1
|
Jiang J, Shu H, Wang DW, Hui R, Li C, Ran X, Wang H, Zhang J, Nie S, Cui G, Xiang D, Shao Q, Xu S, Zhou N, Li Y, Gao W, Chen Y, Bian Y, Wang G, Xia L, Wang Y, Zhao C, Zhang Z, Zhao Y, Wang J, Chen S, Jiang H, Chen J, Du X, Chen M, Sun Y, Li S, Ding H, Ma X, Zeng H, Lin L, Zhou S, Ma L, Tao L, Chen J, Zhou Y, Guo X. Chinese Society of Cardiology guidelines on the diagnosis and treatment of adult fulminant myocarditis. SCIENCE CHINA. LIFE SCIENCES 2024; 67:913-939. [PMID: 38332216 DOI: 10.1007/s11427-023-2421-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 07/25/2023] [Indexed: 02/10/2024]
Abstract
Fulminant myocarditis is an acute diffuse inflammatory disease of myocardium. It is characterized by acute onset, rapid progress and high risk of death. Its pathogenesis involves excessive immune activation of the innate immune system and formation of inflammatory storm. According to China's practical experience, the adoption of the "life support-based comprehensive treatment regimen" (with mechanical circulation support and immunomodulation therapy as the core) can significantly improve the survival rate and long-term prognosis. Special emphasis is placed on very early identification,very early diagnosis,very early prediction and very early treatment.
Collapse
Affiliation(s)
- Jiangang Jiang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hongyang Shu
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dao Wen Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Rutai Hui
- Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Chenze Li
- Zhongnan Hospital of Wuhan University, Wuhan, 430062, China
| | - Xiao Ran
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hong Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Jing Zhang
- Fuwai Huazhong Cardiovascular Hospital, Zhengzhou, 450003, China
| | - Shaoping Nie
- Beijing Anzhen Hospital, Capital Medical University, Beijing, 100029, China
| | - Guanglin Cui
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Dingcheng Xiang
- Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, 510010, China
| | - Qun Shao
- Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Shengyong Xu
- Union Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China
| | - Ning Zhou
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yuming Li
- Taida Hospital, Tianjin, 300457, China
| | - Wei Gao
- Peking University Third Hospital, Beijing, 100191, China
| | - Yuguo Chen
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Yuan Bian
- Qilu Hospital of Shandong University, Jinan, 250012, China
| | - Guoping Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Liming Xia
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Yan Wang
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Chunxia Zhao
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Zhiren Zhang
- Harbin Medical University Cancer Hospital, Harbin, 150081, China
| | - Yuhua Zhao
- Kanghua Hospital, Dongguan, Guangzhou, 523080, China
| | - Jianan Wang
- Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310003, China
| | - Shaoliang Chen
- Nanjing First Hospital, Nanjing Medical University, Nanjing, 210006, China
| | - Hong Jiang
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Jing Chen
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Xianjin Du
- Renmin Hospital of Wuhan University, Wuhan, 430060, Wuhan, China
| | - Mao Chen
- West China Hospital, Sichuan University, Chengdu, 610044, China
| | - Yinxian Sun
- First Hospital of China Medical University, Shenyang, 110002, China
| | - Sheng Li
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Hu Ding
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xueping Ma
- General Hospital of Ningxia Medical University, Yinchuan, 750003, China
| | - Hesong Zeng
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Li Lin
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Shenghua Zhou
- The Second Xiangya Hospital, Central South University, Changsha, 410012, China
| | - Likun Ma
- The First Affiliated Hospital of USTC, University of Science and Technology of China, Hefei, 230002, China
| | - Ling Tao
- The First Affiliated Hospital of Air Force Medical University, Xi'an, 710032, China
| | - Juan Chen
- Central Hospital of Wuhan City, Wuhan, 430014, China
| | - Yiwu Zhou
- Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Xiaomei Guo
- Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| |
Collapse
|
2
|
Scriven JW, Battaloglu E. The Effectiveness of Prehospital Subcutaneous Continuous Lactate Monitoring in Adult Trauma: A Systematic Review. Prehosp Disaster Med 2024; 39:78-84. [PMID: 38047359 PMCID: PMC10882558 DOI: 10.1017/s1049023x23006623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Existing diagnostics for polytrauma patients continue to rely on non-invasive monitoring techniques with limited sensitivity and specificity for critically unwell patients. Lactate is a known diagnostic and prognostic marker used in infection and trauma and has been associated with mortality, need for surgery, and organ dysfunction. Point-of-care (POC) testing allows for the periodic assessment of lactate levels; however, there is an associated expense and equipment burden associated with repeated sampling, with limited feasibility in prehospital care. Subcutaneous lactate monitoring has the potential to provide a dynamic assessment of physiological lactate levels and utilize these trends to guide management and response to given treatments. STUDY OBJECTIVE The aim of this study was to appraise the current literature on dynamic subcutaneous continuous lactate monitoring (SCLM) in adult trauma patients and its use in lactate-guided therapy in the prehospital environment. METHODS The systematic review was conducted in accordance with the PRISMA guidelines and registered with PROSPERO. Searched databases included PubMed, EMBASE via Ovid SP, Cochrane Library, and Web of Science. Databases were searched from inception to March 29, 2022. Relevant manuscripts were further scrutinized for reference citations to interrogate the fullness of the adjacent literature. RESULTS Searches returned 600 studies, including 551 unique manuscripts. Following title and abstract screening, 14 manuscripts met the threshold for full-text sourcing. Subsequent to the scrutiny of all 14 manuscripts, none fully met the specified eligibility criteria. Following careful examination, no article was found to cover the exact area of scientific inquiry due to disparity in technological or environmental characteristics. CONCLUSION Little is known about the utility of dynamic subcutaneous lactate monitoring, and this review highlights a clear gap in current literature. Novel subcutaneous lactate monitors are in development, and the literature describing the prototype experimentation has been summarized. These studies demonstrate device accuracy, which shows a close correlation with venous lactate while providing dynamic readings without significant lag times. Their availability and cost remain barriers to implementation at present. This represents a clear target for future feasibility studies to be conducted into the clinical use of dynamic subcutaneous lactate monitoring in trauma and resuscitation.
Collapse
Affiliation(s)
- Jamie W Scriven
- School of Medicine, Cardiff University, Cardiff, Wales
- West Midlands Central Accident, Resuscitation & Emergency Team, Birmingham, England
| | - Emir Battaloglu
- West Midlands Central Accident, Resuscitation & Emergency Team, Birmingham, England
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, England
| |
Collapse
|
3
|
Monitoring of Lactate in Interstitial Fluid, Saliva and Sweat by Electrochemical Biosensor: The Uncertainties of Biological Interpretation. CHEMOSENSORS 2021. [DOI: 10.3390/chemosensors9080195] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lactate electrochemical biosensors were fabricated using Pediococcus sp lactate oxidase (E.C. 1.1.3.2), an external polyurethane membrane laminate diffusion barrier and an internal ionomeric polymer barrier (sulphonated polyether ether sulphone polyether sulphone, SPEES PES). In a needle embodiment, a Pt wire working electrode was retained within stainless steel tubing serving as pseudoreference. The construct gave linearity to at least 25 mM lactate with 0.17 nA/mM lactate sensitivity. A low permeability inner membrane was also unexpectedly able to increase linearity. Responses were oxygen dependent at pO2 < 70 mmHg, irrespective of the inclusion of an external diffusion barrier membrane. Subcutaneous tissue was monitored in Sprague Dawley rats, and saliva and sweat during exercise in human subjects. The tissue sensors registered no response to intravenous Na lactate, indicating a blood-tissue lactate barrier. Salivary lactate allowed tracking of blood lactate during exercise, but lactate levels were substantially lower than those in blood (0–3.5 mM vs. 1.6–12.1 mM), with variable degrees of lactate partitioning from blood, evident both between subjects and at different exercise time points. Sweat lactate during exercise measured up to 23 mM but showed highly inconsistent change as exercise progressed. We conclude that neither tissue interstitial fluid nor sweat are usable as surrogates for blood lactate, and that major reappraisal of lactate sensor use is indicated for any extravascular monitoring strategy for lactate.
Collapse
|
4
|
Dror N, Weidling J, White S, Ortenzio F, Shreim S, Keating MT, Pham H, Radom-Aizik S, Botvinick E. Clinical evaluation of a novel subcutaneous lactate monitor. J Clin Monit Comput 2021; 36:537-543. [PMID: 33837904 PMCID: PMC8536260 DOI: 10.1007/s10877-021-00685-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 03/02/2021] [Indexed: 01/09/2023]
Abstract
Lactate levels are commonly used as an indirect measure to assess metabolic stress in clinical conditions like sepsis. Dynamic lactate measurements are recommended to assess and guide treatment in patients with shock and other critical care conditions. A minimally invasive, continuous lactate monitor has potential to improve clinical decisions and patient care. The purpose of the study was to evaluate continuous lactate measurements of a novel enzymatic Continuous Lactate Monitor (CLM) developed in our laboratory. Lactate levels were monitored during incremental cycling exercise challenges as a tool for hyperlactatemia. Six healthy individuals 18–45 y/o (4 males, 2 females) participated in the study. CLM devices were inserted subcutaneously in the postero-lateral trunk below the renal angle, one hour before the exercise challenge. Each exercise challenge consisted of a 3 to 12-min warm up period, followed by up to 7, 4-min incremental workload bouts separated by rest intervals. Continuous lactate measurements obtained from CLM were compared with commercial lactate analyzer (Abbott iSTAT) measurements of venous blood (plasma) drawn from the antecubital vein. Blood was drawn at up to 25 time points spanning the duration of before exercise, during exercise, and up to 120 min post exercise. Area under the curve (AUC), and delay time were calculated to compare the CLM readings with plasma lactate concentration. Average plasma lactate concentration increased from 1.02 to 16.21 mM. Ratio of AUC derived from CLM to plasma lactate was 1.025 (0.990–1.058). Average dynamic delay time of CLM to venous plasma lactate was 5.22 min (2.87–10.35). Insertion sites examined 48 h after CLM removal did not show signs of side effects and none required medical attention upon examination. The newly developed CLM has shown to be a promising tool to continuously measure lactate concentration in a minimally invasive fashion. Results indicate the CLM can provide needed trends in lactate over time. Such a device may be used in the future to improve treatment in clinical conditions such as sepsis.
Collapse
Affiliation(s)
- Nitsan Dror
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, USA.,Pediatric Department, Meir Medical Center, Child Health and Sports Center, Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - John Weidling
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA
| | - Sean White
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA
| | - Francesca Ortenzio
- Department of Dermatology, University of California Irvine Health, Irvine, USA
| | - Samir Shreim
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA
| | - Mark T Keating
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA
| | - Hoang Pham
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, USA
| | - Shlomit Radom-Aizik
- Pediatric Exercise and Genomics Research Center, Department of Pediatrics, School of Medicine, University of California Irvine, Irvine, USA
| | - Elliot Botvinick
- Beckman Laser Institute and Medical Clinic, University of California Irvine, Irvine, USA. .,Edwards Lifesciences Center for Advanced Cardiovascular Technology, University of California Irvine, Irvine, USA.
| |
Collapse
|
5
|
Shen C, Wei D, Wang G, Kang Y, Yang F, Xu Q, Xia L, Liu J. Swine hemorrhagic shock model and pathophysiological changes in a desert dry-heat environment. PLoS One 2021; 16:e0244727. [PMID: 33400711 PMCID: PMC7785222 DOI: 10.1371/journal.pone.0244727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 12/15/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND This study aimed to establish a traumatic hemorrhagic shock (THS) model in swine and examine pathophysiological characteristics in a dry-heat environment. METHODS Forty domestic Landrace piglets were randomly assigned to four study groups: normal temperature non-shock (NS), normal temperature THS (NTHS), desert dry-heat non-shock (DS), and desert dry-hot THS (DTHS) groups. The groups were exposed to either normal temperature (25°C) or dry heat (40.5°C) for 3 h. To induce THS, anesthetized piglets in the NTHS and DTHS groups were subjected to liver trauma and hypovolemic shock until death, and piglets in the NS and DS groups were euthanized at 11 h and 4 h, respectively. Body temperature, blood gas, cytokine production, and organ function were assessed before and after environmental exposure at 0 h and at every 30 min after shock to death. Hemodynamics was measured post exposure and post-shock at 0 h and at every 30 min after shock to death. RESULTS Survival, body temperature, oxygen delivery, oxygen consumption, and cardiac output were significantly different for traumatic hemorrhagic shock in the dry-heat groups compared to those in the normal temperature groups. Lactic acid and IL-6 had a marked increase at 0.5 h, followed by a progressive and rapid increase in the DTHS group. CONCLUSIONS Our findings suggest that the combined action of a dry-heat environment and THS leads to higher oxygen metabolism, poorer hemodynamic stability, and earlier and more severe inflammatory response with higher mortality.
Collapse
Affiliation(s)
- Caifu Shen
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| | - Dunhong Wei
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| | - Guangjun Wang
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| | - Yan Kang
- The 69240 Army Hospital of the Chinese People’s Liberation Army, Xinjiang, Urumqi, China
| | - Fan Yang
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| | - Qin Xu
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| | - Liang Xia
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| | - Jiangwei Liu
- Key Laboratory of Special Environmental Medicine of Xinjiang, General Hospital of Xinjiang Military Command of the Chinese People’s Liberation Army, Urumqi, China
| |
Collapse
|
6
|
Ilias I, Apollonatou S, Nikitas N, Theodorakopoulou M, Vassiliou AG, Kotanidou A, Dimopoulou I. Microdialysis-Assessed Adipose Tissue Metabolism, Circulating Cytokines and Outcome in Critical Illness. Metabolites 2018; 8:metabo8040062. [PMID: 30301230 PMCID: PMC6316198 DOI: 10.3390/metabo8040062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 01/02/2023] Open
Abstract
Microdialysis (MD) can provide continuous information about tissue composition. To assess in critically ill patients adipose tissue metabolic patterns, the relationships between metabolic patterns and blood cytokine concentration associations of adipose tissue energy metabolism and clinical outcome we studied 203 mechanically ventilated general intensive care unit (ICU) patients. Upon ICU admission an MD catheter was inserted into the subcutaneous adipose tissue of the upper thigh to measure lactate (L), glucose, pyruvate (P), and glycerol. Serum concentrations of IL-10, IL-6, IL-8, and TNF-α were determined within 48 h from ICU admission. Mitochondrial dysfunction was defined as L/P ratio >30 and pyruvate ≥70 μmol/L, ischemia as L/P ratio >30 and pyruvate <70 μmol/L and no ischemia/no mitochondrial dysfunction (i.e., aerobic metabolism) was as L/P ratio ≤30. Metabolism was aerobic in 74% of patients. In 13% of patients there was biochemical evidence of ischemia and in 13% of patients of mitochondrial dysfunction. Mitochondrial dysfunction was associated with poor outcome. In conclusion, MD showed that about two thirds of critically ill patients have normal aerobic adipose tissue metabolism. Mitochondrial dysfunction was not common but was associated with poor outcome. Identifying subgroups of critically ill patients is crucial as different treatment strategies may improve survival.
Collapse
Affiliation(s)
- Ioannis Ilias
- Endocrine Unit, Elena Venizelou Hospital, GR-11521 Athens, Greece.
| | - Sofia Apollonatou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, GR-12462 Athens, Greece.
| | - Nikitas Nikitas
- Department of Critical Care Medicine, North Middlesex Hospital, London N18 1QX, UK.
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, GR-12462 Athens, Greece.
| | - Alice G Vassiliou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, GR-10552 Athens, Greece.
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, GR-10552 Athens, Greece.
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, GR-10552 Athens, Greece.
| |
Collapse
|
7
|
Cummins G, Kremer J, Bernassau A, Brown A, Bridle HL, Schulze H, Bachmann TT, Crichton M, Denison FC, Desmulliez MPY. Sensors for Fetal Hypoxia and Metabolic Acidosis: A Review. SENSORS (BASEL, SWITZERLAND) 2018; 18:E2648. [PMID: 30104478 PMCID: PMC6111374 DOI: 10.3390/s18082648] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 07/30/2018] [Accepted: 08/02/2018] [Indexed: 12/11/2022]
Abstract
This article reviews existing clinical practices and sensor research undertaken to monitor fetal well-being during labour. Current clinical practices that include fetal heart rate monitoring and fetal scalp blood sampling are shown to be either inadequate or time-consuming. Monitoring of lactate in blood is identified as a potential alternative for intrapartum fetal monitoring due to its ability to distinguish between different types of acidosis. A literature review from a medical and technical perspective is presented to identify the current advancements in the field of lactate sensors for this application. It is concluded that a less invasive and a more continuous monitoring device is required to fulfill the clinical needs of intrapartum fetal monitoring. Potential specifications for such a system are also presented in this paper.
Collapse
Affiliation(s)
- Gerard Cummins
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Jessica Kremer
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Anne Bernassau
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Andrew Brown
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK.
| | - Helen L Bridle
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Holger Schulze
- Division of Infection and Pathway Medicine, Edinburgh Medical School, The Chancellor's Building, The University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK.
| | - Till T Bachmann
- Division of Infection and Pathway Medicine, Edinburgh Medical School, The Chancellor's Building, The University of Edinburgh, Edinburgh EH16 4SB, Scotland, UK.
| | - Michael Crichton
- Institute of Mechanical, Processing and Energy Engineering, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| | - Fiona C Denison
- MRC Centre for Reproductive Health, Queen's Medical Research Institute, University of Edinburgh, Edinburgh EH16 4TJ, Scotland, UK.
| | - Marc P Y Desmulliez
- Institute of Sensors, Signals and Systems, Heriot-Watt University, Riccarton EH14 4AS, Scotland, UK.
| |
Collapse
|
8
|
Ilias I, Apollonatou S, Vassiliadi DA, Nikitas N, Theodorakopoulou M, Diamantakis A, Kotanidou A, Dimopoulou I. Adipose Tissue Lactate Clearance but Not Blood Lactate Clearance Is Associated with Clinical Outcome in Sepsis or Septic Shock during the Post-Resuscitation Period. Metabolites 2018; 8:metabo8020028. [PMID: 29690538 PMCID: PMC6027221 DOI: 10.3390/metabo8020028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 12/29/2022] Open
Abstract
No study has directly measured tissue lactate clearance in patients with sepsis during the post-resuscitation period. In this study we aimed to assess in ICU patients with sepsis (n = 32) or septic shock (n = 79)—during the post-resuscitation phase—the relative kinetics of blood/tissue lactate clearances and to examine whether these are associated with outcome. We measured serially—over a 48-h period—blood and adipose tissue interstitial fluid lactate levels (with microdialysis) and we calculated lactate clearance. Statistics included mixed model analysis, Friedman’s analysis of variance, Wilcoxon’s test, Mann-Whitney’s test, receiver operating characteristics curves and logistic regression. Forty patients died (28-day mortality rate = 28%). Tissue lactate clearance was higher compared to blood lactate clearance at 0–8, 0–12, 0–16, 0–20 and 0–24 h (all p < 0.05). Tissue lactate clearance was higher in survivors compared to non-survivors at 0–12, 0–20 and 0–24 h (all p = 0.02). APACHE II along with tissue lactate clearance <30% at 0–12, 0–20 and 0–24 h were independent outcome predictors. We did not find blood lactate clearance to be related to survival. Thus, in critically ill septic patients, elevated tissue (but not blood) lactate clearance, was associated with a favorable clinical outcome.
Collapse
Affiliation(s)
- Ioannis Ilias
- Endocrine Unit, Elena Venizelou Hospital, Athens 11521, Greece.
| | - Sofia Apollonatou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | | | - Nikitas Nikitas
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | - Maria Theodorakopoulou
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | - Argyris Diamantakis
- Second Department of Critical Care Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10462, Greece.
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10676, Greece.
| | - Ioanna Dimopoulou
- First Department of Critical Care Medicine, Evangelismos Hospital, National and Kapodistrian University of Athens, Medical School, Athens 10676, Greece.
| |
Collapse
|
9
|
Fischer MO, Bonnet V, Lorne E, Lefrant JY, Rebet O, Courteille B, Lemétayer C, Parienti JJ, Gérard JL, Fellahi JL, Hanouz JL. Assessment of macro- and micro-oxygenation parameters during fractional fluid infusion: A pilot study. J Crit Care 2017; 40:91-98. [PMID: 28364680 DOI: 10.1016/j.jcrc.2017.03.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 03/13/2017] [Accepted: 03/23/2017] [Indexed: 11/16/2022]
Abstract
PURPOSE The main goal of this study was to assess whether maximal fluid infusion improves both oxygen delivery (DO2) and micro-circulatory parameters during hemodilution. The secondary objective was to assess the ability of baseline micro-circulatory parameters to predict oxygen consumption (VO2) response following fluid infusion. MATERIALS AND METHODS In a postoperative cardiac ICU, patients received repeated fluid infusion until stroke volume (SV) was maximized. Before and after each fluid expansion, macro- (DO2, VO2) and micro-circulatory oxygenation parameters were recorded [central venous oxygen saturation (ScVO2), blood lactate, difference in veno-arterial carbon dioxide tension (P(v-a)CO2), somatic and cerebral oxygen saturation (rSO2)]. Patients were classified as VO2-Responders or VO2-Non-Responders according to an increase in VO2 above or below 15%, respectively. RESULTS After maximal fluid infusion, all patients showed improved macro- and micro-circulatory oxygenation parameters, but VO2-Responders had lower values (especially for ScVO2 and cerebral rSO2). Only baseline ScVO2 and cerebral rSO2 were useful to predict the VO2 response to maximal fluid infusion (ROCAUC 0.80 (95% CI: 0.54-0.95, P=0.012) and 0.83 (95% CI: 0.57-0.96, P=0.001). CONCLUSIONS Maximal fluid infusion improves macro- and micro-circulatory oxygenation parameters. For VO2-Responders, only ScVO2 and cerebral rSO2 could serve as markers of tissue hypoxia.
Collapse
Affiliation(s)
- Marc-Olivier Fischer
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France; EA 4650, Université de Caen Normandie, Esplanade de la Paix, CS 14 032, F-14 000 Caen, France.
| | - Vincent Bonnet
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France.
| | - Emmanuel Lorne
- Anesthesiology and Critical Care Department, Amiens University Hospital, Place Victor Pauchet, F-80 054 Amiens, France; INSERM ERI12, Jules Vernes University of Picardy, 12 rue des Louvels, F-80 000 Amiens, France.
| | - Jean-Yves Lefrant
- Division of Anaesthesia, Intensive Care, Pain and Emergency Medicine, University Hospital of Nîmes, Nîmes, France.
| | - Olivier Rebet
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France.
| | - Benoît Courteille
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France.
| | - Charlotte Lemétayer
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France.
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France.
| | - Jean-Louis Gérard
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France.
| | - Jean-Luc Fellahi
- Service d'Anesthésie-Réanimation, Hôpital cardiologique Louis Pradel, Avenue du Doyen Lepine, F-69 677 Lyon, France; Faculty of Medicine, University of Lyon 1 Claude Bernard, F-69 008 Lyon, France.
| | - Jean-Luc Hanouz
- Pôle Réanimations Anesthésie SAMU/SMUR, CHU de Caen, Avenue de la Côte de Nacre, CS 30001, F-14 000 Caen, France; EA 4650, Université de Caen Normandie, Esplanade de la Paix, CS 14 032, F-14 000 Caen, France.
| | | |
Collapse
|
10
|
Microdialysis as a Part of Invasive Cerebral Monitoring During Porcine Septic Shock. J Neurosurg Anesthesiol 2016; 28:323-30. [DOI: 10.1097/ana.0000000000000220] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
11
|
Ilias I, Vassiliadi DA, Theodorakopoulou M, Boutati E, Maratou E, Mitrou P, Nikitas N, Apollonatou S, Dimitriadis G, Armaganidis A, Dimopoulou I. Adipose tissue lipolysis and circulating lipids in acute and subacute critical illness: effects of shock and treatment. J Crit Care 2014; 29:1130.e5-9. [PMID: 25012960 DOI: 10.1016/j.jcrc.2014.06.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 05/26/2014] [Accepted: 06/01/2014] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this study is to assess lipid metabolism at the tissue level in critically ill subjects. MATERIALS AND METHODS We studied 182 patients with systemic inflammatory response syndrome/severe sepsis or shock during the acute (day 1) and subacute phase of critical illness (day 6). All subjects had a tissue microdialysis (MD) catheter placed in femoral adipose tissue upon admission to the intensive care unit (ICU). Plasma cholesterol, high-density lipoprotein, low-density lipoprotein, free fatty acids (FFAs), triglyceride, and MD glycerol (GLYC) were measured on days 1 and 6 in the ICU. RESULTS On admission, 56% of the patients had increased levels (>200 μmol/L) of MD GLYC. Patients with shock displayed more pronounced subcutaneous tissue lipolysis and more profound derangements of circulating lipids vs patients without shock (but no appreciable differences in FFA levels). Furthermore, in patients with shock during the acute period, there were positive, albeit weak, correlations of subcutaneous tissue lipolysis (MD GLYC), plasma FFAs (r=0.260; P=.01), and norepinephrine's dose (r=0.230; P=.01), whereas during the subacute phase, MD GLY levels were higher in patients receiving glucocorticoids (344.7±276.0 μmol/L vs 252.2±158.4 μmol/L; P=.03). CONCLUSIONS Subcutaneous tissue lipolysis is only one of the many determinants of plasma FFAs. Routinely applied therapeutic modalities in the ICU interfere with adipose tissue metabolism.
Collapse
Affiliation(s)
- I Ilias
- Endocrine Department, E. Venizelou Hospital, Athens, Greece.
| | - D A Vassiliadi
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - M Theodorakopoulou
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - E Boutati
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - E Maratou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - P Mitrou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - N Nikitas
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - S Apollonatou
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - G Dimitriadis
- Second Department of Internal Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - A Armaganidis
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| | - I Dimopoulou
- Second Department of Critical Care Medicine, National and Kapodistrian University of Athens, Attikon University Hospital, Athens, Greece
| |
Collapse
|
12
|
Burša F, Pleva L. Anaerobic metabolism associated with traumatic hemorrhagic shock monitored by microdialysis of muscle tissue is dependent on the levels of hemoglobin and central venous oxygen saturation: a prospective, observational study. Scand J Trauma Resusc Emerg Med 2014; 22:11. [PMID: 24499479 PMCID: PMC3923388 DOI: 10.1186/1757-7241-22-11] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Accepted: 01/08/2014] [Indexed: 01/06/2023] Open
Abstract
Background Traumatic hemorrhagic shock resulting in tissue hypoxia is a significant cause of morbidity and mortality in polytraumatized patients. Early identification of tissue hypoxia is possible with microdialysis. The aim of this study was to determine the correlation between a marker of tissue hypoxia (L/P; lactate to pyruvate ratio) and selected parameters of systemic oxygen delivery (Hb; hemoglobin) and oxygen extraction (ScvO2; central venous oxygen saturation). We also investigated the severity of tissue hypoxia over the course of care. Methods Adult patients with traumatic hemorrhagic shock were enrolled in this prospective, observational study. Microdialysis of the peripheral muscle tissue was performed. Demographic data and timeline of care were collected. Tissue lactate, pyruvate, glycerol, glucose levels, hemoglobin, serum lactate and oxygen saturation of the central venous blood (ScvO2) levels were also measured. Results The L/P ratio trend may react to changes in systemic hemoglobin levels with a delay of 7 to 10 hours, particularly when systemic hemoglobin levels are increased by transfusion. Decrease in tissue L/P ratio may react to increase in ScvO2 with a delay of up to 10 hours, and such a decrease may signify elimination of tissue hypoxia after transfusion. We also observed changes in the L/P trend in the 13 hours preceding a change in the hemoglobin level. Fluid administration, which is routinely used as a first-line treatment of hypovolemic shock, can cause hemodilution and decreased hemoglobin. When ScvO2 decreases, increase in L/P ratio may precede the ScvO2 trend by 10 or 11 hours. An increase in the L/P ratio is an early warning sign of insufficient tissue oxygenation and should lead to intensive observation of hemoglobin levels, ScvO2 and other hemodynamic parameters. Patients who were treated more rapidly had lower maximal L/P values and a lower degree of tissue ischemia. Conclusion The L/P ratio is useful to identify tissue ischemia and can estimate the effectiveness of fluid resuscitation. An increase in the L/P ratio is an early warning sign of inadequate tissue oxygenation and should lead to more detailed hemodynamic and laboratory monitoring. This information cannot usually be obtained from global markers.
Collapse
Affiliation(s)
- Filip Burša
- Department of anesthesiology and intensive care medicine, University Hospital Ostrava, Faculty of Medicine Universitas Ostrava, 17 listopadu, 1790 Ostrava-Poruba, Czech Republic.
| | | |
Collapse
|