Evolution of Blood Lactate and 90-Day Mortality in Septic Shock. A Post Hoc Analysis of the FINNAKI Study

Shock ◽  
2017 ◽  
Vol 47 (5) ◽  
pp. 574-581 ◽  
Author(s):  
Elina Varis ◽  
Ville Pettilä ◽  
Meri Poukkanen ◽  
Stephan M. Jakob ◽  
Sari Karlsson ◽  
...  
2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Luc Morin ◽  
Karthik Narayanan Ramaswamy ◽  
Muralidharan Jayashree ◽  
Arun Bansal ◽  
Karthi Nallasamy ◽  
...  

Abstract Background The European Society of Pediatric and Neonatal Intensive Care (ESPNIC) developed and validated a definition of pediatric refractory septic shock (RSS), based on two septic shock scores (SSS). Both bedside SSS (bSSS) and computed SSS (cSSS) were found to be strongly associated with mortality. We aimed at assessing the accuracy of the RSS definition on a prospective cohort from India. Methods Post hoc analysis of a cohort issued from a double-blind randomized trial that compared first-line vasoactive drugs in children with septic shock. Sequential bSSS and cSSS from 60 children (single-center study, 53% mortality) were analyzed. The prognostic value of the ESPNIC RSS definition was tested for 28-day all-cause mortality. Results In this septic shock cohort, RSS was diagnosed in 35 patients (58.3%) during the first 24 h. Death occurred in 30 RSS patients (85.7% mortality) and in 2 non-RSS patients (8% mortality), OR = 60.9 [95% CI: 10.5–676.2], p < 0.001 with a median delay from sepsis onset of 3 days [1.0–6.7]. Among patients diagnosed with RSS, the mortality was not significantly different according to vasopressors randomization. Diagnosis of RSS with bSSS and cSSS had a high discrimination for death with an area under the receiver operating curve of 0.916 [95% CI: 0.843–0.990] and 0.925 [95% CI: 0.845–1.000], respectively. High prognostic accuracy of the bSSS was found in the first hours following intensive care admission. The best interval of prognostication occurs after the 12th hour following treatment initiation (AUC 0.973 [95% CI: 0.925–1.000]). Conclusions The ESPNIC refractory septic shock definition accurately identifies, within the first 6 h of septic shock management, children with lethal outcome.


2018 ◽  
Vol 8 (1) ◽  
Author(s):  
Julien Demiselle ◽  
◽  
Martin Wepler ◽  
Clair Hartmann ◽  
Peter Radermacher ◽  
...  

2017 ◽  
Vol 42 (6) ◽  
pp. 637-646 ◽  
Author(s):  
Kirk B. Roberson ◽  
Kevin A. Jacobs ◽  
Morgan J. White ◽  
Joseph F. Signorile

Circuit resistance training (CT) constitutes a high-intensity interval program commonly used to target weight loss; however, the loads and exercise patterns that maximize energy expenditure (EE) remain undetermined. We examined differences in EE among CT protocols using varying loads and contraction speeds in recreationally trained males and females. Seven males (age, 21.1 ± 0.5 years) and 8 females (age, 20.0 ± 0.9 years) performed 3 randomized CT protocols incorporating 3 circuits using heavy-load (80% 1-repetition maximum (1RM)) explosive (HLEC), heavy-load, controlled (2 s) (HLCC), and moderate-load (50% 1RM) explosive contractions (MLEC). Expired air was collected continuously before, during, and after exercise. Blood lactate was collected at rest, immediately postexercise, and 5 min postexercise. No significant differences were detected for resting EE; however, there was a significant difference among conditions during exercise (p = 0.034, ηp2 = 0.229). Post hoc analysis revealed that MLEC produced significantly higher EE than HLCC, but not HLEC (p = 0.023). There was a significant difference among conditions for rate of EE during exercise (p = 0.003, ηp2 = 0.361). Post hoc analysis revealed that HLEC produced a significantly higher EE rate than HLCC (p = 0.012) or MLEC (p = 0.001). A condition × sex interaction was seen for blood lactate changes (ηp2 = 0.249; p = 0.024). Females produced significantly greater change for MLEC than HLEC (p = 0.011), while males showed no significant differences. Our results favor CT using MLEC for a higher EE during a full workout; however, the rate of EE was highest when using HLEC.


2016 ◽  
Vol 60 (7) ◽  
pp. 925-933 ◽  
Author(s):  
M. Cronhjort ◽  
P. B. Hjortrup ◽  
L. B. Holst ◽  
E. Joelsson-Alm ◽  
J. Mårtensson ◽  
...  

2019 ◽  
Vol 45 (5) ◽  
pp. 657-667 ◽  
Author(s):  
Guillaume Geri ◽  
Philippe Vignon ◽  
Alix Aubry ◽  
Anne-Laure Fedou ◽  
Cyril Charron ◽  
...  

2020 ◽  
Vol 55 ◽  
pp. 177-183 ◽  
Author(s):  
Nora Luethi ◽  
Michael Bailey ◽  
Alisa Higgins ◽  
Belinda Howe ◽  
Sandra Peake ◽  
...  

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