Liegt der Sepsis und dem septischen Schock ein globaler Sauerstoffmangel zugrunde? Eine Übersicht in zwei Teilen - Teil 2: Sepsis und Laktat

Ensinger, H.; Georgieff, Michael

doi:10.1055/s-2007-995903

Cited by 3 publications

(3 citation statements)

References 17 publications

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“…Norepinephrine acts predominantly on α -adrenoceptors to induce peripheral vasoconstriction, and has almost no effect on β -adrenoceptors. In addition, the metabolic effects of epinephrine are much stronger than those of norepinephrine 9 . According to the catecholamine effect, several mechanisms are adopted to explain the increase in blood lactate concentrations.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma

Chen

Shen

et al. 2017

Sci Rep

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Severe hyperlactatemia (SH)/lactic acidosis (LA) after laparoscopic resection of pheochromocytoma is an infrequently reported complication. The study aims to investigate the incidence of this complication and to determine the clinical risk factors. Patients who underwent laparoscopic resection for pheochromocytoma between 2011 and 2014 at Peking Union Medical College Hospital were enrolled. LA was defined as pH < 7.35, bicarbonate <20 mmol/L, and serum lactate ≥5 mmol/L; SH as lactate ≥5 mmol/L; and moderate hyperlactatemia (MH) as lactate 2.5–5.0 mmol/L without evidence of acidosis (pH > 7.35 and/or bicarbonate >20 mmol/L). Data concerning patient demographics, clinical history, and laboratory results were collected and statistical analyses were performed. Out of 145 patients, 59 (40.7%) developed post-operative hyperlactatemia. The incidences of MH and SH/LA were 25.5% and 15.2%, respectively. Multivariate analysis demonstrated that body mass index (BMI) (odds ratio [OR], 1.204; 95% confidence interval [CI], 1.016–1.426), 24-hour urine epinephrine concentration (OR, 1.012; 95% CI, 1.002–1.022), and tumor size (OR, 1.571; 95% CI, 1.102–2.240) were independent predictors of post-operative SH/LA. The data show that post-operative SH/LA is not a rare complication after pheochromocytoma resection and may be closely associated with higher BMI, larger tumor size, and higher levels of urine epinephrine.

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Section: Discussionmentioning

confidence: 99%

Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma

Chen

Shen

et al. 2017

Sci Rep

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“…Laktatkonzentrationen über 5 mmol/L mit kausal verknüpfter metabolischer Azidose (pH < 7,35 (7,30); negativer Base Excess < ± 2 mmol/L) werden als Laktazidose (nicht Laktatazidose) bezeichnet [4,5].…”

Section: Hyperlaktatämieunclassified

“…Auch Zytokine können die Glukoseaufnahme und die Glykolyse in der Sepsis steigern [4]. Zusätzlich kann es zu einer Endotoxin vermittelten Hemmung der Pyruvatdehydrogenase kommen, so dass die Pyruvat-Einschleusung in den Krebszyklus gestört ist.…”

Section: Laktat Und Sepsisunclassified

Is Lactate Concentration Always an Indicator for Hypoxia?

Knichwitz

2002

Anasthesiol Intensivmed Notfallmed Schmerzthe

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EinleitungDie pathophysiologische Abhängigkeit zwischen dem global gemessenem Sauerstoffangebot (DO 2 ) und Sauerstoffverbrauch (V Ç O 2 ) galt Anfang der 90er Jahre als primäre Zielgröûe in der adäquaten Therapie einer Gewebshypoxie. Das hierauf basierende Behandlungskonzept des ¹supranormalen Sauerstoffangebotesª von Shoemaker [1] konnte jedoch die Mortalität insbesondere von septischen Patienten nicht günstig beeinflussen [2]. Die Frage nach dem besten Hypoxie-Monitoring zur frühzeitigen Diagnose und nachfolgenden Therapiesteuerung war weiterhin offen. Das ¹globale Monitoringª beispielsweise über den Pulmonaliskatheter war jedoch nicht mehr richtungsweisend und das ¹regionale Monitoringª einzelner Organsysteme gewann zunehmend an Bedeutung.Der Kliniker benötigt frühzeitige Information über eine ungünstige Energiebilanz (Pi/ATP-Ratio, Cytochrome) in den Zellen bestimmter Organsysteme (Herz, ZNS, Niere, Leber, Gastrointestinaltrakt) [3]. Diese kann er zur Zeit nur indirekt über lokale O 2 -, Laktat-oder CO 2 -Veränderungen erfassen.Pro Stunde und kg Körpergewicht werden in Skelettmuskel, Haut, Darmmukosa, Blutzellen, Nieren und Gehirn zusammen ca. 0,7 ± 1,3 mmol Laktat gebildet. Der Laktatabbau erfolgt in der Leber, Niere und dem Herzen. Mit einer maximalen Verwertungskapazität von bis zu 500 mmol Laktat pro Stunde übernimmt insbesondere die Leber 50 ± 70 % der gesamten Laktateli-

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Sauerstoffangebot in der Sepsis Seit 10 Jahren mehr Fragen als Antworten

1999

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Object of this review is to present the physiological principles, diagnostic techniques and therapeutic options that are related to modifications of oxygen delivery in sepsis. Despite intense research activities in this area, many topics regarding oxygen transport and oxygen consumption in sepsis are still not clear. For example, the often discussed shift of the critical value of oxygen delivery to higher values in sepsis has not been proven, yet. Beside an impaired regional perfusion also disturbances in the cellular oxygen utilization may be responsible for organ failure in sepsis. Until now, it was not shown, whether the increase of oxygen delivery to supranormal levels reduces mortality in septic patients. It is also unknown, which catecholamine and which infusion solution is suitable for the treatment of septic patients. In future further research is necessary to solve the problems associated with sepsis therapy.

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Liegt der Sepsis und dem septischen Schock ein globaler Sauerstoffmangel zugrunde? Eine Übersicht in zwei Teilen - Teil 2: Sepsis und Laktat

Cited by 3 publications

References 17 publications

Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma

Risk factors of post-operative severe hyperlactatemia and lactic acidosis following laparoscopic resection for pheochromocytoma

Is Lactate Concentration Always an Indicator for Hypoxia?

Sauerstoffangebot in der Sepsis Seit 10 Jahren mehr Fragen als Antworten

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