scholarly journals Lactate Arterial-Central Venous Gradient among COVID-19 Patients in ICU: A Potential Tool in the Clinical Practice

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Giuseppe Nardi ◽  
Gianfranco Sanson ◽  
Lucia Tassinari ◽  
Giovanna Guiotto ◽  
Antonella Potalivo ◽  
...  
Keyword(s):  
Blood Lactate ◽  
Venous Blood ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Mitochondrial Metabolism ◽  
Lung Cells ◽  
Central Venous ◽  
Central Venous Blood ◽  
Arterial Blood ◽  
Anti Inflammatory

Objective. In physiological conditions, arterial blood lactate concentration is equal to or lower than central venous blood lactate concentration. A reversal in this rate (i.e., higher lactate concentration in central venous blood), which could reflect a derangement in the mitochondrial metabolism of lung cells induced by inflammation, has been previously reported in patients with ARDS but has been never explored in COVID-19 patients. The aim of this study was to explore if the COVID-19-induced lung cell damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of anti-inflammatory therapy (i.e., canakinumab 300 mg subcutaneous) could normalize such abnormal lactate a-cv difference. Methods. A prospective cohort study was conducted, started on March 25, 2020, for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy. Arterial and central venous blood samples were contemporarily collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentrations within 24 h from tracheal intubation (T0) and 24 hours after canakinumab administration (T1). Results. At T0, 19 of 21 (90.5%) patients showed a pathologic Delta a-cv lactate (median 0.15 mmol/L; IQR 0.07–0.25). In the 13 patients undergoing canakinumab administration, at T1, Delta a-cv lactate decreased in 92.3% of cases, the decrease being statistically significant (T0: median 0.24, IQR 0.09–0.31 mmol/L; T1: median −0.01, IQR −0.08–0.04 mmol/L; p=0.002). Conclusion. A reversed Delta a-cv lactate might be interpreted as one of the effects of COVID-19-related cytokine storm, which could reflect a derangement in the mitochondrial metabolism of lung cells induced by severe inflammation or other uncoupling mediators. In addition, Delta a-cv lactate decrease might also reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.

scholarly journals Lactate arterial-central venous gradient among COVID-19 patients in ICU: a potential tool in the clinical practice

2020 ◽  
Author(s):  
Giuseppe Nardi ◽  
Gianfranco Sanson ◽  
Lucia Tassinari ◽  
Giovanna Guiotto ◽  
Antonella Potalivo ◽  
...  
Keyword(s):  
Venous Blood ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Lung Cells ◽  
Central Venous ◽  
Arterial Blood ◽  
Arterial Blood Lactate ◽  
Arterial Blood Lactate Concentration ◽  
The Difference ◽  
Potential Tool

ABSTRACTObjectiveIn physiological conditions arterial blood lactate concentration is equal or lower than central venous. The aim of this study was to explore if the COVID-19 induced lung cells damage was mirrored by an arterial lactatemia higher than the central venous one; then if the administration of immunosuppressant drugs (i.e. canakinumab) could normalize such abnormal lactate a-cv difference.MethodsProspective cohort study started on March 25th 2020 for a duration of 10 days, enrolling 21 patients affected by severe COVID-19 pneumonia undergoing mechanical ventilation consecutively admitted to the ICU of the Rimini Hospital, Italy.Arterial and central venous blood samples were contemporary collected to calculate the difference between arterial and central venous lactate (Delta a-cv lactate) concentration within 24 h from tracheal intubation (T0), and 24 hours after canakinumab administration (T1).ResultsAt the T0 19/21 (90.5%) patients showed a pathologic Delta a-cv lactate (median 0.22 mmol/L; IQR 0.07–0.36), suggesting severe inflammation. In the 13 patients undergoing canakinumab administration, at the T1 Delta a-cv lactate decreased in 92.3% of cases, being the decrease statistically significant (T0: median 0.15, IQR 0.07–0.25 mmol/L; T1: median −0.01, IQR 0.09–0.04 mmol/L; p=0.002).ConclusionA reversed Delta a-cv lactate is likely to be one of the effects of COVID-19 related cytokine storm, that could reflect a derangement in the lung cells mitochondrial metabolism induced by inflammation or other uncoupling mediators. Delta a-cv lactate decrease may reflect the anti-inflammatory activity of canakinumab. Our preliminary findings need to be confirmed by larger outcome studies.

scholarly journals Selection of blood sampling source to measure lactate levels in patients with septic shock

2021 ◽  
Vol 16 (7-8) ◽  
pp. 75-78
Author(s):  
Tinglan Zuo ◽  
F.S. Glumcher ◽  
S.O. Dubrov
Keyword(s):  
Septic Shock ◽  
Blood Lactate ◽  
Predictive Value ◽  
Lactate Level ◽  
Venous Blood ◽  
Central Vein ◽  
Central Venous ◽  
Central Venous Blood ◽  
Arterial Blood ◽  
Lactate Levels

The initial lactate level has been used as one of mortality predictors in patients with septic shock. Different studies measured the concentrations of blood lactate obtained from different vessels. Even in some retrospective studies, blood lactate levels from heterogeneous sources (artery, central vein, and peripheral vein) have been used. Practicing physicians face following questions: what data have the best predictive value, can they replace each other? In our observations, а high positive linear correlation was found between lactate concentrations in arterial and central venous blood (R = 0.895; P < 0.001). Both indicators have satisfactory values for predicting treatment outcome. Lactate level in arterial blood had a slightly better predictive value compared to its concentration in central venous blood.

Effects of cocaine on incremental treadmill exercise in horses

1993 ◽  
Vol 75 (6) ◽  
pp. 2727-2733 ◽  
Author(s):  
K. H. McKeever ◽  
K. W. Hinchcliff ◽  
D. F. Gerken ◽  
R. A. Sams
Keyword(s):  
Right Ventricular ◽  
Blood Lactate ◽  
Venous Blood ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Ventricular Pressure ◽  
Mixed Venous Blood ◽  
Work Intensity ◽  
Venous Blood Lactate ◽  
Mixed Venous

Four mature horses were used to test the effects of two doses (50 and 200 mg) of intravenously administered cocaine on hemodynamics and selected indexes of performance [maximal heart rate (HRmax), treadmill velocity at HRmax, treadmill velocity needed to produce a blood lactate concentration of 4 mmol/l, maximal mixed venous blood lactate concentration, maximal treadmill work intensity, and test duration] measured during an incremental treadmill test. Both doses of cocaine increased HRmax approximately 7% (P < 0.05). Mean arterial pressure was 30 mmHg greater (P < 0.05) during the 4- to 7-m/s steps of the exercise test in the 200-mg trial. Neither dose of cocaine had an effect on the responses to exertion of right atrial pressure, right ventricular pressure, or maximal change in right ventricular pressure over time. Maximal mixed venous blood lactate concentration increased 41% (P < 0.05) with the 50-mg dose and 75% (P < 0.05) with the 200-mg dose during exercise. Administration of cocaine resulted in decreases (P < 0.05) in the treadmill velocity needed to produce a blood lactate concentration of 4 mmol/l from 6.9 +/- 0.5 and 6.8 +/- 0.9 m/s during the control trials to 4.4 +/- 0.1 m/s during the 200-mg cocaine trial. Cocaine did not alter maximal treadmill work intensity (P > 0.05); however, time to exhaustion increased by approximately 92 s (15%; P < 0.05) during the 200-mg trial.(ABSTRACT TRUNCATED AT 250 WORDS)

scholarly journals Arterialized and venous blood lactate concentration difference during different exercise intensities

2017 ◽  
Vol 15 (1) ◽  
pp. 22-26 ◽  
Author(s):  
Leandro C. Felippe ◽  
Guilherme A. Ferreira ◽  
Fernando De-Oliveira ◽  
Flavio O. Pires ◽  
Adriano E. Lima-Silva
Keyword(s):  
Blood Lactate ◽  
Venous Blood ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Concentration Difference ◽  
Venous Blood Lactate

Lactic acid infusion in dogs: effects of varying infusate pH

1983 ◽  
Vol 54 (5) ◽  
pp. 1254-1260 ◽  
Author(s):  
L. B. Gladden ◽  
J. W. Yates
Keyword(s):  
Lactic Acid ◽  
Blood Lactate ◽  
Muscle Blood Flow ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Weak Acid ◽  
Muscle Lactate ◽  
Acid Infusion ◽  
Arterial Blood ◽  
Arterial Ph

This study had two purposes: 1) to determine the effects of varying the pH of lactic acid infusion solutions on the acid-base status of anesthetized dogs, and 2) to determine the effect of elevated blood lactate concentration on muscle lactate concentration. The experiments were performed on the in situ gastro cnemius-plantaris muscle group in 14 mongrel dogs. The infusions increased the arterial blood lactate concentration to 11.0 +/- 0.5 (SE) mM after 20 min. Above an infusate pH of 4.4, the arterial pH increased by 0.118–0.167 during infusion; the arterial pH was unchanged when the infusate pH was between 3.4 and 4.0; and the arterial pH decreased as infusate pH decreased below 3.0. The effect of lactic acid infusion on blood pH appears to be the result of two opposing effects: 1) an acidifying effect due to its weak acid properties, and 2) an alkalinizing effect due to the metabolism of sodium lactate. The estimated ratio between intracellular muscle lactate and venous plasma water lactate averaged 0.647 +/- 0.038, indicative of a substantial gradient between blood and muscle. The infusion produced a significant change from lactate output to lactate uptake by the muscles. The infusion also transiently increased muscle blood flow and oxygen uptake.

Effect of the blood lactate concentration on renal glutamine metabolism in dogs with chronic metabolic acidosis

1985 ◽  
Vol 63 (12) ◽  
pp. 1570-1576
Author(s):  
Mitchell L. Halperin ◽  
Ching B. Chen ◽  
Surinder Cheema-Dhadli
Keyword(s):  
Metabolic Acidosis ◽  
Blood Lactate ◽  
Filtration Rate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Glutamine Metabolism ◽  
Chronic Metabolic Acidosis ◽  
Arterial Blood ◽  
Constant Rate ◽  
Ammonium Metabolism

It appears that glutamine and lactate are the principal substrates for the kidney in dogs with chronic metabolic acidosis. Accordingly, the purpose of this study was to determine if a higher or lower rate of renal lactate extraction would influence the rate of glutamine extraction at a constant rate of renal ATP turnover. The blood lactate concentration was 0.9 ± 0.01 mM in 15 acidotic dogs. However, eight dogs with chronic metabolic acidosis had a spontaneous blood lactate concentration of 0.5 mM or lower. The kidneys of these dogs extracted considerably less lactate from the arterial blood (19 vs. 62 μmol/100 mL glomerular filtration rate (GFR)). Nevertheless, glutamine, alanine, citrate, and ammonium metabolism were not significantly different in these two groups of dogs. Renal ATP balance in acidotic dogs with a low blood lactate could only be achieved if a substrate other than additional glutamine were oxidized in that segment of the nephron which normally oxidized lactate; presumably a fat-derived substrate and (or) lactate derived from glucose was now the metabolic fuel at these more distal sites. When the blood lactate concentration was greater than 1.9 mM, lactate extraction rose to 219 μmol/100 mL GFR. Glutamine, alanine, citrate, and ammonium metabolism were again unchanged; in this case, ATP balance required substrate flux to products other than carbon dioxide, presumably, gluconeogenesis. It appears that renal ammoniagenesis is a proximal event and is independent of the rate of renal lactate extraction.

Comparative study of bedside and laboratory measurements of hemoglobin

1996 ◽  
Vol 5 (6) ◽  
pp. 427-432 ◽  
Author(s):  
DA Krenzischek ◽  
FV Tanseco
Keyword(s):  
Venous Blood ◽  
Hemoglobin Level ◽  
Johns Hopkins Hospital ◽  
Postanesthesia Care Unit ◽  
Laboratory Measurements ◽  
Central Venous ◽  
Blood Samples ◽  
Central Venous Blood ◽  
Arterial Blood ◽  
Group I

OBJECTIVE: The purpose of this study was to examine the effects of variations in technique on measurements of hemoglobin level done at the bedside and to compare these results with laboratory measurements of hemoglobin. DESIGN: In accordance with hospital policy, procedure, and protocol, various techniques were used to obtain samples of capillary and venous blood and of blood from arterial and central venous catheters. Levels of hemoglobin were measured at the bedside and in the laboratory, and the results were compared. SETTING: The Johns Hopkins Hospital adult postanesthesia care unit. SAMPLE: A total of 187 blood samples were obtained from 62 adults who had undergone general surgery. Group I comprised 20 subjects with capillary and venous blood samples. Group II comprised 21 subjects with arterial blood samples. Group III comprised 21 subjects with central venous blood samples. RESULTS: The results showed that the amount of blood to be discarded before obtaining samples of arterial and central venous blood need not be any larger than double the dead space of the catheter, and that shaking the blood sample for 10 seconds was sufficient to mix the sample before measurement of hemoglobin levels. Results of bedside and laboratory measurements of hemoglobin level were comparable. CONCLUSION: Bedside measurement of hemoglobin increases efficiency in patient care, decreases risk of blood-transmitted infection for staff, and decreases cost to the patient. However, the persons who perform the assay must be responsible in adhering to the standard of practice to minimize errors in the measurements.

scholarly journals Arteriovenous differences for amino acids and lactate across kidneys of normal and acidotic rats

1976 ◽  
Vol 160 (1) ◽  
pp. 125-128 ◽  
Author(s):  
E J Squires ◽  
D E Hall ◽  
J T Brosnan
Keyword(s):  
Amino Acids ◽  
Amino Acid ◽  
Blood Lactate ◽  
Blood Concentration ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Arterial Blood

1. Arteriovenous differences fro amino acids across kidneys of normal and chronically acidotic rats were measured. Glutamine was the only amino acid extracted in increased amounts in acidosis. There was a considerable production of serine by kidneys from both normal and acidotic rats. 2. The arterial blood concentration of glutamine was significantly decreased in acidotic animals. 3. The glutamine extracted by kidneys of acidotic rats was largely and probably exclusively derived from the plasma. 4. The blood lactate concentration was unchanged in acidosis, as was the uptake of lactate by the kidney.

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