The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU

Cusack, Rebecca; Rhodes, Andrew; Lochhead, Paul; Jordan, Barbara; Perry, Steve F.; Ball, Jonathan; Grounds, RM; Bennett, E. D.

doi:10.1007/s00134-002-1318-2

Cited by 127 publications

(90 citation statements)

References 35 publications

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“…Our results contradicts the findings of Ratanarat et al as in their study they have found that in comparison to traditional approach, the Stewart approach does not provide any greater advantage to predict mortality in critically ill patients [28]. Cusack et al findings were also similar to our study, as they also have found that SBE, BE (UA,) lactate, pH and AG have the best ability to measure the outcome [29].…”

Section: Discussioncontrasting

confidence: 81%

Acid Base Disorders in Critically Ill Neonatal Intensive Care Patients and Predicting Survival by the Presence of Deranged Acid-Base Variables

Ahmad¹,

Ahmed²

2014

J Neonatal Biol

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Section: Discussioncontrasting

confidence: 81%

Acid Base Disorders in Critically Ill Neonatal Intensive Care Patients and Predicting Survival by the Presence of Deranged Acid-Base Variables

Ahmad¹,

Ahmed²

2014

J Neonatal Biol

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“…Induction, time point of inducing anesthesia; weaning, 5 min after weaning from CPB; closure, time point of chest closure; UMA, unmeasured anions; Change in lactate induction-weaning, change in the lactate level from induction to CPB weaning; Change in lactate weaning-closure, change in the lactate level from CPB weaning to chest closure; Change in lactate induction-closure, change in the lactate level from induction to chest closure; Change in UMA induction-weaning, change in the UMA level from induction to CPB weaning; Change in UMA weaning-closure, change in the UMA level from CPB weaning to chest closure; Change in UMA induction-closure, change in the UMA level from induction to chest closure; AUC, area under curve; Pauc, P value of the comparison of AUCs between lactate and UMA at each time point. pediatric cardiac surgery in some studies (Durward et al 2005;Murray et al 2007), whereas other studies showed that the UMA level offers no additional advantage over the lactate level in predicting surgical outcomes (Cusack et al 2002;Hatherill et al 2003;Rocktaeschel et al 2003). Both of these reports focused on postoperative or critically ill patients in the ICU.…”

Section: Fig 3 Periopetraive Hemodynamic Variables In the Mae Groupmentioning

confidence: 99%

“…Another report suggests that an elevated strong ion gap is superior to lactate levels as a predictor of mortality after cardiac surgery (Durward et al 2005). However, some reports have questioned the role of the UMA level as a predictor of outcome in critically ill patients (Cusack et al 2002;Hatherill et al 2003;Rocktaeschel et al 2003).…”

mentioning

confidence: 99%

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

Park

Kim

Byon

et al. 2012

Tohoku J. Exp. Med.

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Hyperlactatemia and unmeasured anions (UMA) have been suggested to be useful predictors of outcomes after pediatric cardiac surgery in the ICU. However, if we detect high-risk patient in the operating room, we could practice early intervention to decrease mortality and morbidity. The purpose of this study was to determine whether the intraoperative lactate or UMA levels can predict adverse outcomes in pediatric cardiac patients with undergoing cardiopulmonary bypass (CPB). We studied 102 patients with congenital heart disease. Arterial blood samples were obtained after inducing anesthesia, 5 min after weaning from CPB and after chest closure. Major adverse events (MAEs) were defined as cardiac compression, re-sternotomy due to hemodynamic instability, extra-corporeal membrane oxygenator support, creatinine levels greater than 2 mg/dL, or death. Patients were divided into MAE group (8 patients, 7.8%) and non-MAE group. Six patients with MAEs died. Importantly, the lactate levels (mmol/L) at weaning from CPB (4.19 vs 2.1; MAE group vs non-MAE group), chest closure (5.76 vs 2.39; MAE group vs non-MAE group) and the intraoperative increases in lactate levels were significantly higher in the MAE group than in the non-MAE group. However, there was no significant difference in the UMA levels or their changes between the groups. The increase in the lactate level from CPB weaning to chest closure was the best predictor of MAEs (AUC: 0.810). In conclusion, the intraoperative plasma lactate levels were more closely associated with MAEs, and they are more useful for predicting the outcome of pediatric cardiac patients than the UMA levels.

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“…hand, it provides no detailed knowledge on the source of the problem [2]. The SBE is a calculated figure, derived from PaCO2 and arterial pH, whose calculation assumes normal plasma protein and electrolyte contents [3].…”

mentioning

confidence: 99%

An acid-base disorders analysis with the use of the Stewart approach in patients with sepsis treated in an intensive care unit

Szrama¹,

Smuszkiewicz²

2016

Anaesthesiol Intensive Ther

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Background: Patients with sepsis admitted to the intensive care unit often present with acid-base disorders. As the traditional interpretation might be clinically misleading, an alternative approach described by Stewart may allow one to quantify the individual components of acid-base abnormalities and provide an insight into their pathogenesis. The aim of our study was to compare the traditional and Stewart approaches in the analysis of acid-base disturbance. Methods: We analyzed arterial blood gases (ABG) taken from 43 ICU septic patients from admission to discharge categorising them according to SBE values. The traditional concept analysis was compared with the physicochemical approach using the Stewart equations. Results: 990 ABGs were analysed. In the SBE < −2 mEq L -1 group, hyperlactatemia was observed in 34.7% ABG, hypoalbuminemia in 100% and SIG acidosis in 42% ABG. Moreover, a Cl/Na ratio > 0.75 was present in 96.9% ABG. In the normal range SBE group, elevated lactates were present in 21.3% ABG, SIG acidosis in 14.9%, elevated Cl/Na ratio in 98.4% and hypoalbuminemia in all 324 ABG. In the metabolic alkalosis group (SBE > +2 mEq L -1 ), hyperlactatemia was observed in 18.4% ABG, SIG acidosis in 5% ABG, Cl/Na ratio > 0.75 in 88.8%, while 99.1% samples revealed hypoalbuminemia. Conclusion: The use of the Stewart model may improve our understanding of the underlying pathophysiological mechanism and the true etiology of the derangements of acid-base disorders. Indeed, it proves that patients may suffer from mixed arterial blood gas disorders hidden under normal values of SBE and pH.

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The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU

Cited by 127 publications

References 35 publications

Acid Base Disorders in Critically Ill Neonatal Intensive Care Patients and Predicting Survival by the Presence of Deranged Acid-Base Variables

Acid Base Disorders in Critically Ill Neonatal Intensive Care Patients and Predicting Survival by the Presence of Deranged Acid-Base Variables

Intraoperative Plasma Lactate as an Early Indicator of Major Postoperative Events in Pediatric Cardiac Patients

An acid-base disorders analysis with the use of the Stewart approach in patients with sepsis treated in an intensive care unit

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