scholarly journals Current Issues and Perspectives in Patients with Possible Sepsis at Emergency Departments

Antibiotics ◽  
2019 ◽  
Vol 8 (2) ◽  
pp. 56 ◽  
Author(s):  
Ioannis Alexandros Charitos ◽  
Skender Topi ◽  
Francesca Castellaneta ◽  
Donato D’Agostino
Keyword(s):  
Septic Shock ◽  
Septic Patient ◽  
Clinical Symptoms ◽  
Supportive Therapy ◽  
Organ Damage ◽  
Serum Lactate ◽  
Altered Level ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

In the area of Emergency Room (ER), many patients present criteria compatible with a SIRS, but only some of them have an associated infection. The new definition of sepsis by the European Society of Intensive Care Medicine and the Society of Critical Care Medicine (2016), revolutionizes precedent criteria, overcoming the concept of SIRS and clearly distinguishing the infection with the patient’s physiological response from the symptoms of sepsis. Another fundamental change concerns the recognition method: The use of SOFA (Sequential-Sepsis Related-Organ Failure Assessment Score) as reference score for organ damage assessment. Also, the use of the qSOFA is based on the use of three objective parameters: Altered level of consciousness (GCS <15 or AVPU), systolic blood pressure ≤ 100 mmHg, and respiratory rate ≥ 22/min. If patients have at least two of these altered parameters in association with an infection, then there is the suspicion of sepsis. In these patients the risk of death is higher, and it is necessary to implement the appropriate management protocols, indeed the hospital mortality rate of these patients exceeds 40%. Patients with septic shock can be identified by the association of the clinical symptoms of sepsis with persistent hypotension, which requires vasopressors to maintain a MAP of 65 mmHg, and serum lactate levels >18 mg/dL in despite of an adequate volume resuscitation. Then, patient first management is mainly based on: (1) Recognition of the potentially septic patient (sepsis protocol-qSOFA); (2) Laboratory investigations; (3) Empirical antibiotic therapy in patients with sepsis and septic shock. With this in mind, the authors discuss the most important aspects of the sepsis in both adults and infants, and also consider the possible treatment according current guidelines. In addition, the possible role of some nutraceuticals as supportive therapy in septic patient is also discussed.

scholarly journals Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

2020 ◽  
Vol 7 (6) ◽  
pp. 1213
Author(s):  
Rashmi Patil ◽  
Chikkanarasareddy P. S. ◽  
Mallesh K.
Keyword(s):  
Septic Shock ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Early Stage ◽  
Therapeutic Option ◽  
Lactate Clearance ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

scholarly journals STUDY OF SERUM LACTATE LEVELS IN PATIENTS WITH SEPSIS ON THE BASIS OF SURVIVAL AND NON-SURVIVAL

2021 ◽  
pp. 8-10
Author(s):  
Anisha Tanwar ◽  
Bushra Fiza ◽  
Bhupesh Medatwal ◽  
Rubal Singh ◽  
Maheep Sinha
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Lactic Acid ◽  
Survival Rate ◽  
Lactate Concentration ◽  
Serum Lactate ◽  
Mortality Prediction ◽  
P Value ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

INTRODUCTION:- Sepsis is a leading cause of morbidity and mortality internationally Early spotting and . interventions are essential to ensure better patient's outcome. Lactate concentration in septic patients is of particular prognostic value in predicting septic shock and mortality. AIM:- The present study was intended to evaluate the serum Lactate levels on the basis of severity rate in patients suffering of sepsis, severe sepsis and septic shock. MATERIAL & METHOD:- 100 patients diagnosed for sepsis were enrolled for the study and they were grouped as sepsis (n=30), severe sepsis (n=37)and septic shock (n=33). On the basis of survival rate serum Lactate levels in patients with sepsis were estimated in all the 3 categories of subjects according to the inclusion criteria. A p-Value of ≤0.05 were considered as statistically significant. RESULT:- In the present study when the lactate levels were evaluated among all the three categories, it was observed that the Lactate levels were found to be statistically significant (p-value <0.0001). Lactic acid evaluated on the basis of survival rate was also found to be statistically significant with the p-Value 0.015. CONCLUSION:- Lactic acid could be utilized as a reliable marker to assess prognosis at the initial phase of presentation because its initial evaluation shows good predictability in mortality prediction in sepsis patients.

Diagnostic Validity of Ratio between Differences of Central Venous to Arterial CO2 and Arterial to Central Venous O2 Content in Diagnosis of Anaerobic Metabolism among Septic Patients

2021 ◽  
Vol 8 (1) ◽  
pp. 34-38
Author(s):  
Subroto Kumar Sarker ◽  
Umme Kulsum Choudhury ◽  
Mohammad Mohsin ◽  
Subrata Kumar Mondal ◽  
Muslema Begum
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Intensive Care ◽  
Anaerobic Metabolism ◽  
Venous Blood ◽  
Blood Gases ◽  
Serum Lactate ◽  
Central Venous ◽  
College Hospital ◽  
Sepsis And Septic Shock

Background: Detection of anaerobic metabolism is very crucial for the management of the septic patients. Objective: The purpose of the present study was to validate the ratio between differences of central venous to arterial CO2 and arterial to central venous O2 content in diagnosis of anaerobic metabolism among septic patients. Methodology: This prospective observational study was conducted in the Intensive Care Unit of the department of Anaesthesia Analgesia, Palliative and Intensive Care Medicine at Dhaka Medical College Hospital, Dhaka, Bangladesh from January 2016 to December 2016. All patients admitted to ICU with the features of severe sepsis and septic shock according to SSC guidelines with the age of more than or equal to 18 years in both sexes were included in this study. The arterial and central venous blood gases were measure simultaneously. At the same time serum lactate was measured. Result: Among the 69 patients, 31(44.9%) were of severe sepsis and 38(55%) were of septic shock patients. In the severe sepsis and septic shock patients the mean P(v-a)CO2/C(a-v)O2 is 1.39±0.41 and 1.11±0.40 respectively. Serum lactate in case of severe sepsis and septic shock patients is 2.85±1.40 and 3.85±1.04 respectively. The ROC analysis showed an area under curve 0.89 and P(v-a)CO2/C(a-v)O2 ratio cutoff value of 1.21 showed sensitivity 0.84 and specificity 0.94. Conclusion: The P(v-a)CO2/C(a-v)O2  ratio is also a another marker of global anaerobic metabolism and it would be used for diagnosis as well as management of septic patient.  Journal of Current and Advance Medical Research, January 2021;8(1):34-38

Targeting peripheral perfusion versus serum lactate levels in septic shock

2019 ◽  
Vol 14 (6) ◽  
pp. 999-1001 ◽  
Author(s):  
Marianna Porzio ◽  
◽  
Guido Baldini ◽  
Cristiana Di Maggio
Keyword(s):  
Septic Shock ◽  
Serum Lactate ◽  
Peripheral Perfusion ◽  
Lactate Levels

scholarly journals Evolutive standard base excess and serum lactate level in severe sepsis and septic shock patients resuscitated with early goal-directed therapy: still outcome markers?

Clinics ◽  
2006 ◽  
Vol 61 (1) ◽  
pp. 47-52 ◽  
Author(s):  
Marcelo Park ◽  
Luciano Cesar Pontes Azevedo ◽  
Alexandre Toledo Maciel ◽  
Vladimir Ribeiro Pizzo ◽  
Danilo Teixeira Noritomi ◽  
...  
Keyword(s):  
Septic Shock ◽  
Severe Sepsis ◽  
Base Excess ◽  
Serum Lactate ◽  
Serum Lactate Level ◽  
Goal Directed Therapy ◽  
Early Goal Directed Therapy ◽  
Standard Base Excess ◽  
Standard Base ◽  
Sepsis And Septic Shock

Sepsis-Induced Myocardial Dysfunction in Pediatric Septic Shock: Prevalence, Predictors, and Outcome—A Prospective Observational Study

2021 ◽  
Author(s):  
Viresh S. Swami ◽  
Lalitha A. V. ◽  
Santu Ghosh ◽  
Mounika Reddy
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Patient Outcomes ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Myocardial Dysfunction ◽  
Severity Of Illness ◽  
Serum Lactate ◽  
Lactate Levels ◽  
Organ Dysfunctions

AbstractThere is a paucity of literature on the prevalence, predictors, prognostic markers, and outcomes of sepsis-induced myocardial dysfunction (SMD) in pediatric septic shock. The objectives of our study were to estimate the prevalence of SMD in pediatric septic shock by point-of-care functional echocardiography (POCFE) and to study the association of SMD with severity of illness, organ dysfunctions, and outcomes. This prospective, observational study was conducted over a period of 1 year (from July 2018 to July 2019) in a 12-bed, tertiary pediatric intensive care unit (PICU) of an academic and referral hospital in South India. Children presenting with septic shock were enrolled in the study. POCFE was done within 6 hours of PICU admission and patients were categorized as having SMD based on POCFE findings. The prevalence of SMD (left ventricle ± right ventricle) was 32% (32/100). More than half of the children (54.5%) died in SMD group, whereas only 7.5% died in non-SMD group (p < 0.001). SMD was associated with higher organ dysfunctions, worse patient outcomes, and was found to be an independent predictor of mortality. The median lactate levels were higher in SMD group (3.15 [2.7, 5] vs. 2 [1.3, 2.7], p < 0.001) as compared with non-SMD group. We observed significantly lower median lactate clearance at 6 hours in SMD than non-SMD (30.0% [−14.44, 44.22] vs. 59.8% [45.83, 71.43], p < 0.001). Lactate levels at 6 hours with a threshold of 2.4 mmol/L was a good predictor of SMD with sensitivity and specificity of 73 and 80%, respectively. SMD is not an uncommon entity in children with septic shock. SMD was associated with worse patient outcomes, organ dysfunction, and mortality. Serum lactate trends may predict SMD and can be used as prognosticate markers as well.

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