Implementation of a 6-Hour Severe Sepsis Bundle in Multiple Asian Countries Is Associated With Decreased Mortality

Na, Sungwon; Joshi, M.; Li, Chih-Huang; Mahadevan, Malcolm; Varma, Amit; Lee, Chien‐Chang; Ray, Sumit; Lu, Yiming; Sen, Kuan Win; Jaiswal, Bhavini; Nguyen, H. Bryant

doi:10.1378/chest.136.4_meetingabstracts.20s-g

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“…Previous studies found that lactate did not increase in some adult with sepsis (alactatemia). 7,11,12 In this pilot study, we find similar results, as 63%of our pediatric shock patients have alactatemia. Hence we conclude that lactate clearance, particularly in alactatemic conditions, can not be used as a means of assessing the success of fluid resuscitation.…”

Section: Discussionsupporting

confidence: 77%

“…In contrast, in adult sepsis study by Hernandez et al reported that only 1/3 of patients with septic shock had alactatemia, and those alactatemia shock patients had lower mortality rates.7 Moreover, Na S et al found that as few as 9.1%of 512 adult septic patients had alactatatemia. 12 In addition, a multi-center study of 2,424 septic shock patients by Cannonet al found that 37.6% patients had alactatemia. 13 The cause of alactatemia remains unclear.…”

Section: Discussionmentioning

confidence: 99%

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Lactate profiles of pediatric shock patients in Cipto Mangunkusumo General Hospital 2015: a pilot study

Yuniar

2017

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Background The 2015 Surviving Sepsis Campaign (SSC) guidelines for management of shock recommend blood lactate to assess the success of resuscitation in shock. However, a study in adults found that 1/3 of septic shock patients had normal lactate levels (alactatemia) and lower mortality rates. Objective To evaluate lactate profiles, possible factors affecting lactate levels, and mortality outcomes in pediatric shock patients in the emergency room (ER) and pediatric intensive care unit (PICU). Methods This was a retrospective study on pediatric shock patients aged 1 month to 18 years in the ER or PICU from June 2014 to December 2015. Data were taken from subjects' medical records including lactate levels, examination data required to calculate a PELOD score, and mortality outcomes. Results Of 223 shock patients evaluated, only 92 cases (41.2%) underwent lactate examinations. Of these, 59 (64.1%) had alactatemia and 33 (35.9%) had hyperlactatemia. A total of 23.7% of the alactatemia group and 36.4% of the hyperlactatemia group died, thus, the initial lactate level was not significantly associated with patient outcomes (P=0.197). The mortality rates of patients with <10% and ≥10% lactate clearance were 31.3% and 17.6%, respectively (P=0.362). Conclusion In alactatemia patients, lactate level can not be used as a goal for resuscitation. Further study is needed to find a biomarker for assessing the success of pediatric shock resuscitation. Moreover, the clinical relevance of alactatemia is uncertain in pediatric shock patients

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Section: Discussionsupporting

confidence: 77%

Section: Discussionmentioning

confidence: 99%