Agreement Between Peripheral Venous and Arterial Lactate Levels

Gallagher, E.John; Rodriguez, Kevin; Touger, Michael

doi:10.1016/s0196-0644(97)70220-8

Cited by 103 publications

(89 citation statements)

References 10 publications

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“…Lactate has previously been investigated in similar studies, while glucose and base excess are often deranged in acute illness. In the statistical analysis, we did not differentiate between venous or arterial blood-gas sampling [15,25,26]. However, we acknowledge that arterial and venous lactate measurement may differ in very abnormal samples [9].…”

Section: Discussionmentioning

confidence: 99%

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions

Abbott

Torrance

Cron

et al. 2016

European Journal of Internal Medicine

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Warning Score (NEWS). We hypothesised that the combination of NEWS and blood gas variables (lactate, glucose or base-excess) was more strongly associated with clinical outcome compared to NEWS alone.Methods: This was a prospective cohort study of adult medical admissions to a singlecentre over 20-days. Blood gas results and physiological observations were recorded at admission. NEWS was calculated retrospectively and combined with the biomarkers in multivariable logistic regression models. The primary outcome was a composite of mortality or critical care escalation within 2 days of hospital admission.The secondary outcome was hospital length of stay.

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Section: Discussionmentioning

confidence: 99%

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions

Abbott

Torrance

Cron

et al. 2016

European Journal of Internal Medicine

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“…The first variable to treat is blood pressure; the Medial Arterial Pressure (MAP) recommended for the management of the patient with septic shock must be higher than 65 mmHg, since lower pressures can affect tissue perfusion [9]. Higher than normal suggested pressures can deteriorate the clinical outcome of septic patients [19], while the recommended MAP must be higher than 65 mmHg, and a strategy to achieve it is the use of vasopressors, the use of this drugs for pressures higher than 70 mmHg are not likely to be associated with an improved survival of septic patients [20,21].…”

Section: Treating the Hypoperfusionmentioning

confidence: 99%

“…Markers and predictors of fluid responsiveness are found in the literature, with variable controversy in their use, among them there is the measurement of Central Venous Pressure (CVP) [15], the ultrasonographic measurement of inferior vena cava index [28], the calculation of the variability of systolic pressure with the respiratory movements [29], and the response to the passive leg raise [30], among others. In case of requiring fluid support it is convenient the use of crystalloid boluses [9]; in case of requiring large amounts of intravenous fluids, the use of intravenous albumin can be considered [31], this is specially helpful if the patient has a known low albumin level [32].…”

Section: Treating the Hypoperfusionmentioning

confidence: 99%

“…Goals from which is useful to transfuse packed red blood cells [9]. The next step should be to assess myocardial contractility with echocardiography [33,34], or with cardiac biomarkers like troponin [35].…”

Section: Treating the Hypoperfusionmentioning

confidence: 99%

“…There are diverse tissue perfusion markers, and they can be divided in clinical and laboratory markers ( [9], being greater the value from the venous sample. However, a trauma patient's study showed no statistical difference between the arterial or venous value [10], therefore the initial approach would be to try and get an arterial sample, but if it isn't easy to accomplish, a venous sample is a viable option.…”

Section: Introductionmentioning

confidence: 99%

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Perfusion Measurement of the Septic Patient in the Emergency Department

Devia-Jaramillo¹

2014

Emergency Medicine

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Sepsis is a deadly disease, more complex and frequent every day, that requires management from different specialists. The emergency physician is the first and one of the most important physicians that has to deal with the septic critically ill patients, because an appropriate initial management is key to a favorable outcome.In the emergency department it can be hard to predict which patients will become sicker just with information from the vital signs, and it's even harder to predict which patients will require a more intensive medical treatment. That is the reason why there must be more resources to measure tissue perfusion in an early and simple way in the emergency room, so that the emergency physician can manage to establish which patients requires earlier intervention to improve their perfusion state, despite not showing any clinically evident signs that help in the diagnosis of their current state.The goal of this paper is to propose a diagnostic and therapeutic algorithm for the hypoperfused patient with septic shock in the emergency department.venous oxygen saturation, arterial and venous lactate, microcirculatory study in different anatomical sites and oxygenation indexes.The emergency department, a place of rapid transit, with time constraints, progressive overcrowding and limited physical space, requires efficient indicators of early appearance and simple implementation in the system. That is why this article aims to show a proposal of early detection of hypoperfusion in the septic patient in the emergency room.

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Venous vs Arterial Lactate and 30-Day Mortality in Pediatric Sepsis

2017

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To the Editor Scott et al 1 reported on 1299 children evaluated for suspected sepsis at a tertiary emergency department. They observed a 3-fold increase in 30-day mortality in children with a venous lactate level greater than 36 mg/dL (to convert to millimoles per liter, multiply by 0.111) in comparison with levels of 36 mg/dL or less. In this single-center study with a mortality rate of 1.9%, 7.9% of patients (n = 103 of 1299) had increased lactate levels at admission, and 20% of deaths (n = 5 of 25) occurred in this group. The authors demonstrated that early lactate measurements assist in the assessment of sepsis severity, thereby shedding light on the potential benefits of monitoring lactate as a marker of response to resuscitation. 2 Sampling venous blood is often the preferred method in children outside intensive care because of the difficulties in obtaining arterial access. However, venous hyperlactatemia has been criticized because spurious lactate elevation may occur in patients with poor local perfusion and difficult access. 3 We previously demonstrated the relevance of lactate at intensive care unit admission to identify children with substantially higher sepsis mortality in a binational population-based study of 4403 children admitted to an intensive care unit with invasive infections. 4 This study used the prospective database established by the Australian and New Zealand Intensive Care Society Centre for Outcomes and Resource Evaluation and the Paediatric Study Group. Among children with invasive infections, the source of lactate measurement was known for 46.3% of admissions (n = 2040). We tested the multivariable association between arterial and venous lactate taken within 1 hour of intensive care unit admission and 30-day mortality in this cohort. Despite differences in crude mortality, the association between lactate and 30-day mortality was not significantly different between venous and arterial measurement (χ 2 = 1.14, P = .29). The relative odds of 30-day mortality was 1.28 (95% CI, 1.20-1.37) for each millimole per liter increase in arterial lactate measurements and 1.30 (95% CI, 1.20-1.40) for each millimole per liter increase in venous lactate measurements.While arterial access has advantages for continuous monitoring and repetitive sampling, our findings indicate that both arterial and venous lactate levels can be used as early markers of severity of pediatric sepsis. Our findings support the recent National Institute for Health and Care Excellence guidelines that recognize lactate level greater than 36 mg/dL as an immediate trigger to administer fluid bolus and involve critical care teams (https://www.nice.org.uk/guidance/ng51 /resources). In view of the 2016 adult sepsis-3 definitions proposing a cutoff of 18 mg/dL 5 as 1 of 3 septic shock criteria, we believe these findings indicate the need to consider lactate as one of the best and easily accessible laboratory markers of pediatric sepsis severity.

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Agreement Between Peripheral Venous and Arterial Lactate Levels

Cited by 103 publications

References 10 publications

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions

A single-centre cohort study of National Early Warning Score (NEWS) and near patient testing in acute medical admissions

Perfusion Measurement of the Septic Patient in the Emergency Department

Venous vs Arterial Lactate and 30-Day Mortality in Pediatric Sepsis

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