Tag: lactate
Assessment of the adequacy of oxygen delivery
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... read more
Does Lactate Clearance Prognosticates Outcomes in ECMO Therapy
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... read more
pH-guided Fluid Resuscitation and BICAR-ICU
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... read more
New York State Sepsis Reporting Mandate Appears to Improve Care and Reduce Deaths
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... read more
Hemodynamic Consequences of Severe Lactic Acidosis in Shock States
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... read more
Lies, Damned Lies, and Sepsis Bundles
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,... read more
Functional Status Change Among Children With ECMO to Support Cardiopulmonary Resuscitation in a Pediatric Cardiac ICU
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... read more
MAP of 65: Target of the Past?
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.... read more
The Fluid Debate: Balanced or Unbalanced
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... read more
Sepsis Guidelines Spark EM Petition
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... read more
The Ten Pitfalls of Lactate Clearance in Sepsis
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.,... read more
Is It CHF? Sepsis? Something Else?
A 59-year-old morbidly obese woman with a history of congestive heart failure presented with three days of intermittent chest discomfort. She characterized it as heartburn—a mid-epigastric burning sensation radiating up... read more
Prevention of Low Cardiac Output Syndrome After Pediatric Cardiac Surgery
Dobutamine and milrinone are safe, well tolerated, and equally effective in prevention of low cardiac output syndrome after pediatric cardiac surgery. The hemodynamic response of the two drugs is comparable. In uncomplicated... read more
Choosing the Right Hemodynamic Platform
Choosing the Right Hemodynamic Platform: ABG, SV to PAC – Barbara McLean, MN, RN, CCNS-BC, NP-BC Barbara McLean, MN, RN, CCNS-BC, NP-BC Critical Care Clinical Specialist Critical Care Division Grady Health System... read more
The Great Lactate Debate
Over the last half-decade, there has been a distinct shift in the approach to lactate elevation. The long-held belief that elevated serum lactate requires tissue or cellular hypoxia has fallen away. Indeed, in sepsis, tissues... read more
The EM Educator Series: Sepsis in the ED
These posts provide brief mini-cases followed by key questions to consider while working. The featured questions provide important learning points for those working with you, as well as vital items to consider in the evaluation... read more
IV Fluids and Solutions Quick Reference Guide Cheat Sheet
Intravenous solutions are used in fluid replacement therapy by changing the composition of the serum by adding fluids and electrolytes. Quick reference guide on the different intravenous solutions.... read more
Serum Lactate Upon Emergency Department Arrival as Predictor of 30-day In-Hospital Mortality
Despite of numerous evidences that elevated serum lactate levels were associated with unfavorable outcomes, there have been no study demonstrated an optimal cutoff of serum lactate in unselected patients. This study was aimed... read more
Sodium Lactate Improves Hemodynamics
Sodium lactate has been shown to improve hemodynamics and avoid fluid overload. The objective of this study was to confirm a beneficial effect on fluid balance with sodium lactate infusion and to specify whether the advantage... read more
The Association of Early Combined Lactate and Glucose Levels with Subsequent Renal and Liver Dysfunction
Abnormal combined lactate and glucose measurements may provide an early indication of organ dysfunction. In critically ill patients a 'normal' glucose with an elevated lactate should not be considered desirable, as this combination... read more
The Lactate Dilemma
After a long and exhausting discussion with an inferior human being, a cardiologist, which happens to be an old friend, I decided to write some thoughts about lactate. So, I'll do like I do in my lectures, which is state... read more
Adrenomedullin: a marker of impaired hemodynamics in cardiogenic shock
Bio-ADM is a valuable prognosticator and marker of impaired hemodynamics in CS patients. High levels of bio-ADM may show shock refractoriness and developing end-organ dysfunction and thus help to guide therapeutic approach... read more
