scholarly journals Lactate Clearance as a Predictive Marker of Mortality in Adult Intensive Care Unit

2020 ◽  
Vol 5 (2) ◽  
pp. 32-38
Author(s):  
Shirish Raj Joshi ◽  
Renu Gurung ◽  
Subhash Prasad Acharya ◽  
Bashu Dev Parajuli ◽  
Navindra Raj Bista
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Lactate Clearance ◽  
Icu Mortality ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Significant Difference

Introduction: Lactate clearance has been widely investigated. Serial lactate concentrations can be used to examine disease severity and predict mortality in the intensive care unit. We investigated the diagnostic accuracy of lactate concentration and lactate clearance in predicting mortality in critically ill patients during the first 24 hours in Intensive Care Unit (ICU).Methods: It was a Prospective, observational study conducted in ICU. Sixty eight consecutive patients having blood lactate level >2 mmol/L were included irrespective of disease and postoperative status. We measured blood lactate concentration at ICU admission(H0), at six hours(H6), 12 hours(H12), and 24 hours(H24). Lactate clearance was measured for H0-H6, H0-H12 and H0-H24 time period.Results: ICU mortality was 33.8%. Lactate clearance was 15.80 ± 17.21% in survivors and 1.73±11% in non survivors for the H0-H6 (p = 0.001) and remained higher in survivors than in non survivors over the study period of 24 hours; 17.97±15 vs. -2.04±19.84% for H0-H12 and 27.40 ± 11.41% vs. -14.83 ± 26.84% for the H0-H24 period (p < 0.001 for each studied period). There was significant difference in lactate concentration (static) between survivors and non survivors during the course of initial 24 hours. The best predictor of ICU mortality was lactate clearance for the H0-H24 period (AUC =0.89; 95% CI 0.78-1.01). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status (p = 0.005, OR = 0.922 and 95% CI 0.871-0.976).Conclusion: Blood lactate concentration and lactate clearance are both predictive for mortality during initial 24 hours of ICU admission.

scholarly journals Lactate Kinetics Reflect Organ Dysfunction and Are Associated with Adverse Outcomes in Intensive Care Unit Patients with COVID-19 Pneumonia: Preliminary Results from a GREEK Single-Centre Study

Metabolites ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. 386
Author(s):  
Alice G. Vassiliou ◽  
Edison Jahaj ◽  
Ioannis Ilias ◽  
Vassiliki Markaki ◽  
Sotirios Malachias ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Lactate ◽  
Organ Dysfunction ◽  
Apache Ii ◽  
Icu Mortality ◽  
Icu Patients ◽  
Time Pattern ◽  
Cox Regression Analysis ◽  
Icu Admission

Coronavirus disease-19 (COVID-19) continues to be a health threat worldwide. Increased blood lactate is common in intensive care unit (ICU) patients; however, its association with outcomes in ICU COVID-19 patients remains currently unexplored. In this retrospective, observational study we assessed whether lactate is associated with outcomes in COVID-19 patients. Blood lactate was measured on ICU admission and thereafter daily up to day 14 in 45 patients with confirmed COVID-19 pneumonia. Acute physiology and chronic health evaluation (APACHE II) was calculated on ICU admission, and sequential organ failure assessment (SOFA) score was assessed on admission and every second day. The cohort was divided into survivors and non-survivors based on 28-day ICU mortality (24.4%). Cox regression analysis revealed that maximum lactate on admission was independently related to 28-day ICU mortality with time in the presence of APACHE II (RR = 2.45, p = 0.008). Lactate’s area under the curve for detecting 28-day ICU mortality was 0.77 (p = 0.008). Mixed model analysis showed that mean daily lactate levels were higher in non-survivors (p < 0.0001); the model applied on SOFA scores showed a similar time pattern. Thus, initial blood lactate was an independent outcome predictor in COVID-19 ICU patients. The time course of lactate mirrors organ dysfunction and is associated with poor clinical outcomes.

scholarly journals Intensive Care Unit Capacity Strain and Outcomes of Critical Illness in a Resource-Limited Setting: A 2-Hospital Study in South Africa

2018 ◽  
Vol 35 (10) ◽  
pp. 1104-1111 ◽  
Author(s):  
George L. Anesi ◽  
Nicole B. Gabler ◽  
Nikki L. Allorto ◽  
Carel Cairns ◽  
Gary E. Weissman ◽  
...  
Keyword(s):  
South Africa ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critical Illness ◽  
Primary Outcome ◽  
Resource Limited Setting ◽  
Icu Mortality ◽  
Icu Admission ◽  
Resource Limited ◽  
Limited Setting

Objective: To measure the association of intensive care unit (ICU) capacity strain with processes of care and outcomes of critical illness in a resource-limited setting. Methods: We performed a retrospective cohort study of 5332 patients referred to the ICUs at 2 public hospitals in South Africa using the country’s first published multicenter electronic critical care database. We assessed the association between multiple ICU capacity strain metrics (ICU occupancy, turnover, census acuity, and referral burden) at different exposure time points (ICU referral, admission, and/or discharge) with clinical and process of care outcomes. The association of ICU capacity strain at the time of ICU admission with ICU length of stay (LOS), the primary outcome, was analyzed with a multivariable Cox proportional hazard model. Secondary outcomes of ICU triage decision (with strain at ICU referral), ICU mortality (with strain at ICU admission), and ICU LOS (with strain at ICU discharge), were analyzed with linear and logistic multivariable regression. Results: No measure of ICU capacity strain at the time of ICU admission was associated with ICU LOS, the primary outcome. The ICU occupancy at the time of ICU admission was associated with increased odds of ICU mortality (odds ratio = 1.07, 95% confidence interval: 1.02-1.11; P = .004), a secondary outcome, such that a 10% increase in ICU occupancy would be associated with a 7% increase in the odds of ICU mortality. Conclusions: In a resource-limited setting in South Africa, ICU capacity strain at the time of ICU admission was not associated with ICU LOS. In secondary analyses, higher ICU occupancy at the time of ICU admission, but not other measures of capacity strain, was associated with increased odds of ICU mortality.

scholarly journals The nursing workload assessed through the Nursing Activities Score as a predictor for the occurrence of ventilator-associated pneumonia in an adult intensive care unit

2019 ◽  
Vol 9 (9) ◽  
pp. 104
Author(s):  
Fabiola Alves Gomes ◽  
Denise Von Dolinger de Brito Röder ◽  
Thúlio Marquez Cunha ◽  
Rosângela De Oliveira Felice ◽  
Guilherme Silva Mendonça ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Hospital Costs ◽  
University Hospital ◽  
Nursing Workload ◽  
Ventilator Associated Pneumonia ◽  
Adult Intensive Care Unit ◽  
Icu Admission ◽  
Stay Time ◽  
The Impact

Objective: Evaluate the relation of nursing workload, evaluated by the Nursing Activities Score (NAS), with the occurrence of Ventilator-associated Pneumonia (VAP) in an Intensive Care Unit (ICU) and the impact of VAP on hospitalization costs.Methods: Retrospective cohort study in Adult ICU of a high complexity Brazilian university hospital. The profile, outcomes, costs, and daily NAS from patients were collected. We also proposed some workload indicators based on NAS daily evaluation.Results: The study included 195 patients, 27.17% diagnosed with VAP. VAP was more prevalent in patients diagnosed with trauma on admission. The total costs of care were higher for VAP patients. In all multivariate models tested were predictive for VAP: the patient's intubation that occurs in days prior of the ICU admission day (higher risk if occurs in days prior the ICU admission day) and ventilation time prior ICU (higher risk if higher time). We found others predictors, but these were dependent on the model tested. Additional risk predictors were tracheostomy, propofol use, neuromuscular blocker use and the higher NAS from admission. The protective factors found were the percentage of adequacy of the assignment based in NAS that measure if the workload measured by the NAS was offered and the increment in NAS during the ventilation time.Conclusions: The offering of an adequate nursing work scale (adequate number of professionals for the care), as a function of the nursing workload measured by the NAS, could be effective in the reduction of VAP, hospital stay time and hospital costs.

scholarly journals La privación de sueño no afecta la resistencia aeróbica ni la concentración de lactato en sangre de jóvenes deportistas (Sleep deprivation does not affect aerobic resistance or blood lactate concentration of young athletes)

Retos ◽  
2018 ◽  
pp. 221-223
Author(s):  
Jorge Alberto Aburto Corona ◽  
Tatiana Miranda Núñez ◽  
Alicia Bárcenas Ugalde ◽  
Roberto Espinoza Gutiérrez ◽  
Emilio Manuel Arrayales Millán
Keyword(s):  
Sleep Deprivation ◽  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Aerobic Performance ◽  
Control Group ◽  
Experimental Conditions ◽  
Male Athletes ◽  
Physical Test ◽  
Significant Difference

El objetivo de este estudio fue determinar si la resistencia aeróbica y la concentración de lactato en sangre, pueden ser influenciados por la privación parcial o total del sueño en un grupo de deportistas. Se reclutaron 13 deportistas masculinos (21.8 ± 2.9 años de edad) los cuales fueron sometidos a tres condiciones experimentales: dormir cuatro horas (D4H), no dormir (0H) y una condición contol de dormir ocho horas (D8H). No se encontraron diferencias estadísticamente significativas en la resistencia aeróbica (p=.845). De la misma manera, no se halló diferencia significativa en la concentración de lactato en sangre (p>.05). Estos resultados señalan que la privación parcial (dormir cuatro horas) o total (no dormir) del sueño, previo a una prueba física, no es un factor que influya en el rendimiento aeróbico ni en la concentración de lactato en sangre en comparación a la cantidad de horas de sueño recomendadas (dormir ocho horas).Abstract. The purpose of this study was to determinate if aerobic performance and blood lactate concentration are influenced by partial or total sleep deprivation. Thirteen male athletes (age: 21.8 ± 2.9 y.o) were randomly assigned to three experimental conditions: sleep four hours (D4H), no sleep (0H), and sleep eigth hours (D8H, control group). No significant difference was found in the aerobic performance (p=.845). Similarly, there was no sifnificant difference in blood lactate concentration (p>.05). This results suggest that partial (sleep four hours) or total (no sleep) sleep deprivation before a physical test are not a factor influencing aerobic performance or blood lactate concentration compared to the amount of recommended hours of sleep (sleep eight hours).

Mammalian metabolite flux rates in a teleost: lactate and glucose turnover in tuna

1986 ◽  
Vol 250 (3) ◽  
pp. R452-R458 ◽  
Author(s):  
J. M. Weber ◽  
R. W. Brill ◽  
P. W. Hochachka
Keyword(s):  
Blood Lactate ◽  
Turnover Rate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Lactate Clearance ◽  
Glucose Turnover ◽  
Skipjack Tuna ◽  
Turnover Rates ◽  
Total Blood ◽  
Lactate Turnover

Lactate and glucose turnover rates were measured by bolus injection of [U-14C]lactate and [6-3H]glucose in cannulated lightly anesthetized skipjack tuna, Katsuwonus pelamis. Our goals were to find out whether the high rates of lactate clearance reported during recovery from burst swimming in tuna could be accounted for by high blood lactate fluxes; to extend the observed correlation between lactate turnover and lactate concentration in mammals to a nonmammalian system, and to assess the importance of lactate and glucose as metabolic fuels in tuna and to compare their flux rates with values reported for mammals. Measured lactate turnover rates ranged from 112 to 431 mumol X min-1 X kg-1 and were correlated with blood lactate concentration. Glucose turnover rate averaged 15.3 mumol X min-1 X kg-1. When correcting for body mass and temperature, skipjack tuna has at least as high or even higher lactate turnover rates than those recorded for mammals. Tuna glucose turnover rate is similar to that of mammals but much higher than levels found in other teleosts. Even the highest lactate turnover rate measured in tuna cannot fully account for the rate of blood lactate clearance observed during recovery, suggesting that some of the lactate produced in skeletal muscle must be metabolized in situ. After injection of [U-14C]lactate, less than 5% of the total blood activity was recovered in glucose, suggesting that the Cori cycle is not an important pathway of lactate metabolism in tuna.

scholarly journals Quantitative Assessment of Blood Lactate in Shock: Measure of Hypoxia or Beneficial Energy Source

2020 ◽  
Vol 2020 ◽  
pp. 1-24
Author(s):  
David G. Levitt ◽  
Joseph E. Levitt ◽  
Michael D. Levitt
Keyword(s):  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
Tca Cycle ◽  
Lactate Clearance ◽  
Tissue Hypoxia ◽  
Response To Therapy ◽  
Lactate Release ◽  
Liver And Kidney ◽  
Exercise Induced

Blood lactate concentration predicts mortality in critically ill patients and is clinically used in the diagnosis, grading of severity, and monitoring response to therapy of septic shock. This paper summarizes available quantitative data to provide the first comprehensive description and critique of the accepted concepts of the physiology of lactate in health and shock, with particular emphasis on the controversy of whether lactate release is simply a manifestation of tissue hypoxia versus a purposeful transfer (“shuttle”) of lactate between tissues. Basic issues discussed include (1) effect of nonproductive lactate-pyruvate exchange that artifactually enhances flux measurements obtained with labeled lactate, (2) heterogeneous tissue oxygen partial pressure (Krogh model) and potential for unrecognized hypoxia that exists in all tissues, and (3) pathophysiology that distinguishes septic from other forms of shock. Our analysis suggests that due to exchange artifacts, the turnover rate of lactate and the lactate clearance are only about 60% of the values of 1.05 mmol/min/70 kg and 1.5 L/min/70 kg, respectively, determined from the standard tracer kinetics. Lactate turnover reflects lactate release primarily from muscle, gut, adipose, and erythrocytes and uptake by the liver and kidney, primarily for the purpose of energy production (TCA cycle) while the remainder is used for gluconeogenesis (Cori cycle). The well-studied physiology of exercise-induced hyperlactatemia demonstrates massive release from the contracting muscle accompanied by an increased lactate clearance that may occur in recovering nonexercising muscle as well as the liver. The very limited data on lactate kinetics in shock patients suggests that hyperlactatemia reflects both decreased clearance and increased production, possibly primarily in the gut. Our analysis of available data in health and shock suggests that the conventional concept of tissue hypoxia can account for most blood lactate findings and there is no need to implicate a purposeful production of lactate for export to other organs.

scholarly journals Neutrophil-Lymphocyte Ratio as a Potential Biomarker for Delirium in the Intensive Care Unit

2021 ◽  
Vol 12 ◽  
Author(s):  
Chai Lee Seo ◽  
Jin Young Park ◽  
Jaesub Park ◽  
Hesun Erin Kim ◽  
Jaehwa Cho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Detection ◽  
Inflammatory Markers ◽  
Inflammatory Marker ◽  
Neutrophil Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Icu Admission ◽  
Potential Biomarker ◽  
Significant Difference

Background: Recognition and early detection of delirium in the intensive care unit (ICU) is essential to improve ICU outcomes. To date, neutrophil-lymphocyte ratio (NLR), one of inflammatory markers, has been proposed as a potential biomarker for brain disorders related to neuroinflammation. This study aimed to investigate whether NLR could be utilized in early detection of delirium in the ICU.Methods: Of 10,144 patients who admitted to the ICU, 1,112 delirium patients (DE) were included in the current study. To compare among inflammatory markers, NLR, C-reactive protein (CRP), and white blood cell (WBC) counts were obtained: the mean NLR, CRP levels, and WBC counts between the initial day of ICU admission and the day of initial delirium onset within DE were examined. The inflammatory marker of 1,272 non-delirium patients (ND) were also comparatively measured as a supplement. Further comparisons included a subgroup analysis based on delirium subtypes (non-hypoactive vs. hypoactive) or admission types (elective vs. emergent).Results: The NLR and CRP levels in DE increased on the day of delirium onset compared to the initial admission day. ND also showed increased CRP levels on the sixth day (the closest day to average delirium onset day among DE) of ICU admission compared to baseline, while NLR in ND did not show significant difference over time. In further analyses, the CRP level of the non-hypoactive group was more increased than that of the hypoactive group during the delirium onset. NLR, however, was more significantly increased in patients with elective admission than in those with emergent admission.Conclusion: Elevation of NLR was more closely linked to the onset of delirium compared to other inflammatory markers, indicating that NLR may play a role in early detection of delirium.

scholarly journals Diferencias en el OBLA en jugadoras de fútbol en relación a su posición en el campo de juego (Differences in OBLA in football players based on their field position)

Retos ◽  
2016 ◽  
pp. 58-61
Author(s):  
Jose E. Del Río Valdivia ◽  
Ciria Margarita Salazar ◽  
Julio Cuevas Romo ◽  
Adriana Isabel Andrade Sánchez ◽  
Pedro Julian Flores Moreno ◽  
...  
Keyword(s):  
Blood Lactate ◽  
Lactate Concentration ◽  
Blood Lactate Concentration ◽  
P Value ◽  
Significance Level ◽  
Speed Test ◽  
Physiological Variables ◽  
Significant Difference ◽  
Speed Level ◽  
Field Position

La posición en el campo de juego en el fútbol, no obedece solo a un interés personal, sino que podría depender de variables fisiológicas individuales. El presente estudio determina el OBLA en las diferentes posiciones. La población del estudio fue integrada por 16 jugadoras universitarias de la modalidad soccer (4 por cada posición) evaluadas en una banda sin fin, con una prueba de velocidades crecientes. En cada velocidad utilizada se midió la concentración de lactato sanguíneo con un analizador portátil Accuntrend Lactate Plus. Para el análisis de los datos se propuso una fórmula matemática de interpolación entre las variables velocidad y concentración de lactato. Se encontró, una variación significativa del OBLA, en la muestra estudiada, dependiendo de la posición de juego (porteras, defensas, medio-campistas y delanteras). Utilizando la prueba de Kruskal-Wallis, con un nivel de significancia (α) del 5 %, en búsqueda de la relación entre el OBLA y la posición de las jugadoras, se obtuvo un p-valor de 0.004, por lo que no es posible aceptar la igualdad entre las poblaciones, por lo tanto, se puede afirmar que existe una diferencia estadística significativa cuando se compara el comienzo de acumulación de lactato en sangre (OBLA) con la posición en la que juegan las futbolistas. Los resultados demuestran que existen diferencias estadísticamente significativas entre los grupos de jugadoras de acuerdo a la posición que desempeñan en el campo de juego y a la concentración de lactato en sangre.Abstract. Choosing a field position in football may not depend only on personal interest, but also on individual physiological variables. The aim of the study is to determine the Onset of Blood Lactate Accumulation (OBLA) in the different field positions of football. The study sample was composed by 16 female players (four per position) evaluated using an increased speed test carried out on treadmill. At each speed level, blood lactate concentrations were measured with the portable analyzer Accuntrend Lactate Plus. A mathematical formula interpolating speed and lactate concentration was proposed for the analysis of the data obtained. A significant variation of OBLA was found in the participants, associated with playing position (goalkeepers, defenders, midfielders, and strikers). Setting the significance level (α) at 5%, a p-value of 0.004 was obtained using the Kruskal-Wallis test in order to study the relation between OBLA and players’ field position. This demonstrates that there is no equivalence among positions, at the same time as a statistically significant difference is shown when comparing OBLA with players’ field position. Results show that there are statistically significant differences between the groups of players based on their field position and on blood lactate concentration.

The Pediatric Intensive Care Unit as a Critical Care Setting for Adults during the COVID-19 Pandemic: A Service Evaluation

2021 ◽  
Author(s):  
Elizabeth J. A. Fitchett ◽  
Matthew Rubens ◽  
Katherine Styles ◽  
Thomas Bycroft ◽  
Simon Nadel ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Pediatric Intensive Care ◽  
Adult Patients ◽  
Pediatric Care ◽  
Organ Support ◽  
Adult Intensive Care Unit ◽  
Significant Difference

AbstractOne strategy to expand critical care capacity during the coronavirus disease 2019 (COVID-19) pandemic within the United Kingdom has been to repurpose other clinical departments, including the pediatric intensive care unit (PICU) and pediatric multidisciplinary team, to accommodate critically unwell adult patients. While multiple PICUs have treated adult patients with COVID-19, there is an absence of data on the characteristics of patients transferred to pediatric care and their resulting outcomes in comparison to standard adult intensive care unit (AICU) provision. Data were collected for all adult COVID-19 intensive care admissions between March and May 2020, in three ICUs within a single center: PICU, AICU, and theater recovery ICU (RICU). Patient characteristics, severity of illness, and outcomes were described according to the ICU where most of their bed-days occurred. Outcomes included duration of organ support and ICU admission, and mortality at 30 days. Mortality was compared between patients in PICU and the other adult ICUs, using a logistic regression model, adjusting for known confounding variables. Eighty-eight patients were included: 15 (17.0%) in PICU, 57 (64.7%) in AICU, and 16 (18.1%) in RICU. Patients' characteristics and illness severity on admission were comparable across locations, with similar organ support provided. Ten (66.7%) patients survived to hospital discharge from PICU, compared with 27 (47.4%) and nine (56.3%) patients from AICU and RICU, respectively, with no significant difference in 30-day mortality (OR 0.46, 95% CI 0.12–1.85; p = 0.276). Our analysis illustrates the feasibility of evaluating outcomes of patients who have been cared for in additional, emergency ICU beds, whilst demonstrating comparable outcomes for adults cared for in pediatric and adult units.

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