scholarly journals Lactate Clearance at 24 of Hours as Predictors of Outcome in Children with Shock

2021 ◽  
Vol 17 (10) ◽  
Author(s):  
Bibhudatta Mishra ◽  
Satyen Gyani ◽  
Arjit Mohapatra ◽  
Bishwajit Mishra ◽  
Vidya Patawari
Keyword(s):  
Blood Lactate ◽  
Prospective Observational Study ◽  
Early Recognition ◽  
Tissue Perfusion ◽  
Lactate Clearance ◽  
Blood Lactate Level ◽  
Predictors Of Outcome ◽  
Ventilator Support ◽  
Prognostic Importance ◽  
Sick Children

Background: Monitoring of tissue perfusion markers like lactate and its clearance is necessary for early recognition of shock in sick children which will enable the caregiver to initiate an appropriate and timely therapy. Objective: To study the blood lactate clearance at 24 hours of admission and its prognostic importance in predicting the outcomes in children with shock. Methods: This was a “prospective observational” study, conducted in NICU and PICU at Sparsh multispeciality hospital, Bhilai and Jagannath hospital, Bhubaneswar over 80 children presented with shock, from January 2018 to December 2020. Blood lactate level at admission and after 24 hours were evaluated and lactate clearance was compared with mortality. Results: In lactate clearance >20% group, mortality was only 3.8% wherein LC<20% group, mortality was 52.17%. In Lactate clearance < 10% group, inotropes (p0.0002), ventilator support (p-0.0015) were needed more than Lactate clearance > 20% group. When initial lactate >6mmol/dl, 35% of neonates died in comparison to 11.76% in the group having initial lactate <6mmol/dl. The average lactate clearance among the survivors was 28.35% and among the non-survivors was 5.73% (P <0.001). AUC between lactate clearance and mortality was 0.73 suggestive of a good correlation. Conclusion: Lactate clearance of less than 10% at 24 hours of admission showed a good correlation in predicting the mortality in children with shock.

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

Circulation ◽  
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.

scholarly journals Monitoring skin blood flow to rapidly identify alterations in tissue perfusion during fluid removal using continuous veno-venous hemofiltration in patients with circulatory shock

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Wasineenart Mongkolpun ◽  
Péter Bakos ◽  
Jean-Louis Vincent ◽  
Jacques Creteur
Keyword(s):  
Blood Flow ◽  
Blood Lactate ◽  
Skin Blood Flow ◽  
Removal Rate ◽  
Lactate Concentration ◽  
Tissue Perfusion ◽  
Fluid Removal ◽  
Hemodynamic Variables ◽  
Group A ◽  
Group B

Abstract Background Continuous veno-venous hemofiltration (CVVH) can be used to reduce fluid overload and tissue edema, but excessive fluid removal may impair tissue perfusion. Skin blood flow (SBF) alters rapidly in shock, so its measurement may be useful to help monitor tissue perfusion. Methods In a prospective, observational study in a 35-bed department of intensive care, all patients with shock who required fluid removal with CVVH were considered for inclusion. SBF was measured on the index finger using skin laser Doppler (Periflux 5000, Perimed, Järfälla, Sweden) for 3 min at baseline (before starting fluid removal, T0), and 1, 3 and 6 h after starting fluid removal. The same fluid removal rate was maintained throughout the study period. Patients were grouped according to absence (Group A) or presence (Group B) of altered tissue perfusion, defined as a 10% increase in blood lactate from T0 to T6 with the T6 lactate ≥ 1.5 mmol/l. Receiver operating characteristic curves were constructed and areas under the curve (AUROC) calculated to identify variables predictive of altered tissue perfusion. Data are reported as medians [25th–75th percentiles]. Results We studied 42 patients (31 septic shock, 11 cardiogenic shock); median SOFA score at inclusion was 9 [8–12]. At T0, there were no significant differences in hemodynamic variables, norepinephrine dose, lactate concentration, ScvO2 or ultrafiltration rate between groups A and B. Cardiac index and MAP did not change over time, but SBF decreased in both groups (p < 0.05) throughout the study period. The baseline SBF was lower (58[35–118] vs 119[57–178] perfusion units [PU], p = 0.03) and the decrease in SBF from T0 to T1 (ΔSBF%) higher (53[39–63] vs 21[12–24]%, p = 0.01) in group B than in group A. Baseline SBF and ΔSBF% predicted altered tissue perfusion with AUROCs of 0.83 and 0.96, respectively, with cut-offs for SBF of ≤ 57 PU (sensitivity 78%, specificity 87%) and ∆SBF% of ≥ 45% (sensitivity 92%, specificity 99%). Conclusion Baseline SBF and its early reduction after initiation of fluid removal using CVVH can predict worsened tissue perfusion, reflected by an increase in blood lactate levels.

Lactate Clearance Versus Base Deficit Correction in Monotoring of Septic Shock

QJM ◽  
2021 ◽  
Vol 114 (Supplement_1) ◽  
Author(s):  
Adel Mikhail Fahmy ◽  
Ahmed Kamal ◽  
Wael Abd Elmonem Mohamed Abdelwahab ◽  
Ameer Shokry Ahmed
Keyword(s):  
Septic Shock ◽  
Clinical Utility ◽  
Tissue Perfusion ◽  
Lactate Clearance ◽  
Serum Lactate ◽  
Base Deficit ◽  
Mortality And Morbidity ◽  
Survivor Group ◽  
Prediction Of Mortality ◽  
Group I

Abstract Background Tissue perfusion and oxygenation monitoring is the fundamental of management to immediately identify and properly manage (impending) organ dysfunction in septic shock. This is a study of a prospective randomized trial that aims to comparing the prognostic value of lactate clearance versus base deficit correction as an indicator of tissue perfusion in septic shock, trying to prove the superiority of one over the other. Objective To assess the clinical utility of lactate clearance and arterial base deficit correction in predicting mortality in septic shock. Patients and Methods This is a Prospective randomized observational study that was conducted to assess the clinical utility of lactate clearance and arterial base deficit in predicting mortality in septic shock. This study included forty patients who were divided into two equal groups; each of twenty patients, group I (non-survivors), and group II (survivors). Results In this study, the base deficit values revealed statistically notable difference between the two groups at admission, 18 hours, 24 hours and 2 days of admission. The values revealed no notable difference at the 3rd. 4th, and 5th day of admission. At the 6th and 7th day of admission, the base deficit started to increase again in the non-survivor group with statistically notable increase in the values as compared to the survivor group. The cutoff point of base deficit to differentiate between nonsurvivors from survivors was &gt; 11.43 with 62% sensitivity and 100% specificity. In this study, initial serum lactate levels at admission revealed higher accuracy in prediction of mortality as compared with initial base deficit. Conclusion Lactate clearance is a better predictor of mortality and morbidity than base deficit correction.

scholarly journals Serial blood lactate levels as a prognostic factor for sepsis mortality

2014 ◽  
Vol 54 (3) ◽  
pp. 168
Author(s):  
Keswari Aji Patriawati ◽  
Nurnaningsih Nurnaningsih ◽  
Purnomo Suryantoro
Keyword(s):  
Blood Lactate ◽  
Lactate Clearance ◽  
Major Health Problem ◽  
Major Health ◽  
Serial Blood ◽  
Factors Associated ◽  
Relative Risks ◽  
Increased Risk ◽  
Lactate Levels ◽  
Blood Lactate Levels

Background Sepsis is a major health problem in children and aleading cause of death. In recent decades, lactate has been studiedas a biomarker for sepsis, and as an indicator of global tissuehypoxia, increased glycolysis, endotoxin effect, and anaerobicmetabolism. Many studies h ave shown both high levels andincreased serial blood lactate level measurements to be associatedwith increased risk of sepsis mortality.Objective To evaluate serial blood lactate levels as a prognosticfactor for sepsis mortality.Methods We performed an observational, prospective study in thePediatric Intensive Care Unit (PICU) at DR. Sardjito Hospital,Yogyakarta from July to November 2012. We collected serialblood lactate specimens of children with sepsis, first at the time ofadmission, followed by 6 and 24 hours later. The outcome measurewas mortality at the end ofintensive care. Relative risks and 95%confidence intervals of the factors associated with mortality werecalculated using univariate and multivariate analyses.Results Sepsis was found in 91 (50.3%) patients admitted tothe PIW , of whom 75 were included in this study. Five patients(6. 7%) died before the 24-hour lactate collection and 39 patients(52.0%) died during the study. Blood lactate levels of ~ 4mmol;Lat the first and 24-hour specimens were associated with mortality(RR 2.9; 95%CI 1.09 to 7 .66 and RR 4.92; 95%CI 1.77 to 13.65,respectively). Lactate clearance of less than 10% at 24 hours(adjusted RR 5.3; 95% CI 1.1 to 24.5) had a significantly greaterrisk fo llowed by septic shock (adjusted RR 1.54; 95%CI 1.36 to6.4 7) due to mortality.Conclusion In children with sepsis there is a greater risk of mortalityin those with increasing or persistently high serial blood lactatelevels, as shown by less than 10% lactate clearance at 24-hours afterPIW admission.

scholarly journals Comparison of serial blood lactate level between dengue shock syndrome and dengue hemorrhagic fever (evaluation of prognostic value)

2007 ◽  
Vol 47 (4) ◽  
pp. 150 ◽  
Author(s):  
M. Tatang Puspanjono ◽  
Abdul Latief ◽  
Alan R. Tumbelaka ◽  
Sudigdo Sastroasmoro ◽  
Hartono Gunardi
Keyword(s):  
Oxygen Saturation ◽  
Blood Lactate ◽  
Dengue Hemorrhagic Fever ◽  
Lactate Level ◽  
Venous Blood ◽  
Dengue Shock Syndrome ◽  
Hemorrhagic Fever ◽  
Blood Lactate Level ◽  
Cross Sectional ◽  
The Difference

Background Dengue shock syndrome (DSS) mortality is still high.Monitoring of blood lactate level is important to evaluate shock.Objectives The study were to review the difference between bloodlactate level of DSS and that of dengue hemorrhagic fever (DHF),to correlate blood lactate level with hypoxia state as shock riskfactors (PaO 2 , oxygen saturation, and anion gap) and to determinethe cut-off point of blood lactate level to predict shock.Methods The study was carried out at the Department of ChildHealth, Medical School, University of Indonesia, CiptoMangunkusumo Hospital, Jakarta, from January until July 2006.Three mL venous blood specimen was collected from all subjectsfor peripheral blood, blood gasses, serology, and blood lactateexaminations. This study consisted of a retrospective cohort anda cross sectional method. Data were analyzed with Chi-squaretest. Continous data tested using Mann-Whitney method. Toknow the correlation between blood lactate level and shock riskfactors we use logistic regression test.Results In DSS group, 73% shows hyperlactatemia (lactate =2mmol/L). Conversion of lactate means between two groups issignificantly different from day one to day two and three. Therewas a negative correlation between lactate level and pO 2 andoxygen saturation. Oxygen saturation is the only value that hasclinical correlation. Regressions analysis can be applied using Y= 7.05–0.05 X equation. The cut-off point of lactate level asmarker for shock by using ROC curve is 32.015 mmol/L with 70%sensitivity and 83.3% specificity.Conclusions Hyperlactatemia in DSS can be considered as a signfor unappropriate treatment of shock. Blood lactate level can beused as a biochemical marker for tissue hypoxia, to assess severityof the disease, as monitoring of treatment, and has prognosticvalue of DHF cases.

scholarly journals Use of the Accusport semi-automated analyser to determine blood lactate as an aid in the clinical assessment of horses with colic

2001 ◽  
Vol 72 (1) ◽  
Author(s):  
M.L. Schulman ◽  
J.P. Nurton ◽  
A.J. Guthrie
Keyword(s):  
Blood Lactate ◽  
Laboratory Data ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Tissue Perfusion ◽  
Diagnostic Methods ◽  
Initial Assessment ◽  
Clinically Normal ◽  
Case Outcome

The most useful diagnostic methods in the initial evaluation of horses with colic assess the morphological and functional status of the gastrointestinal tract and cardiovascular status. This evaluation is best achieved using a combination of clinical and laboratory data. Blood lactate concentration (BL) is one of these variables. BL rises mainly due to poor tissue perfusion and anaerobic glycolysis associated with shock, providing an indicator of both the severity of disease and its prognosis. A hand-held lactate meter, Accusport, provides a rapid (60 seconds), inexpensive dry-chemical-based determination of BL. This trial evaluated the Accusport's ability to provide BL data as an adjunct to the initial clinical evaluation of horses with colic. The accuracy of the Accusport was tested by evaluation of its interchangeability with the benchmark enzymatic kit evaluation of BL in a trial using data collected firstly from 10 clinically normal control horses and subsequently from 48 horses presented with signs of colic. The BL values were recorded together with the clinical variables of heart rate (HR), capillary refill time (CRT), haematocrit (Hct), and pain character and severity on the initial assessment of the colic horses. Information regarding choice of therapeutic management (medical or surgical) and eventual case outcome (full recovery or died/euthanased) was recorded. The Accusport was found to be interchangeable with the enzymatic kit for recording BL values in colic horses with BL <10 mmol/ , which is within the BL range associated with survival. The interchangeability of an additional, laboratory-based wet chemical assay for BL, the Stat 7 was simultaneously evaluated for the colic and control horses. The Stat 7 was found to be interchangeable with the enzymatic kit for BL determination of colic horses. No linear associations between BL values with HR, CRT, Hct or pain assessment were observed. No relationship with either selection of therapeutic method or eventual case outcome was observed. All horses with BL >8 mmol/ died or were euthanased.

Multisite Near-Infrared Spectroscopy Predicts Elevated Blood Lactate Level in Children After Cardiac Surgery

2009 ◽  
Vol 23 (5) ◽  
pp. 663-667 ◽  
Author(s):  
Sujata B. Chakravarti ◽  
Alexander J.C. Mittnacht ◽  
Jason C. Katz ◽  
Khahn Nguyen ◽  
Umesh Joashi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Infrared Spectroscopy ◽  
Blood Lactate ◽  
Near Infrared Spectroscopy ◽  
Lactate Level ◽  
Near Infrared ◽  
Blood Lactate Level ◽  
Elevated Blood

scholarly journals Muscle fatigue evaluation method of driver at long time driving based on blood lactate level increase

2020 ◽  
Vol 86 (889) ◽  
pp. 19-00433-19-00433
Author(s):  
Takumi YAMAKAWA ◽  
Soichiro HAYAKAWA ◽  
Katsuhiro ASANO ◽  
Shigeyoshi TSUTSUMI ◽  
Ryojun IKEURA
Keyword(s):  
Muscle Fatigue ◽  
Blood Lactate ◽  
Lactate Level ◽  
Evaluation Method ◽  
Blood Lactate Level ◽  
Level Increase ◽  
Long Time ◽  
Fatigue Evaluation

scholarly journals Assessment of adverse drug reaction profile of the disease-modifying anti-rheumatic drugs at the department of orthopaedics in a tertiary care hospital, Silchar, Assam, India

2019 ◽  
Vol 8 (5) ◽  
pp. 1007
Author(s):  
Vijoy S. Kairi ◽  
Pinaki Chakravarty ◽  
Arun Kumar Sipani
Keyword(s):  
Prospective Observational Study ◽  
Tertiary Care Hospital ◽  
Early Recognition ◽  
Tertiary Care ◽  
P Value ◽  
Care Hospital ◽  
Case Record ◽  
Medical College ◽  
Disease Modifying ◽  
Reaction Profile

Background: The mainstay of treatment of Rheumatoid Arthritis (RA) is the use of the disease-modifying anti-rheumatic drugs (DMARDs). Methotrexate, sulfasalazine and hydroxychloroquine are some of the DMARDs which are used in combination for the treatment of RA. The current study was undertaken to assess the adverse drug reactions (ADRs) of DMARDs that are commonly encountered with the treatment of RA.Methods: The present study was designed as a prospective, observational study on newly diagnosed patients with RA. Patients diagnosed with RA above 18 years (excluding pregnant women) of either sex who were prescribed DMARDs in combination were included. ADRs reported spontaneously by the patients and also responses obtained in a questionnaire related to likely ADRs from the patients was recorded in the case record form. Statistical analysis was done using graph pad and p value <0.05 was considered to be statistically significant.Results: A total of 47 patients attending the Outpatient Department of Orthopaedics, Silchar Medical College and Hospital, Silchar, Assam, India were screened for the study. ADRs were monitored up to the last visit on 41 patients excluding the patients who were lost and who were not able to adhere to the treatment. A total of 27 ADRs were reported from 19 ADR forms. Gastrointestinal manifestations were the most common adverse effects of combination DMARDs seen in 10 patients (24.39%). Severity assessment done using modified Hartwig and Siegel scale that showed majority of the ADRs were mild (74.07%).Conclusions: Present study showed that DMARDs are well-tolerated and have an acceptable toxicity profile as majority of ADRs seen were mild. It was however difficult to prevent the occurrence of ADRs. Proper monitoring of therapy is needed for early recognition of ADRs.

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