Hypoxia Is Not the Sole Cause of Lactate Production during Shock

Luchette, Fred A.; Jenkins, W. Timothy; Friend, Lou Ann; Su, Chunhua; Fischer, Josef E.; James, J. Howard

doi:10.1097/00005373-200203000-00001

Cited by 68 publications

(48 citation statements)

References 20 publications

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“…28 day mortality was 143 (59.6 %). It shows that in every two pa ent diagnosed as severe sepsis and sep c shock one will die, similar results 24 were found by study done by Chris an brun et al The single lactate value as a predic on of mortality in severe sepsis and sep c shock is controversial as it may increase in non pathological condi on for instance as a result of a high adrenaline level or alcohol intake and several studies were [25][26][27][28] not able to show lactate as predic ve value of mortality. APACHE II scoring system were used widely to assess out come in severe sepsis and sep c shock but this is me consuming, expensive and lengthy process having mul ple variables to calculate, so it is very imprac cal to use APACHE II scoring system in busy emergency room.…”

Section: Discussionsupporting

confidence: 62%

Serum Lactate Albumin Ratio as a Predictor of Mortality in Severe Sepsis and Septic Shock at Tribhuwan University Teaching Hospital, Kathmandu

Thapa

Prasad

Shakya

2017

Birat J. Health Sci.

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IntroductionSevere sepsis and septic shock, is a common cause of emergency room admission and is associated with high morbidity and mortality worldwide. This study inspects the prediction of mortality in severe sepsis and septic shock with increased lactate/albumin ratio.Objective The objective of the study was to predict the serum lactate albumin ratio as an indicator of mortality in severe sepsis and septic shock.MethodologyIt was a hospital based cross sectional study done at Tribhuvan University Teaching Hospital, Kathmandu from November 2015 to October 2016. The consent was taken from patients. Acute Physiology and Chronic Health Evaluation II score, serum lactate and serum albumin levels on first day of arrival in emergency room were calculated. Patients were classified as severe sepsis and septic shock and treated according to Surviving Sepsis Campaign 2012 guideline. The patient were follow up at 28 day, The associations of 28-day outcome with Acute Physiology and Chronic Health Evaluation II score, serum lactate value, serum albumin value and serum lactate albumin ratio value were derived.ResultsOut of total 240 severe sepsis and septic shock patients it is found that increased serum lactate/albumin ratio was an independent predictor of the mortality with cut off value of 0.07. Furthermore serum lactate albumin ratio shows strong correlation with APACHE 2 score in predicting mortality in severe sepsis and septic shock.ConclusionIncreased lactate/albumin ratio predicts mortality in patients with severe sepsis and septic shock. Birat Journal of Health Sciences Vol.2/No.1/Issue 2/ Jan - April 2017, Page: 191-195

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Section: Discussionsupporting

confidence: 62%

Serum Lactate Albumin Ratio as a Predictor of Mortality in Severe Sepsis and Septic Shock at Tribhuwan University Teaching Hospital, Kathmandu

Thapa

Prasad

Shakya

2017

Birat J. Health Sci.

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“…Lactate traditionally "lags" due to its dependence on hepatic clearance, making it less of an accurate, dynamic marker of status. Also, it has been well-documented that epinephrine, produced abundantly during physiologic stress, stimulates lactate production by well-oxygenated skeletal muscle [Luchette 1999] [Luchette 2002. Due to these limitations, an elevated lactate level may not translate to a DO 2 deficiency.…”

Section: Discussionmentioning

confidence: 99%

Use of Near-Infrared Spectroscopy in Early Determination of Irreversible Hemorrhagic Shock

Taylor

Mulier

Myers

et al. 2005

The Journal of Trauma: Injury, Infection, and Critical Care

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“…31,32 The production is stimulated by adrenaline and lactate, in this case rather fuel than waste product, acts as an energy shuttle from skeletal muscles to vital organs, such as the heart and brain. 33,34 In addition, lactate elevations may result not only from increased production but also from decreased elimination as in acute liver dysfunction.…”

Section: Lactatementioning

confidence: 99%

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

Hauffe¹,

Krüger²,

Béttex³

et al. 2015

Cardiac Failure Review

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Shock in cardio-surgical intensive care unit (ICU) patients is a serious condition with a high morbidity and mortality.1,2 Prompt identification of the underlying conditions and correct management of the lifethreatening physiological deteriorations are crucial to save the patient's life. In daily practice, however, focusing on the main goal -to provide adequate oxygen delivery thereby preventing further organ damage -is often difficult due to multiple influences, distractions, and pending results. Hence, the setting up of priorities is necessary.In addition, many questions arise on how to optimally treat patients in shock: What blood pressure should we target? What fluid should we use and how much? Which vasoactive drug is best and which inotrope? While discussions about these issues can be very fruitful for experts, they risk confusing younger colleagues and nurses at the bedside. Disputes about controversial therapy opinions might consequently delay adequate resuscitation, putting the patient at risk of an adverse outcome. This review aims to give recommendations for the management during the early phase of shock of cardio-surgical patients hospitalised in the ICU. The focus is on the first 6 hours, which are also called 'the golden hours'. Methods Clinical SettingThe cardio-surgical ICU at the University Hospital Zurich is a 12-bed, high-intensity unit that cares for more than 1,100 patients every year.The majority of these critically ill patients undergo cardiac and/or major vascular surgery, most of them being mechanically ventilated and on inotrope/vasopressor support. The unit is part of a successful heart failure programme that includes extracorporeal life support, ventricular assist devices and a heart transplantation service. In order to optimise the initial resuscitation of patients and to avoid adverse effects of inadequate treatment, the consultants of the unit have agreed on treatment recommendations, which are presented here.They are based on current evidence and complemented by clinical experience in areas of uncertainty. Data ExtractionFor this narrative review, a search of the PubMed database and a review of bibliographies from selected articles were performed to identify original data relating to this topic. Key words used for the search were 'shock', 'cardiac surgery', 'critical care', 'inotropes', 'inotropic therapy', 'circulatory support', 'cardiogenic shock' and 'sepsis'. National and international guidelines were reviewed and integrated, e.g. The 2015 ESC guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation, 3 The 2014 ESC/ EACTS guidelines on myocardial revascularization 4 and The Surviving Sepsis Campaign guidelines 5 . Articles were scrutinised regarding their study design, population evaluated, interventions, outcomes, and limitations. Finally, personal recommendations were included and highlighted as such to give a comprehensive overview on this topic. Rationale for an Early Management of ShockShock in patients under...

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Hypoxia Is Not the Sole Cause of Lactate Production during Shock

Abstract: Increased Na+-K+ATPase activity during epinephrine treatment or hemorrhage contributes to muscle lactate production. Hypoxia is not necessarily the sole cause of hyperlactatemia during and after hemorrhagic shock.

Cited by 68 publications

References 20 publications

Serum Lactate Albumin Ratio as a Predictor of Mortality in Severe Sepsis and Septic Shock at Tribhuwan University Teaching Hospital, Kathmandu

Serum Lactate Albumin Ratio as a Predictor of Mortality in Severe Sepsis and Septic Shock at Tribhuwan University Teaching Hospital, Kathmandu

Use of Near-Infrared Spectroscopy in Early Determination of Irreversible Hemorrhagic Shock

Shock Management For Cardio-Surgical ICU Patients — The Golden Hours

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