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.

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.

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.

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 Correlation between Arterial Lactate and Central Venous Lactate in Children with Sepsis

2016 ◽  
Vol 2016 ◽  
pp. 1-5 ◽  
Author(s):  
Jaime Fernández Sarmiento ◽  
Paula Araque ◽  
María Yepes ◽  
Hernando Mulett ◽  
Ximena Tovar ◽  
...  
Keyword(s):  
Septic Shock ◽  
Blood Sample ◽  
Pediatric Patients ◽  
Venous Blood ◽  
Tissue Perfusion ◽  
Central Venous ◽  
Important Indicator ◽  
Arterial Lactate ◽  
Arterial Blood ◽  
Sepsis And Septic Shock

Introduction. Lactate is an important indicator of tissue perfusion. The objective of this study is to evaluate if there are significant differences between the arterial and central venous measurement of lactate in pediatric patients with sepsis and/or septic shock.Methods. Longitudinal retrospective observational study. Forty-two patients were included between the age of 1 month and 17 years, with a diagnosis of sepsis and septic shock, who were admitted to the intensive care unit of a university referral hospital. The lactate value obtained from an arterial blood sample and a central venous blood sample drawn simultaneously, and within 24 hours of admission to the unit, was recorded.Results. The median age was 2.3 years (RIC 0,3–15), with a predominance of males (71.4%), having a 2.5 : 1 ratio to females. Most of the patients had septic shock (78.5%) of pulmonary origin (50.0%), followed by those of gastrointestinal origin (26.1%). Using Spearman’s Rho, a 0.872 (p<0.001) correlation was found between arterial and venous lactate, which did not vary when adjusted for age (p<0.05) and the use of vasoactive drugs (p<0.05).Conclusion. There is a good correlation between arterial and venous lactate in pediatric patients with sepsis and septic shock, which is not affected by demographic variables or type of vasoactive support.

scholarly journals Lactate levels from arterial, central venous and peripheral venous blood in severe sepsis and septic shock patients

Critical Care ◽  
2007 ◽  
Vol 11 (Suppl 2) ◽  
pp. P452 ◽  
Author(s):  
M Assuncao ◽  
A Nascente ◽  
C Guedes ◽  
B Mazza ◽  
M Jacki ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Venous Blood ◽  
Central Venous ◽  
Peripheral Venous Blood ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

scholarly journals Establishment of a Linear Correlation Model of Central Venous Blood Oxygen Saturation and Lactate in Sepsis

2020 ◽  
Keyword(s):  
Septic Shock ◽  
Venous Blood ◽  
Complex Relationship ◽  
Blood Oxygen ◽  
Central Venous ◽  
Blood Oxygen Saturation ◽  
Intensive Care Patients ◽  
Central Venous Blood ◽  
Linear Modelling ◽  
The Relationship

Introduction: Studies have shown that there is a complex relationship between lactate and ScvO2. Methods: A retrospective study was carried out in 37 intensive care patients with sepsis or septic shock. The relationship between lactate and ScvO2 was explored with correlation analysis and simple linear modelling. Results: Lactate and ScvO2 were significantly correlated in patients with septic shock (r2 = 0.46, p = 0.001; y = -4.11x+ 82.62), but not in sepsis. y Significant correlation between these parameters was also found in the group of patients who went on to die (r2 = 0.67, p < 0.01; y = -3.70x + 78.61), but not in patients who survived. Conclusions: In sepsis, the correlation between ScvO2 and lactate is not constant over the sepsis course and may be dynamic. In the resuscitation of sepsis and/or septic shock, changes in ScvO2 requires further study.

scholarly journals Pre-Hospital Lactatemia Predicts 30-Day Mortality in Patients with Septic Shock—Preliminary Results from the LAPHSUS Study

2020 ◽  
Vol 9 (10) ◽  
pp. 3290
Author(s):  
Romain Jouffroy ◽  
Teddy Léguillier ◽  
Basile Gilbert ◽  
Jean Pierre Tourtier ◽  
Emmanuel Bloch-Laine ◽  
...  
Keyword(s):  
Septic Shock ◽  
Blood Lactate ◽  
Disease Severity ◽  
Lactate Level ◽  
Cox Regression ◽  
Blood Lactate Level ◽  
Controlled Study ◽  
Cox Regression Analysis ◽  
Lactate Levels ◽  
Blood Lactate Levels

Background: Assessment of disease severity in patients with septic shock (SS) is crucial in determining optimal level of care. In both pre- and in-hospital settings, the clinical picture alone is not sufficient for assessing disease severity and outcomes. Because blood lactate level is included in the clinical criteria of SS it should be considered to improve the assessment of its severity. This study aims to investigate the relationship between pre-hospital blood lactate level and 30-day mortality in patients with SS. Methods: From 15 April 2017 to 15 April 2019, patients with SS requiring pre-hospital Mobile Intensive Care Unit intervention (MICU) were prospectively included in the LAPHSUS study, an observational, non-randomized controlled study. Pre-hospital blood lactate levels were measured at the time of first contact between the patients and the MICU. Results: Among the 183 patients with septic shock requiring action by the MICU drawn at random from LAPHSUS study patients, six (3%) were lost to follow-up on the 30th day and thus 177 (97%) were analyzed for blood lactate levels (mean age 70 ± 14 years). Pulmonary, urinary and digestive infections were probably the cause of the SS in respectively 58%, 21% and 11% of the cases. The 30-day overall mortality was 32%. Mean pre-hospital lactatemia was significantly different between patients who died and those who survived (respectively 7.1 ± 4.0 mmol/L vs. 5.9 ± 3.5 mmol/L, p < 10−3). Using Cox regression analysis adjusted for potential confounders we showed that a pre-hospital blood lactate level ≥ 4 mmol/L significantly predicted 30-day mortality in patients with SS (adjusted hazard ratio = 2.37, 95%CI (1.01–5.57), p = 0.04). Conclusion: In this study, we showed that pre-hospital lactatemia predicts 30-day mortality in patients with septic shock handled by the MICU. Further studies will be needed to evaluate if pre-hospital lactatemia alone or combined with clinical scores could affect the triage decision-making process for those patients.

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