Determination of plasma lactate in the emergency department for the early detection of tissue hypoperfusion in septic patients

Gómez-Ramos, José Juan; Marín-Medina, Alejandro; Prieto-Miranda, Sergio Emilio; Dávalos-Rodríguez, Ingrid Patricia; Alatorre-Jiménez, Moisés Alejandro; Esteban‐Zubero, Eduardo

doi:10.1016/j.ajem.2017.12.068

Cited by 6 publications

(8 citation statements)

References 17 publications

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“…However, it took 66 h to make. No Gómez-Ramos J.J. et al [ 42 ] Patient monitor Technical report and quasi experiment 3D printed box with chemical reagents and connected to a smartphone. Compared to gold standard and on a volunteer undergoing physical activity.…”

Section: Resultsmentioning

confidence: 99%

3D printing in critical care: a narrative review

et al. 2020

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Background 3D printing (3DP) has gained interest in many fields of medicine including cardiology, plastic surgery, and urology due to its versatility, convenience, and low cost. However, critical care medicine, which is abundant with high acuity yet infrequent procedures, has not embraced 3DP as much as others. The discrepancy between the possible training or therapeutic uses of 3DP in critical care and what is currently utilized in other fields needs to be addressed. Objective This narrative literature review describes the uses of 3DP in critical care that have been documented. It also discusses possible future directions based on recent technological advances. Methods A literature search on PubMed was performed using keywords and Mesh terms for 3DP, critical care, and critical care skills. Results Our search found that 3DP use in critical care fell under the major categories of medical education (23 papers), patient care (4 papers) and clinical equipment modification (4 papers). Medical education showed the use of 3DP in bronchoscopy, congenital heart disease, cricothyroidotomy, and medical imaging. On the other hand, patient care papers discussed 3DP use in wound care, personalized splints, and patient monitoring. Clinical equipment modification papers reported the use of 3DP to modify stethoscopes and laryngoscopes to improve their performance. Notably, we found that only 13 of the 31 papers were directly produced or studied by critical care physicians. Conclusion The papers discussed provide examples of the possible utilities of 3DP in critical care. The relative scarcity of papers produced by critical care physicians may indicate barriers to 3DP implementation. However, technological advances such as point-of-care 3DP tools and the increased demand for 3DP during the recent COVID-19 pandemic may change 3DP implementation across the critical care field.

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Section: Resultsmentioning

confidence: 99%

3D printing in critical care: a narrative review

et al. 2020

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“…Several studies established that lactate cut-off value between 4 and 4.25 mmol/L had a significantly higher prognostic value in predicting mortality/deterioration/complications than a value <4 mmol/L, which is lower than the optimal cut-off values in our study. 5,8,15,19,22,23…”

Section: Discussionmentioning

confidence: 99%

“…There is a direct relationship between increased lactate and mortality and morbidity 2–6 . Also, increased lactate may be a silent marker of hypoperfusion such as hypotension 7 , 8 …”

Section: Introductionmentioning

confidence: 99%

Arterial lactate as a prognostic tool to predict mortality and disposition in the emergency department: A prospective observational single-centre study

Wilson

Selvaraj

Kumar

et al. 2020

Hong Kong Journal of Emergency Medicine

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Background: Point-of-care tools are invaluable in the emergency department. Arterial lactate has been used for prognostication in subsets of population in the emergency department but not often for a heterogeneous population. Objectives: We aimed to study the use of arterial lactate as a prognostication and disposition tool in an undifferentiated population presenting to the emergency department. Methods: We conducted a prospective study among all consenting emergency department patients with age >18 years, who had an arterial blood gas performed as a part of routine care and had a lactate value ⩾2 mmol/L. We collected data on demographics, comorbidities and patient disposition from the emergency department and 28-day mortality as a follow-up telephonically. Results: We included 469 patients with a median age of 37 years. Sixteen provisional diagnoses were made in the emergency department, and pneumonia/lower respiratory tract infection was relatively higher (13.6%). The median lactate was 4.6 (interquartile range = 3.2–7) with 155 patients (33%) being transferred to intensive care unit and 62 deaths (13.2%) recorded at 28 days. Furthermore, we observed optimum values for lactates at 5 mmol/L predicted intensive care unit admissions and 6 mmol/L predicted mortality. A unit increase in arterial lactate in the emergency department significantly increased mortality by 66% (95% confidence interval = 1.45–1.88; p < 0.001) and had a 2.15 times (95% confidence interval = 1.63–2.83; p < 0.001) significantly higher chance of being transferred to the intensive care unit. Conclusion: Arterial lactate can be used as a prognostication tool for a heterogeneous population presenting to the emergency department. Clinical significance: Point-of-care investigations such as arterial lactate can help the emergency physician make quick decisions on the floor and guide prognostication and disposition.

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“…Other signs of systemic hypoperfusion would be expected to be seen, such as ischemic hepatitis, due to profound hypotension [14]. The serum lactate level would also be predicted to be significantly elevated in such patients [15].…”

Section: Discussionmentioning

confidence: 99%