Etiology and Therapeutic Approach to Elevated Lactate Levels

Andersen, Lars W.; Mackenhauer, Julie; Roberts, Jonathan C.; Berg, Katherine M.; Cocchi, Michael N.; Donnino, Michael W.

doi:10.1016/j.mayocp.2013.06.012

Cited by 572 publications

(504 citation statements)

References 136 publications

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“…Results compared with the Catherina Hospital study [8] were similar and prove rather the need of a direct-admission PACU.…”

Section: Resultsmentioning

confidence: 54%

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The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients

2017

JACCOA

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Background: Cardiac Surgery dept. is a new unit of Joint Corps Armed Forces since March 2013. In order to support the project of organization and opening of a direct admission CS-ICU supported by minimum but well trained staff nurses we developed a fast-track concept. Methods:After an 8 months observation period, cooperation with the other parts of the dept. and the local medical ethics committee approval, we put in application the use of Leipzig fast-track protocol. It is about well-prepared but not selected patients. It regards their perioperative period until they discharge hospital. The database contains these 3 perioperative periods as multifactorial indicators.Results: Readmission is associated with patient outcomes. ASA, NYHA, perfusion XCL time and temperature at admission are predictors [1] of early extubation, short duration of ICU care, hospitalization and readmission. It also proves a high quality level of CS-ICU organization, based on the use of protocols as ORCHESTRA study [2] suggest, ready to respond challenges. Conclusion:In well preoperative prepared patients, we found that the Leipzig fasttrack protocol [3] is safe for cardiac surgery patients and an efficient method to combat the problem of decreasing numbers of ICU beds, working nurses and to save costs as a result of shortened length of stay [4].

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“…Results compared with the Catherina Hospital study [8] were similar and prove rather the need of a direct-admission PACU.…”

Section: Resultsmentioning

confidence: 54%

“…We have to remind that is elevated in situations like cardiogenic or hypovolemic shock, post cardiac arrest, tissue ischemia and excessive work of breathing [8]. Lactate < 2 mmol/L is the target.…”

Section: Discussionmentioning

confidence: 99%

The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients

2017

JACCOA

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“…These results may be explained by various etiologies of cardiac arrest or comorbidities known to be associated with high lactate levels, such as hepatic failure or thiamine deficiency, and which were not evaluated. Also lactate levels are influenced by the duration of the cardiac arrest [20]. We were not able to accurately collect data on the duration of cardiac arrest and the only variable available was the time to ALS, which was similar in survivors and non-survivors.…”

Section: Discussionmentioning

confidence: 96%

Investigation of biomarker variations post-return of spontaneous circulation following an out-of-hospital cardiac arrest

Golea

Rusu

Dumulesc

et al. 2017

Revista Romana De Medicina De Laborator

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“…Third, the values measured are more likely to be abnormal (and therefore more likely to be measured by treating clinicians) in the more severely ill and, as a result, the cohort may have a disproportionate number of patients with more extreme critical illness, such as severe sepsis. Finally, the INR [11], total bilirubin concentration [12] and lactate [13] levels are not specific to liver injury and are often elevated by a range of process which have little or no direct or specific impact on the liver. In critical illness these parameters reflect general organ dysfunction and illness severity markers rather than liver-specific measures [14].…”

Section: Editorialmentioning

confidence: 99%

Is LiFe worth living? It all depends on the liver

Warrillow

Herrera-Gutiérrez

2016

Intensive Care Med

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Regardless of the initial cause, critical illness almost invariably involves serious derangement of function across multiple organs and body systems. While much attention has rightly been directed towards the development of predictive models which seek to measure illness severity and forecast outcome in severe multiple organ failure [1], severe respiratory failure [2] and renal injury [3], less work has been undertaken to elucidate the specific impact of acute hepatic dysfunction in the context of chronic liver disease-despite recognition that liver injury in critically ill patients is associated with poor outcome [4]. The complex care needs and high mortality of patients with severe acute liver failure is well-described [5], and approaches for predicting outcomes for patients with chronic liver disease [6], decompensated cirrhosis [7] and cirrhotic patients in the intensive care unit (ICU) [8] are established. Regardless of these advances, however, the importance of evolving hepatic dysfunction as part of an overall non-liver specific critical illness may still be underappreciated [9], even in patients with known chronic liver problems. In their work to develop a laboratory-based liver injury failure evaluation (LiFe) score, Edmark et al. [10] outline an interesting approach to the development, validation and potential application of a simple tool that may assist intensivists in the evaluation and management of patients with known chronic liver disease admitted to the ICU.In developing the LiFe score, Edmark and colleagues first conducted an online survey of European Society of Intensive Care Medicine members and received over 150 responses, mainly from European clinicians. Over onethird of respondents indicated that they worked in academic centers with specific hepatobiliary expertise. From the survey results, the three most highly ranked markers of liver injury were identified: the international normalised ratio (INR), total bilirubin and arterial lactate-considered to be representative of liver synthetic capacity, excretory function and metabolic properties, respectively. A research registry holding records from two large academic medical centres in Boston was then accessed to obtain de-identified records of patients admitted to the ICU during an 18-year period ending in 2007. Over 90,000 records were evaluated, of which more than 85,000 were excluded from the analysis because the patients did not have chronic liver disease and more than 6000 were excluded because laboratory test results for the three aforementioned parameters were not available. The Boston-based derivation cohort was therefore ultimately based on 945 patients. Records from a major liver transplant centre in London were then accessed to obtain the validation cohort of 971 patients. A clinical prediction tool was then created using a logistic regression model describing the risk of 30-day mortality as a function of lactate, INR and total bilirubin data collected from the derivation cohort at admission to ICU. Further statistical refinement an...

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Etiology and Therapeutic Approach to Elevated Lactate Levels

Cited by 572 publications

References 136 publications

The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients

The Use of a Fast-Track Protocol for Perioperative Management of Cardiac Surgery Patients

Investigation of biomarker variations post-return of spontaneous circulation following an out-of-hospital cardiac arrest

Is LiFe worth living? It all depends on the liver

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