The relationship of blood lactate concentrations, oxygen delivery and oxygen consumption in septic shock and the adult respiratory distress syndrome

Nimmo, G. R.; Mackenzie, S. J.; Walker, Samantha; Catnach, J.; Nicol, M; Armstrong, I.; Grant, I. S.

doi:10.1111/j.1365-2044.1992.tb04194.x

“…No entanto, é importante salientar que na sepse também pode haver perfusão tecidual inadequada na ausência de sinais clínicos (hipoperfusão oculta). O seu mecanismo não está completamente esclarecido, porém pode ser uma combinação de fatores, como alteração da distribuição de fluxo sangüíneo pela vasodilatação, bem como aumento da distância para difusão entre o capilar e a célula, ocasionado pelo edema intersticial, associado à lesão do capilar 15 . Dos oito casos de sepse, apenas um não apresentou aumento do lactato.…”

Section: Discussionunclassified

Blood lactate concentration as prognostic marker in critically ill children

Koliski¹,

Cat²,

Giraldi³

et al. 2005

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Objective: To assess the use of lactate as a marker of tissue hypoperfusion and as a prognostic index in critically ill patients.Methods: Prospective, longitudinal, observational study of 75 patients admitted to the pediatric ICU of Hospital de Clínicas of Universidade Federal do Paraná, between November 1998 and May 1999. According to the lactate level on admission, patients were divided into group A (lactate > 18 mg/dl) and group B (lactate < 18 mg/dl). In terms of outcome, patients were classified into survivors and nonsurvivors. In group A, the clinical evaluation and the collection of arterial blood samples were performed on admission, at 6, 12, 24, 48 hours, and every 24 hours after that. In group B, they were carried out in the same way, but interrupted 48 hours after admission.Results: Groups A and B consisted of 50 and 25 patients, respectively. Group A presented more clinical signs of hypoperfusion (24/50). There was a statistically significant difference regarding the mean lactate levels on admission between those patients who died within 24 hours of admission (95 mg/dl) and those who died 24 hours after admission (28 mg/dl). The lactate level at 24 hours of admission revealed better sensitivity (55.6%) and specificity (97.2%) as a predictor of death.Conclusions: Most patients with lactate levels > 18 mg/dl showed clinical signs of hypoperfusion on admission. The normalization or reduction of lactate levels at and after 24 hours of admission was significantly related with higher chances of survival. J Pediatr (Rio J)

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“…Esse fato já está descrito e é explicado pelo aparecimento de uma resposta hemodinâmica compensatória 16 . Nos casos em que essa resposta não pode ser constatada, o nível de lactato permanece alto ou aumenta na evolução com 100% de mortalidade 15 .…”

Section: Discussionunclassified

Blood lactate concentration as prognostic marker in critically ill children

Koliski¹,

Cat²,

Giraldi³

et al. 2005

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Objective: To assess the use of lactate as a marker of tissue hypoperfusion and as a prognostic index in critically ill patients.Methods: Prospective, longitudinal, observational study of 75 patients admitted to the pediatric ICU of Hospital de Clínicas of Universidade Federal do Paraná, between November 1998 and May 1999. According to the lactate level on admission, patients were divided into group A (lactate > 18 mg/dl) and group B (lactate < 18 mg/dl). In terms of outcome, patients were classified into survivors and nonsurvivors. In group A, the clinical evaluation and the collection of arterial blood samples were performed on admission, at 6, 12, 24, 48 hours, and every 24 hours after that. In group B, they were carried out in the same way, but interrupted 48 hours after admission.Results: Groups A and B consisted of 50 and 25 patients, respectively. Group A presented more clinical signs of hypoperfusion (24/50). There was a statistically significant difference regarding the mean lactate levels on admission between those patients who died within 24 hours of admission (95 mg/dl) and those who died 24 hours after admission (28 mg/dl). The lactate level at 24 hours of admission revealed better sensitivity (55.6%) and specificity (97.2%) as a predictor of death.Conclusions: Most patients with lactate levels > 18 mg/dl showed clinical signs of hypoperfusion on admission. The normalization or reduction of lactate levels at and after 24 hours of admission was significantly related with higher chances of survival. J Pediatr (Rio J)

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“…Its mechanism has not been clearly described, but it may involve a combination of factors such as a change in the distribution of blood flow by vasodilation, or an increase in the diffusion distance between the capillary and the cell as a result of interstitial edema, associated with capillary injury. 15 Of the eight sepsis cases, only one did not have high levels of lactate. This fact has already been described and may be explained by the development of a compensatory …”

Section: Resultsmentioning

confidence: 99%

“…16 In the cases in which such response cannot be detected, lactate level remains elevated or increases during hospitalization leading to a 100% mortality rate. 15 These findings led intensivists to check whether lactate concentration, besides being clinically useful as an indicator of circulatory involvement and of the oxygenation state, could also be used as prognostic marker for the risk of death among critically ill patients. 5,16,17 Hyperlactatemia has been detected in critically ill patients and several clinical studies have shown an association between its levels and the type of outcome, with higher levels in those patients who will eventually die.…”

Section: Discussionmentioning

confidence: 99%

Lactato sérico como marcador prognóstico em crianças gravemente doentes

Koliski¹,

Cat²,

J³

et al. 2005

J. Pediatr. (Rio J.)

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Objective: To assess the use of lactate as a marker of tissue hypoperfusion and as a prognostic index in critically ill patients.Methods: Prospective, longitudinal, observational study of 75 patients admitted to the pediatric ICU of Hospital de Clínicas of Universidade Federal do Paraná, between November 1998 and May 1999. According to the lactate level on admission, patients were divided into group A (lactate > 18 mg/dl) and group B (lactate < 18 mg/dl). In terms of outcome, patients were classified into survivors and nonsurvivors. In group A, the clinical evaluation and the collection of arterial blood samples were performed on admission, at 6, 12, 24, 48 hours, and every 24 hours after that. In group B, they were carried out in the same way, but interrupted 48 hours after admission.Results: Groups A and B consisted of 50 and 25 patients, respectively. Group A presented more clinical signs of hypoperfusion (24/50). There was a statistically significant difference regarding the mean lactate levels on admission between those patients who died within 24 hours of admission (95 mg/dl) and those who died 24 hours after admission (28 mg/dl). The lactate level at 24 hours of admission revealed better sensitivity (55.6%) and specificity (97.2%) as a predictor of death.Conclusions: Most patients with lactate levels > 18 mg/dl showed clinical signs of hypoperfusion on admission. The normalization or reduction of lactate levels at and after 24 hours of admission was significantly related with higher chances of survival.J Pediatr (Rio J). 2005;81(4):287-92: Blood lactate, lactic acidosis, hyperlactatemia, prognostic index, PICU mortality.

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The relationship of blood lactate concentrations, oxygen delivery and oxygen consumption in septic shock and the adult respiratory distress syndrome

Abstract: SummaryTissue hypoxia is thought to be pivotal to the development of multiple organ failure, but

Cited by 26 publications

References 19 publications

Blood lactate concentration as prognostic marker in critically ill children

Blood lactate concentration as prognostic marker in critically ill children

Blood lactate concentration as prognostic marker in critically ill children

Lactato sérico como marcador prognóstico em crianças gravemente doentes

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