Prognosis of patients presenting extreme acidosis (pH &lt;7) on admission to intensive care unit

Allyn, Jérôme; Vandroux, David; Jabot, Julien; Brulliard, Caroline; Galliot, Richard; Tabatchnik, Xavier; Combe, P; Martinet, Olivier; Allou, Nicolas

doi:10.1016/j.jcrc.2015.09.025

Cited by 23 publications

(17 citation statements)

References 22 publications

(37 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, acid-base homeostasis exerts a major influence on protein function and therefore critically affects tissue and organ performance [ 55 ] which is supported by experimental studies in piglets and dogs indicating that severe acidemia might be at least a contributor to organ dysfunction [ 57 , 58 ]. The study population used for the study reported here was unique in that 307 calves had extreme acidemia, defined as a jugular venous blood pH < 7.00 [ 59 ], and 35 of those calves had a blood pH < 6.80. To our knowledge, this study population represents the largest number of critically ill patients studied with extreme acidemia [ 59 , 60 ].…”

Section: Discussionmentioning

confidence: 99%

“…The study population used for the study reported here was unique in that 307 calves had extreme acidemia, defined as a jugular venous blood pH < 7.00 [ 59 ], and 35 of those calves had a blood pH < 6.80. To our knowledge, this study population represents the largest number of critically ill patients studied with extreme acidemia [ 59 , 60 ]. As a result, this study population provided an opportunity to determine the effects of extreme acidemia on survival in critically ill calves with naturally occurring disease.…”

Section: Discussionmentioning

confidence: 99%

“…Other findings of interest were that the non-survival rate for calves with blood pH < 7.00 was 28%, and 57% for blood pH < 6.80. Mortality rates in critically ill humans with blood pH < 7.00 vary from 90% for patients with cardiac arrest before admission, 66% for septic shock, and 22% for cases linked with diabetes mellitus [ 59 ]. Capillary blood pH can decrease to 6.80 in elite track and field athletes undergoing a short exercise program [ 61 ] and venous blood pH decreased to 6.74 in an Olympic gold medalist oarsman undergoing a simulated race on a rowing ergometer [ 62 ].…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea

et al. 2017

View full text Add to dashboard Cite

Profound acidemia impairs cellular and organ function and consequently should be associated with an increased risk of mortality in critically ill humans and animals. Neonatal diarrhea in calves can result in potentially serious metabolic derangements including profound acidemia due to strong ion (metabolic) acidosis, hyper-D-lactatemia, hyper-L-lactatemia, azotemia, hypoglycemia, hyperkalemia and hyponatremia. The aim of this retrospective study was to assess the prognostic relevance of clinical and laboratory findings in 1,400 critically ill neonatal calves with diarrhea admitted to a veterinary teaching hospital. The mortality rate was 22%. Classification tree analysis indicated that mortality was associated with clinical signs of neurologic disease, abdominal emergencies, cachexia, orthopedic problems such as septic arthritis, and profound acidemia (jugular venous blood pH < 6.85). When exclusively considering laboratory parameters, classification tree analysis identified plasma glucose concentrations < 3.2 mmol/L, plasma sodium concentrations ≥ 151 mmol/L, serum GGT activity < 31 U/L and a thrombocyte count < 535 G/L as predictors of mortality. However, multivariable logistic regression models based on these laboratory parameters did not have a sufficiently high enough sensitivity (59%) and specificity (79%) to reliably predict treatment outcome. The sensitivity and specificity of jugular venous blood pH < 6.85 were 11% and 97%, respectively, for predicting non-survival in this study population. We conclude that laboratory values (except jugular venous blood pH < 6.85) are of limited value for predicting outcome in critically ill neonatal calves with diarrhea. In contrast, the presence of specific clinical abnormalities provides valuable prognostic information.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea

et al. 2017

View full text Add to dashboard Cite

show abstract

“…More LT‐PLTs responded to collagen activation compared with PLTs at pH levels ranging from 6.8 to 7.4 (Fig. A), the range of blood pH that occurs during mild to severe acidosis . To determine the effect of LT‐PLTs on clotting during acidosis, thrombin generation time was measured in acidified PRP (pH ~ 7.2).…”

Section: Resultsmentioning

confidence: 99%

“…More LT-PLTs responded to collagen activation compared with PLTs at pH levels ranging from 6.8 to 7.4 (Fig. 3A), the range of blood pH that occurs during mild to severe acidosis [25]. (Fig.…”

Section: Platelet Response and Clot Formation During Acidosismentioning

confidence: 99%

Platelets loaded with liposome‐encapsulated thrombin have increased coagulability

Chan

Sarkari

Sunderland

et al. 2018

Journal of Thrombosis and Haemostasis

View full text Add to dashboard Cite

Background Platelets are integral to clot formation and are often transfused to stop or prevent bleeding. However, transfusions of platelets are not always effective, particularly in the most severe cases of hemorrhage. Nanoparticle systems have been developed to mimic platelets but inherently lack important aspects of platelet function, which limits their potential effectiveness. Objectives Increasing the natural coagulability of transfusable platelets could increase their efficacy during treatment of severe hemorrhage. Thrombin is a potent platelet agonist that currently cannot be used intravenously because of the risk of thrombosis. We hypothesized that delivery of thrombin to ex vivo platelets via liposomal encapsulation would enable transfusable platelets to become more coagulable in response to platelet agonists. Methods Thrombin was encapsulated into nanoliposomes and delivered to platelets ex vivo. Platelet coagulability was measured by monitoring platelet activation, clot contraction, clot time and clot stability in several in vitro assays. These parameters were also measured under conditions where coagulation is compromised, including during acidosis, antiplatelet drugs, hemophilia A and trauma-induced coagulopathy. Results Liposomal thrombin was endocytosed and used by platelets ex vivo but was not secreted upon activation. These modified platelets became more sensitive and responsive to agonists and improved clotting time even under conditions that normally cause platelet dysfunction or have impaired coagulation. Conclusions Several aspects of platelet function were enhanced by ex vivo delivery of liposomal thrombin.

show abstract

Acidosis: Diagnosis and Treatment

Quintard

Ichai

2017

Metabolic Disorders and Critically Ill Patients

View full text Add to dashboard Cite

Prognosis of patients presenting extreme acidosis (pH <7) on admission to intensive care unit

Cited by 23 publications

References 22 publications

Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea

Clinical signs, profound acidemia, hypoglycemia, and hypernatremia are predictive of mortality in 1,400 critically ill neonatal calves with diarrhea

Platelets loaded with liposome‐encapsulated thrombin have increased coagulability

Acidosis: Diagnosis and Treatment

Contact Info

Product

Resources

About