The Hemodynamic “Target”: A Visual Tool of Goal-Directed Therapy for Septic Patients

Vallée, Fabrice; Fourcade, Olivier; Marty, Philippe; Sanchez, Pascale; Samii, Kamran; Généstal, M.

doi:10.1590/s1807-59322007000400012

Cited by 13 publications

(10 citation statements)

References 13 publications

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“…Other studies performed in intensive care unit after initial resuscitation support these data [20,21]. …”

Section: Discussionsupporting

confidence: 52%

“…In ICU-resuscitated patients, ScvO 2 or mixed venous oxygen saturation is often larger than 70% despite evidence of abnormal tissue oxygenation. This oxygen extraction defects might be related to severe microcirculatory disorders [23] and/or mitochondrial damage and/or impairment of cellular respiration [24] resulting in most of the cases in elevated ScvO 2 or SvO2 values [21,25]. Low levels reflect 1) an inadequate cardiac output with an excessive extraction of oxygen, 2) a low hemoglobin concentration, and/or 3) a low level of arterial oxygen pressure (PaO 2 ).…”

Section: Discussionmentioning

confidence: 99%

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Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study

Roquilly²,

et al. 2013

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BackgroundThis study was design to investigate the prognostic value for death at day-28 of lactate course and lactate clearance during the first 24 hours in Intensive Care Unit (ICU), after initial resuscitation.MethodsProspective, observational study in one surgical ICU in a university hospital. Ninety-four patients hospitalized in the ICU for severe sepsis or septic shock were included. In this septic cohort, we measured blood lactate concentration at ICU admission (H0) and at H6, H12, and H24. Lactate clearance was calculated as followed: [(lactateinitial - lactatedelayed)/ lactateinitial] x 100%].ResultsThe mean time between severe sepsis diagnosis and H0 (ICU admission) was 8.0 ± 4.5 hours. Forty-two (45%) patients died at day 28. Lactate clearance was higher in survivors than in nonsurvivors patients for H0-H6 period (13 ± 38% and −13 ± 7% respectively, p = 0.021) and for the H0-H24 period (42 ± 33% and −17 ± 76% respectively, p < 0.001). The best predictor of death at day 28 was lactate clearance for the H0-H24 period (AUC = 0.791; 95% CI 0.6-0.85). Logistic regression found that H0-H24 lactate clearance was independently correlated to a survival status with a p = 0.047 [odds ratio = 0.35 (95% CI 0.01-0.76)].ConclusionsDuring the first 24 hr in the ICU, lactate clearance was the best parameter associated with 28-day mortality rate in septic patients. Protocol of lactate clearance-directed therapy should be considered in septic patients, even after the golden hours.

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“…Other studies performed in intensive care unit after initial resuscitation support these data [20,21]. …”

Section: Discussionsupporting

confidence: 52%

Section: Discussionmentioning

confidence: 99%

Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study

Roquilly²,

et al. 2013

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“…Providing a well-defined scaled model with clear cutoff points that indicate the risk of mortality helps to identify high-risk patients, organizes patient management, and allows earlier planning from the ICU team. 7,31 Lactate-guided end point of resuscitation is also supported by the Clinical Practice Guidelines for trauma resuscitation. 32 A further benefit of lactate-guided management is that it has been shown to reduce hospital length of stay, 33 which subsequently reduces hospital costs.…”

Section: Importance For Cliniciansmentioning

confidence: 99%

Mortality Prediction after Cardiac Surgery: Blood Lactate Is Indispensible

Badreldin

Doerr

Elsobky

et al. 2013

Thorac cardiovasc Surg

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“…This could provide clinicians some structure on how to therapeutically correct the abnormalities detected. Some fused parameters already provide some graphical or diagrammatic platform, 130 including the HeRO score (figure 4) and VSI. The key is to provide the means by which clinicians can apply/change management in response to what they see.…”

Section: Challenges To the Generation Of Physiologic Signatures In Crmentioning

confidence: 99%

Using What You Get

Holder

Clermont

2015

Critical Care Clinics

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A physiologic signature can be defined as a consistent and robust collection of physiologic measurements characterizing a disease process and its temporal evolution. If a library of physiologic signatures of impending cardiopulmonary instability were available to clinicians caring for inpatients, many episodes of clinical decompensation and their downstream effects could potentially be averted. The development and resolution of cardiopulmonary instability are processes that take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in the concept of physiologic signatures. Changes in vital signs such as blood pressure and heart rate, as well as measures of flow such as cardiac output are some of the standard variables used by clinicians to determine cardiopulmonary instability. When these primary variables are collected with high enough frequency to derive new variables, this data hierarchy can be used to development physiologic signatures. The construction of new variables from primary variables, and therefore the creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exists. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve patient outcomes.

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The Hemodynamic “Target”: A Visual Tool of Goal-Directed Therapy for Septic Patients

Cited by 13 publications

References 13 publications

Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study

Lactate clearance for death prediction in severe sepsis or septic shock patients during the first 24 hours in Intensive Care Unit: an observational study

Mortality Prediction after Cardiac Surgery: Blood Lactate Is Indispensible

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