Implications of Centers for Medicare & Medicaid Services Severe Sepsis and Septic Shock Early Management Bundle and Initial Lactate Measurement on the Management of Sepsis

Abstract

Delays in lactate measurement are associated with delayed antibiotics and increased mortality in patients with initial intermediate or elevated lactate levels. Systematic early lactate measurement for all patients with sepsis will lead to a significant increase in lactate draws that may prompt more rapid physician intervention for patients with abnormal initial values.

Time to Lactate Measurement Affects Efficacy of Initial Lactate on Mortality in critically ill patients with sepsis.

“…Lactate measurement, which is an important component of a sepsis bundle, has increased dramatically since 2003 and is performed on patients without overt shock [10]. Current evidence indicates the necessity of early lactate measurement in patients with initial intermediate or elevated lactate levels [21][22][23]8,24]. This provided the basis for the proposal of the 1-hour bundle.…”

“…Lactate measurement is an important component of the early management of sepsis, and its optimal execution time is the focus of the current study. Current evidence indicates that delays in the detection time of lactate will lead to an increase in poor prognosis, including death [8][9][10][11]. However, whether the delay of lactate measurement will affect the e cacy of initial lactate on mortality has always been neglected.…”

Electromagnetic Navigation-Guided One-Stage Dual Localization of Small Pulmonary Nodules

“…The study concluded that hook-wire localization had lower successful operative field targeting rates, lipiodol localization had the highest overall success rates, and microcoil localization had the lowest complication rates. 1 From a surgeon's perspective, there are other concerns when determining the optimal method of localization, in addition to success rates and complication rates. The location of the pulmonary nodule and the workflow are also important issues.…”

“…We agree with Drs Bakker and Hernandez that our work does not prove a causal relationship between delayed lactate measurements and increased mortality in patients with initially elevated lactate measurements, but rather an association. 1 The fact that this association is no longer significant when adjusted for time to antibiotic and intravenous fluid administration suggests that earlier interventions likely mediate this association. Even after adjusting for severity of illness, we found that abnormal lactate values were correlated with more rapid interventions by clinicians.…”

Response

“…The study concluded that hook-wire localization had lower successful operative field targeting rates, lipiodol localization had the highest overall success rates, and microcoil localization had the lowest complication rates. 1 From a…”