Early Lactate Dynamics in Critically Ill Non-Traumatic Patients in a Resuscitation Room of a German Emergency Department (OBSERvE-Lactate-Study)

Kramer, Andre; Urban, Norman; Döll, Stephanie; Hartwig, Thomas; Yahiaoui-Doktor, Maryam; Burkhardt, Ralph; Petros, Sirak; Gries, A.; Bernhard, Michaël

doi:10.1016/j.jemermed.2018.10.033

Cited by 16 publications

(23 citation statements)

References 42 publications

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“…Therefore these parameters are useful in risk strati cation within the group of already detected critically ill patients. The clinical value of point of care lactate measurement is also shown by Kramer et al, but after exclusion of patients receiving cardiopulmonary resuscitation at ED arrival, initial lactate did not differ between survivors and nonsurvivors [26].…”

Section: Discussionmentioning

confidence: 57%

Short-term outcome and characteristics of critical care for nontrauma patients in the emergency department

et al. 2021

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Background: Emergency medical care for critically ill patients varies between different emergency departments (ED) and health care systems, while resuscitation of trauma patients is always performed within the ED. In many ED critically ill patients are treated and stabilized while in many German ED they are transferred to intensive care units (ICU) without performing of critical care measures in the ED.Against this background we conducted this retrospective analysis of prospectively collected critically ill patients treated with an ED critical care concept in a 754-bed teaching hospital. Methods: The collective of prospectively collected critically ill patients (October 1st 2018 to March 31st 2019) was analysed after ethical approval. Patient characteristics, performed critical care measures, short-term outcomes and the comparison of admission characteristics between survivors and nonsurvivors were evaluated. Additionally the accordance of ED diagnoses and discharge diagnoses were analysed. Results: Overall 243/19,854 patients (1.22%) were treated within the resuscitation room. After exclusion of trauma patients, 193 critically ill patients were included. Overall mortality was 29% (n=56), 24-hour mortality was 13% (n=25). Patient characteristics (vital signs, blood gas analysis) differed signi cantly between survivors and non-survivors except for respiratory rate and pain scale. Conducted critical care measures (number ± standard deviation; e.g. endotracheal intubation, arterial-line): 4.06±1.73 (survivors) and 4.70±2.0 (non-survivors) p=0.0453. The length of ED stay was 148.2±202.7 min. Admission diagnoses matched with hospital discharge diagnoses in 73.7%.Conclusions: Critical care stabilisation of non-trauma patients was feasible in routine care. The observed mortality was high and non-survivors showed signi cantly more impaired vital parameters and blood gas analysis parameters. Vital parameters together with blood gas analysis enable ED risk strati cation of CIP. Although a rst diagnostic workup was performed within the ED, admission and discharge diagnoses matched only in 73.7%. However, stabilisation and diagnostic workup of CIP enables optimal allocation to specialized ICUs. Future (randomised) trials have to evaluate of resuscitation room stabilisation for nontrauma patients is bene cial in contrast to direct ICU admission.Trial registration: The study was registered retrospectively in the Clinical Trials Centre of the RWTH Aachen University (Germany), registration number CTC-A 20-131.

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Section: Discussionmentioning

confidence: 57%

Short-term outcome and characteristics of critical care for nontrauma patients in the emergency department

et al. 2021

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“…Due to the empirical nature of the presented investigation, we did not evaluate the lactate clearance and its effect on outcome. However, lactate clearance may be associated with improved outcome in heterogeneous ICU and ED patients [ 8 , 17 , 18 ].…”

Section: Discussionmentioning

confidence: 99%

“…The goal being to manage the sepsis as quick as possible. Further data from critically ill ED patients who were admitted to the resuscitation room showed that lactate dynamics and time weighted average lactate may predict survival beyond 30 days [8]. Additionally, blood lactate measurements are used to detect patients in critical conditions: e.g.…”

Section: Introductionmentioning

confidence: 99%

Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients

Bernhard

Döll

Kramer

et al. 2020

Scand J Trauma Resusc Emerg Med

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Background Elevated blood lactate levels were reported as useful predictors of clinical outcome and mortality in critically ill patients. To identify higher-risk patients, this investigation evaluated the relationship between patient mortality and admission lactate levels during the management of non-trauma critically ill patients in the emergency department (ED). Methods In this prospective, single centre observational study in a German university ED, all adult patients who were admitted to the ED resuscitation room were evaluated between September 1, 2014 and August 31, 2015. Blood samples for blood gas analysis, including lactate levels, were obtained immediately at admission. Study endpoint was 30-day mortality. Results During the study period, 532 patients were admitted to the resuscitation room of the ED. The data of 523 patients (98.3%) were available. The overall 30-day mortality was 34.2%. Patients presenting to the resuscitation room with admission lactate levels < 2.0 mmol/l had a 30-day mortality of 22.7%, while admission lactate levels above 8.0 mmol/l were associated with higher mortality (8.0–9.9 mmol/l: OR: 2.83, 95%CI: 1.13–7.11, p = 0.03, and ≥ 10 mmol/l: OR: 7.56, 95%CI: 4.18–13.77, p < 0.001). Conclusion High lactate levels at admission are associated with an increased 24-h and 30-day mortality. These measurements may be used not only to predict mortality, but to help identify patients at risk for becoming critically ill. The breakpoint for mortality may be an ALL ≥8.0 mmol/l.

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“…Labordiagnostik und Blutgasanalyse: Zur Abklärungsprozedur gehört die Blutabnahme (s. Abschnitt "Pointof-Care-Testing und Labordiagnostik") inklusive einer (venösen) Blutgasanalyse (BGA). Die BGA ermöglicht, den Hämoglobinwert und das Serumlaktat als Surrogatparameter schwerer Akuterkrankungen [12,13] unmittelbar zu kennen. Bei Frauen im gebärfähigen Alter sollte initial eine β-hCG-Bestimmung (hCG: humanes Choriongonadotropin) erfolgen.…”

Section: Basisdiagnostik In Der Notfallmedizinunclassified

Vom Leitsymptom zur Diagnose: abdominelle Beschwerden

Michael¹,

Kleophas²,

Keitel³

et al. 2021

Anästhesiol Intensivmed Notfallmed Schmerzther

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ZusammenfassungAbdominelle Beschwerden sind ein häufiges Leitsymptom in der Notfallmedizin. Unter diesem Symptomkomplex sind eine Vielzahl verschiedener Krankheitsbilder zu fassen, die sich in intra- und extraabdominelle bzw. retroperitoneale Pathologien unterscheiden lassen und Patienten aller Altersklassen betreffen können. Ursächlich für abdominelle Beschwerden können dabei banale Erkrankungen bis hin zu vital bedrohlichen Notfällen sein. Das Akute Abdomen ist ein interdisziplinärer Notfall, bei dem eine interdisziplinäre Teamarbeit notwendig ist. Eine rasche Ersteinschätzung und Risikostratifizierung hat zum Ziel, kritisch kranke Patienten mit akutem Interventionsbedarf frühzeitig zu detektieren und einer geeigneten Therapie zuzuführen. Ein strukturiertes Vorgehen ist hierbei zum Ausschluss bzw. zur Bestätigung der wichtigsten Differenzialdiagnosen essenziell.

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Early Lactate Dynamics in Critically Ill Non-Traumatic Patients in a Resuscitation Room of a German Emergency Department (OBSERvE-Lactate-Study)

Cited by 16 publications

References 42 publications

Short-term outcome and characteristics of critical care for nontrauma patients in the emergency department

Short-term outcome and characteristics of critical care for nontrauma patients in the emergency department

Elevated admission lactate levels in the emergency department are associated with increased 30-day mortality in non-trauma critically ill patients

Vom Leitsymptom zur Diagnose: abdominelle Beschwerden

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