing practices or value of recent innovations can be glacially slow when we insist on following the conventional stepwise scientific pathway. Moreover, a widely accepted but... read more
Minimizing Catecholamines and Optimizing Perfusion
The main goal of hemodynamic resuscitation in shock is to improve tissue perfusion and oxygenation. As these cannot be directly evaluated at bedside in routine practice, physicians are left with surrogates such as perfusion... read more
