ED bedside point-of-care lactate in patients with suspected sepsis is associated with reduced time to iv fluids and mortality

Singer, Adam J.; Taylor, Maria; LeBlanc, Debra; Williams, Justin; Thode, Henry C.

doi:10.1016/j.ajem.2014.06.027

Cited by 35 publications

(45 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The POCT was reported to be helpful in 56% of patients, changed the triage level in 15% of patients, and led to 6% of patients being brought back for rapid physician evaluation. A recent study by Singer et al found that introduction of bedside lactate POCT in ED patients with suspected sepsis was associated with significant reductions in time to IV fluid administration and rates of ICU admissions [11]. It is also possible that POCT may have other important benefits that may not be related to LOS.…”

Section: Discussionmentioning

confidence: 96%

“…Often, a major barrier to early diagnosis is the delay associated with central laboratory testing. Although the time required to analyze blood samples once they reach the central laboratory has improved dramatically and may be short, preanalytical and postanalytical delays, which are outside the control of the central laboratory, may be considerable [2][3][4][5][6][7][8][9][10][11]. The time from ordering and obtaining a blood sample until the practitioner is aware of the test results and can act upon them is often referred to as the "vein-to-brain" time.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Comprehensive bedside point of care testing in critical ED patients: a before and after study

Singer¹,

Williams²,

Taylor³

et al. 2015

The American Journal of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Comprehensive bedside point of care testing in critical ED patients: a before and after study

Singer¹,

Williams²,

Taylor³

et al. 2015

The American Journal of Emergency Medicine

Self Cite

View full text Add to dashboard Cite

“…There have been a plethora of publications over the past two decades documenting the prognostic utility of lactate [6, 7, 23–25], its use as a therapeutic target for resuscitation [8, 9], its ability to alter provider behavior [26], and the potential for rapid testing to improve patient outcomes [10]. Studies demonstrating the use of lactate as a severity marker in hemodynamically stable patients with suspected infection [7, 25] could also explain why clinicians are increasingly extending the test to patients who are not on vasopressors.…”

Section: Discussionmentioning

confidence: 99%

“…Measuring lactate levels have been shown to risk stratify patients with suspected sepsis, to prompt aggressive early treatment, and to help monitor the impact of therapy [4–9]. Implementation of bedside lactate measurement in the emergency department has also been associated with reduced time to administration of intravenous fluids in patients with suspected sepsis and decreased rates of ICU admission and mortality [10]. …”

Section: Introductionmentioning

confidence: 99%

Lactate Testing in Suspected Sepsis

Rhee

Murphy

Platt

2015

Critical Care Medicine

View full text Add to dashboard Cite

Objectives Serum lactate monitoring is central to risk stratification and management of sepsis and is now part of a potential quality measure. We examined 11-year trends in lactate testing and predictors of failure to measure lactates in patients with severe sepsis. Design Retrospective cohort study. Setting Two U.S. academic hospitals. Patients Adult patients admitted from 2003–2013. Interventions Annual rates of lactate measurement were assessed in patients who had blood cultures ordered and patients with severe sepsis, as defined by concomitant ICD-9 codes for infection and organ dysfunction. The approximate time of suspected sepsis was determined by the first blood culture order with concurrent antibiotic initiation. Multivariate analysis was performed to identify predictors of failure to measure lactates in severe sepsis cases in 2013. Measurements and Results Among hospitalizations with blood culture orders, rates of lactate measurement increased from 11% in 2003 to 48% in 2013 (p<0.001 for linear trend). Rates of repeat lactate measurement within 6 hours after lactate levels ≥ 4.0 mmol/L increased from 23% to 69% (p<0.001). Patients were progressively less likely to be on vasopressors at the time of first lactate measurement (49% in 2003 vs 21% in 2013, p<0.001). Despite these trends, lactates were measured at the time of suspected sepsis in only 65% of patients with severe sepsis in 2013. On multivariate analysis, hospital-onset of sepsis and hospitalization on a nonmedical service were significant predictors of failure to measure lactates (adjusted ORs 7.56, 95% CI 6.31–9.06 and 2.08, 95% CI 1.76–2.24, respectively). Conclusions Lactate testing has increased dramatically over time and is being extended to patients without overt shock. However, rates of serial lactate testing are still suboptimal and lactates are not being measured in many patients with severe sepsis. Hospital-onset sepsis and nonmedical units may be high-yield targets for quality improvement initiatives.

show abstract

“…This Vol 8, No 3, 2017 study is in concordance with previously available data/ studies that handheld POC lactate devices may serve as an effective alternative method of evaluation of blood lactate levels. [10,[20][21][22][23][24] A study conducted by Singer et al [24] showed that not only was there a reduction in time to administration of intravenous fl uids and antibiotics with a handheld/bedside POC device for lactate measurement, but there was also a reduction in the overall admissions to intensive care units and mortality.…”

Section: Discussionmentioning

confidence: 99%

Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country

Baig¹,

Shahzad²,

Hussain³

et al. 2017

World Journal of Emergency Medicine

View full text Add to dashboard Cite

BACKGROUND: Timely identifi cation of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care (POC) testing is being increasingly utilized in the emergency department (ED). We examined the accuracy and timesaving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients. METHODS:A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fi ngertip POC lactate measurement with a portable device and simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation (ICC) and Bland and Altman plots.

show abstract

ED bedside point-of-care lactate in patients with suspected sepsis is associated with reduced time to iv fluids and mortality

Cited by 35 publications

References 14 publications

Comprehensive bedside point of care testing in critical ED patients: a before and after study

Comprehensive bedside point of care testing in critical ED patients: a before and after study

Lactate Testing in Suspected Sepsis

Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country

Contact Info

Product

Resources

About