Lactate is THE target for early resuscitation in sepsis

Bakker, Jan

doi:10.5935/0103-507x.20170021

Cited by 10 publications

(10 citation statements)

References 15 publications

(16 reference statements)

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“…Thus, it is justifiable that lactate and blood gas test results, which also aid in the identification of organic dysfunction, did not change because organic involvement is described as a consequence of the sepsis process. ( 33 )…”

Section: Discussionmentioning

confidence: 99%

Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

Martins

Silveira

Viégas

et al. 2019

Revista Brasileira De Terapia Intensiva

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Objective To evaluate the neutrophil-lymphocyte ratio as a predictor of sepsis and mortality in patients admitted to an intensive care unit. Methods Case-control study of adult patients admitted to an intensive care unit. Patients who had sepsis as the reason for admission and who had a previous complete blood count examination were included as case patients. The following statistical analyses were performed: ROC curves, binary logistic regression, and Mann-Whitney and Pearson's chi-square tests. p < 0.05 was considered significant. Results The ROC curve values were 0.62 for neutrophil-lymphocyte ratio, 0.98 for band neutrophils and 0.51 for total leukocytes. The presence of a neutrophil-lymphocyte ratio greater than 5.0, leukocyte count above 12,000mm 3 /mL and band neutrophil percentage above 10% were risk factors for sepsis; however, only the SAPS 3 and SOFA score were related to patient mortality. Conclusion The neutrophil-lymphocyte ratio and band neutrophils in combination with other parameters may be markers for the early detection of sepsis in intensive care units.

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Section: Discussionmentioning

confidence: 99%

Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

Martins

Silveira

Viégas

et al. 2019

Revista Brasileira De Terapia Intensiva

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“…Reductions in ScvO 2 occur when oxygen delivery to tissues is reduced and oxygen extraction is increased [8]. Lactate, the product of anaerobic metabolism, is considered the biomarker of choice for determining the presence of tissue hypoxia [1–3, 5, 9]. Recent critical care literature, including clinical practice guidelines, intertwines these two biomarkers as indicative of “tissue hypoperfusion,” an entity which is not clearly defined, but which represents some combination of reduced tissue oxygen delivery and tissue hypoxia [30, 31].…”

Section: Discussionmentioning

confidence: 99%

“…The critical care literature has considered central venous oxygen saturation (ScvO 2 ), mixed venous oxygen saturation (SvO 2 ), and serum lactate to be measures of tissue oxygenation in shock [1–9]. Following the Rivers trial of early goal-directed therapy (EGDT) for sepsis, ScvO 2 became popular as a substitute for SvO 2 in a variety of shock states [10], and the two measures have been demonstrated to be strongly correlated [6, 8, 11, 12].…”

Section: Introductionmentioning

confidence: 99%

“…Some authors advocate that ScvO 2 remains a vital component of sepsis treatment that should not be left out [14]. Serum lactate has also been used as a marker for tissue oxygenation [1–3, 5, 9, 15, 16]; in fact, both ScvO 2 and lactate are independent predictors of mortality in sepsis, and normalization of either or both biomarkers is associated with improved outcomes in sepsis and septic shock [17–23]. Additionally, both lactate and ScvO 2 have been used as markers of tissue oxygenation in cardiogenic and hemorrhagic shocks [24–28].…”

Section: Introductionmentioning

confidence: 99%

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Serum lactate poorly predicts central venous oxygen saturation in critically ill patients: a retrospective cohort study

et al. 2019

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Background Serum lactate and central venous oxygen saturation (ScvO 2 ) are commonly used and commonly recommended as markers of tissue oxygenation in shock states. Medical literature has both explicitly stated and implied that the two biomarkers are interchangeable in the management of patients with shock. However, there have been relatively few direct comparisons of these tests in clinical circumstances, and the relationship between them is uncertain. The objective of our study was to evaluate whether simultaneous or near-simultaneous measurements of lactate and ScvO 2 reveal a consistent relationship between these two biomarkers. Methods A retrospective cohort study was conducted in an urban, academic US hospital. All adults in ICUs between March 2007 and March 2017 who had a lactate measurement and ScvO 2 or mixed venous oxygen saturation (SvO 2 ) measurement made +/− 1 h from the lactate were included. Linear and non-linear correlations of ScvO 2 and lactate were assessed in a variety of shock states. Results Two thousand sixty-two patients were included. Lactate and ScvO 2 correlated poorly ( r 2 = 0.0041, p = 0.0019). This was true for patients with ScvO 2 ≤ 65% ( r 2 = 0.0431, p < 0.001), patients with normal kidney and liver function ( r 2 = 0.0517, p < 0.001), and septic shock patients ( r 2 = 0.0037, p = 0.17). For patients with an O 2 extraction ratio ≥ 50%, lactate and ScvO 2 were strongly correlated ( r 2 = 0.93, p = 0.0019), but these patients represented only 2.8% of patients in whom the ratio could be calculated. Conclusions Lactate can predict ScvO 2 when patients are at or below the critical oxygen delivery threshold, but relatively few shock patients meet this criterion. In the overall population of critically ill patients, serum lactate predicts ScvO 2 poorly, even after controlling for factors that may affect lactate production. Lactate and ScvO 2 should not be assumed to be interchangeable markers of tissue oxygenation/perfusion. Electronic supplementary material The online version of this article (10.1186/s40560-019-0401-5) contains supplementary material, which is available to authorized users.

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“…We believe POCT largely enabled the increased testing and compliance at our institution. Lactate monitoring can identify at-risk patients early and has been linked to survival of sepsis [ 30 , 31 ], so we were not surprised to see improved survival associated with increased testing. However, we also developed additional systems as part of the implementation of the POCT system.…”

Section: Discussionmentioning

confidence: 99%

Implementation of point-of-care blood gas testing at a large community hospital: Cost analysis, sepsis bundle compliance, and employee engagement

Chase¹,

DeJuilio²,

Huml³

et al. 2021

Can J Respir Ther

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Introduction/Background Point-of-care testing (POCT) platforms support patient-centered approaches to health care delivery and may improve patient care. We evaluated implementation of a POCT platform at a large, acute care hospital in the Midwestern United States. Methods We used lactate testing as part of a sepsis bundle protocol to evaluate compliance and mortality outcomes. Respiratory team members were surveyed to assess perception of efficiency, ease of use, timely patient care, and overall engagement with the POCT system. Annualized cost per test of a benchtop analyzer and a POCT platform were compared across 3 years for each platform. Results Lactate testing volume increased from 61% to 91%, which was associated with improved sepsis bundle protocol compliance. Employees reported high levels of engagement, improvements in efficiency and time savings, and better patient care with POCT. Average cost per test was $10.02 for the benchtop system and $6.21 for the POCT platform. POCT saved our institution $88,476 annually in labor costs. Discussion Combined with a robust training program emphasizing the use of lactate testing in the context of the overall clinical picture, POCT enabled adherence to the sepsis bundle protocol and may have contributed to lower mortality. Additionally, the COVID-19 pandemic has provided us with unanticipated benefits of using POCT; it has enhanced our ability to deal with stringent infectious disease protocols, saving time and minimizing patient and staff exposure. Conclusions Implementation of a POCT platform was associated with improved compliance to our sepsis protocol, reduced sepsis mortality, high employee engagement, and cost savings.

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Lactate is THE target for early resuscitation in sepsis

Cited by 10 publications

References 15 publications

Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

Neutrophil-lymphocyte ratio in the early diagnosis of sepsis in an intensive care unit: a case-control study

Serum lactate poorly predicts central venous oxygen saturation in critically ill patients: a retrospective cohort study

Implementation of point-of-care blood gas testing at a large community hospital: Cost analysis, sepsis bundle compliance, and employee engagement

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