Goal-Directed Therapy in Small Animal Critical Illness

Butler, Amy L.

doi:10.1016/j.cvsm.2011.05.002

Cited by 32 publications

(27 citation statements)

References 123 publications

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“…Hyperlactatemia results from either an imbalance between tissue oxygen supply and demand (type A) or altered cellular metabolism (type B). In patients with sepsis, hyperlactatemia may occur due to hypoperfusion, mitochondrial dysfunction, increased leukocyte activity, organ dysfunction, decreased lactate clearance, Na + ‐K + ATPase activation, hypoglycemia, or dysregulation of pyruvate dehydrogenase . Recent veterinary studies have found neoplasia to be a cause of increased lactate but typically this is not clinically significant and was unlikely to be a significant confounder in our study as a neoplastic process was only identified in 6 (7%) of the enrolled patients .…”

Section: Discussionmentioning

confidence: 80%

Plasma lactate concentrations in septic peritonitis: A retrospective study of 83 dogs (2007–2012)

Cortellini

Seth

Kellett‐Gregory

2014

J Vet Emergen Crit Care

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Objective -To determine if absolute plasma lactate concentration or lactate clearance in dogs with septic peritonitis is associated with morbidity or mortality. Design -Retrospective cohort study from 2007 to 2012. Setting -University teaching hospital. Animals -Eighty-three dogs with septic peritonitis were included. Patients had at least 1 plasma lactate measurement during the course of the hospitalization. Results -Sixty-four percent of the patients survived to discharge, 22% were euthanized, and 14% died during hospitalization. Plasma lactate concentration >2.5 mmol/L on admission (29% of the patients) was associated with mortality (P = 0.001). Median admission plasma lactate concentration (n = 81) was significantly different between nonsurvivors (2.5 mmol/L, range 0.5-8.4) and survivors (1.4 mmol/L, range 0.5-9.7; P = 0.007). Admission plasma lactate concentration >4 mmol/L yielded a sensitivity of 36% and a specificity of 92% for nonsurvival. The inability to normalize plasma lactate concentration within 6 hours of admission (n = 10/24) yielded a sensitivity of 76% and specificity of 100% for nonsurvival. Postoperative hyperlactatemia (plasma lactate concentration >2 mmol/L; n = 18/76) had a sensitivity of 46% and specificity of 88% for nonsurvival. Persistent postoperative hyperlactatemia (n = 11/18) had a sensitivity of 92% and a specificity of 100% for nonsurvival. Lactate clearance less than 21% at 6 hours (n = 20) had a sensitivity of 54% and specificity of 91% for nonsurvival. Lactate clearance less than 42% at 12 hours (n = 18) had a sensitivity of 82% and a specificity of 100% for nonsurvival. Conclusions -Admission plasma lactate concentration and lactate clearance were good prognostic indicators in dogs with septic peritonitis. Crit Care 2015; 25(3): 388-395) (J Vet Emerg

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Section: Discussionmentioning

confidence: 80%

Plasma lactate concentrations in septic peritonitis: A retrospective study of 83 dogs (2007–2012)

Cortellini

Seth

Kellett‐Gregory

2014

J Vet Emergen Crit Care

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“…Blood samples were obtained at study admission and then daily at the same time for each day of hospitalization. Clinical criteria recorded at the time of blood sampling included vital signs (rectal temperature, pulse rate, and respiratory rate), clinical severity score (0‐12), pain score (0‐10), hydration status and the presence of SIRS (yes/no) based on established criteria . A CBC (Advia 120 Hematology System, Siemens Healthcare Diagnostics Inc, Newark, Delaware), venous blood gases and electrolyte concentrations (pH, anion gap, base excess, and L‐lactate, bicarbonate, sodium, chloride, potassium, and glucose concentrations; ABL 800 Flex Blood Gas Analyzer, Radiometer, Bronshoj, Denmark), PCV/TS, and serum D‐lactate concentration were determined on each sample.…”

Section: Methodsmentioning

confidence: 99%

“…A baseline clinical severity score using a previous composite scoring system, 21 hydration status (% dehydration), and baseline pain score also were assigned to each patient (Data S1-S2) by the authors. [20][21][22] All dogs were hospitalized and supportive treatment for their disease was determined based on their assignment within a larger randomized, prospective study comparing an inpatient versus outpatient CPV treatment protocol. 19 Both protocol groups had IV catheters placed and received goal-directed fluid resuscitation at admission using an isotonic crystalloid (Normosol-R, Abbott Laboratories, North Chicago, Illinois), with dextrose (Hospira Inc, Lake Forest, Illinois) supplementation as indicated by the initial venous blood gas and electrolyte results.…”

Section: Methodsmentioning

confidence: 99%

Serum D‐lactate concentrations in dogs with parvoviral enteritis

Venn

Barnes

Hansen

et al. 2020

Veterinary Internal Medicne

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Background Dogs infected with canine parvovirus (CPV) have compromised intestinal epithelial barrier integrity. Production of D‐lactate by enteric bacteria may directly reflect disease severity or contribute to metabolic acid‐base status in these dogs. Hypothesis Serum D‐lactate concentration will be increased in CPV dogs compared to healthy controls and correlate with markers of disease severity and acid‐base status. Animals Dogs with CPV undergoing treatment (n = 40) and healthy control dogs (n = 9). Methods Prospective observational study. Dogs with CPV had a baseline and daily CBC, venous blood gas with serum electrolyte concentrations, composite clinical severity score, and serum D‐lactate concentration performed. A single serum D‐lactate measurement was obtained from healthy control dogs. Results The CPV dogs had a higher D‐lactate concentration (mean ± SD) of 469 ± 173 μM compared to controls, 306 ± 45 μM (P < .001). There was no difference in baseline D‐lactate concentrations for CPV survivors (474 ± 28 μM), versus nonsurvivors (424 ± 116 μM; P = .70). D‐lactate concentration decreased over the first 4 days of treatment (−9.6 μM/d; P = .46). Dogs hospitalized for <4 days had lower baseline D‐lactate concentrations compared to those hospitalized ≥4 days (400 ± 178 μM versus 520 ± 152 μM; P = .03). No sustained correlation over time between serum D‐lactate concentration and clinical severity score or recorded acid‐base results. Conclusions and Clinical Importance Serum D‐lactate concentrations are higher in dogs with CPV compared to healthy controls but do not appear to be clinically relevant. No relationship identified between serum D‐lactate concentrations and markers of CPV disease severity, acid‐base status, or outcome.

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“…Normalization of arterial blood pressure is another clinical parameter that is often used to guide shock fluid therapy. 6 A recent veterinary study evaluating canine patients with septic shock also emphasized the importance of goal-directed hemodynamic optimization in improving outcomes. More recently, evaluation of the microcirculation has been considered as a potential endpoint for resuscitation in humans, particularly in septic patients.…”

Section: Resuscitation Endpoints and Monitoringmentioning

confidence: 99%