Endurance training regimen based upon arterial blood lactate: Effects on anaerobic threshold

Lactate has been thoroughly studied and found useful for stratification of patients with sepsis, in the Intensive Care Unit, and trauma care. However, little is known about lactate as a risk-stratification marker in the Medical Emergency Team- (MET-) call setting. We aimed to determine whether the arterial blood lactate level at the time of a MET-call is associated with increased 30-day mortality. This is an observational study on a prospectively gathered cohort at a regional secondary referral hospital. All MET-calls during the two-year study period were eligible. Beside blood lactate, age and vital signs were registered at the call. Among the 211 calls included, there were 64 deaths (30.3%). Median lactate concentration at the time of the MET-call was 1.82 mmol/L (IQR 1.16–2.7). We found differences between survivors and nonsurvivors for lactate and oxygen saturation, a trend for age, but no significant correlations between mortality and systolic blood pressure, respiratory rate, and heart rate. As compared to normal lactate (<2.44 mmol/L), OR for 30-day mortality was 3.54 (p<0.0006) for lactate 2.44–5.0 mmol/L and 4.45 (p<0.0016) for lactate > 5.0 mmol/L. The present results support that immediate measurement of blood lactate in MET call patients is a useful tool in the judgment of illness severity.

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Abstract 339: Capillary Transmitted Light Intensity for the Monitoring of Tissue Perfusion: CLIP Study

Circulation ◽

10.1161/circ.130.suppl_2.339 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Naoto Morimura ◽

Tetsuya Sakamoto ◽

Kyoko Matsumori ◽

Kohei Takahashi ◽

Tomoki Doi ◽

...

Keyword(s):

Light Intensity ◽

Blood Lactate ◽

Critically Ill Patients ◽

Pulse Oximeter ◽

Predictive Value ◽

Lactate Level ◽

Tissue Perfusion ◽

Blood Lactate Level ◽

Arterial Blood ◽

Arterial Blood Lactate

Background: We developed a new device for quantifying capillary refill time (CRT) by applying the pulse oximeter principle, and reported the excellent correlation between quantitative CRT (Q-CRT) and tissue hypoperfusion status as represented by arterial blood lactate levels in critically ill patients in the pilot study. Methods: Diagnostic accuracy study was undergone in ICU of a tertiary emergency medical center. While the pulse oxygen saturation sensor was placed on the finger of the patients, transmitted light intensity was measured with a pulse oximeter (OLV-3100, Nihon Kohden Corp., Japan) before start and during compression of the finger. Correlation between delta Ab, defined as the absorbance of light intensity of infra-red (A-ir) minus that of red (A-r), and arterial blood lactate level was analyzed. Results: The delta Ab was analyzed a total of 69 waveforms in 23 patients. The sensitivity, specificity, positive predictive value, and negative predictive value of the delta Ab less than 0.06 for predicting a lactate level more than 2.0 mmol/l were 100%, 93%, 89%, 100%, respectively. Conclusions: The delta Ab was well correlated to high level of blood lactate level in critically ill patients. Further study will confirm to place the delta Ab as one of non-invasive predictors of tissue perfusion status.

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