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Eichinger M, Shah K, Palt N, Eichlseder M, Pichler A, Zoidl P, Zajic P, Rief M. Association of prehospital lactate levels with base excess in various emergencies - a retrospective study. Clin Chem Lab Med 2024; 62:1602-1610. [PMID: 38373063 DOI: 10.1515/cclm-2024-0060] [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] [Received: 11/01/2022] [Accepted: 02/08/2024] [Indexed: 02/21/2024]
Abstract
OBJECTIVES Blood gas analysis, including parameters like lactate and base excess (BE), is crucial in emergency medicine but less commonly utilized prehospital. This study aims to elucidate the relationship between lactate and BE in various emergencies in a prehospital setting and their prognostic implications. METHODS We conducted a retrospective analysis of prehospital emergency patients in Graz, Austria, from October 2015 to November 2020. Our primary aim was to assess the association between BE and lactate. This was assessed using Spearman's rank correlation and fitting a multiple linear regression model with lactate as the outcome, BE as the primary covariate of interest and age, sex, and medical emergency type as confounders. RESULTS In our analysis population (n=312), lactate and BE levels were inversely correlated (Spearman's ρ, -0.75; p<0.001). From the adjusted multiple linear regression model (n=302), we estimated that a 1 mEq/L increase in BE levels was associated with an average change of -0.35 (95 % CI: -0.39, -0.30; p<0.001) mmol/L in lactate levels. Lactate levels were moderately useful for predicting mortality with notable variations across different emergency types. CONCLUSIONS Our study highlights a significant inverse association between lactate levels and BE in the prehospital setting, underscoring their importance in early assessment and prognosis in emergency care. Additionally, the findings from our secondary aims emphasize the value of lactate in diagnosing acid-base disorders and predicting patient outcomes. Recognizing the nuances in lactate physiology is essential for effective prehospital care in various emergency scenarios.
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Affiliation(s)
- Michael Eichinger
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Karan Shah
- Section of Biostatistics, Quantitative Health Sciences, 2569 Cleveland Clinic , Cleveland, OH, USA
| | - Niklas Palt
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Michael Eichlseder
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Alexander Pichler
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Philipp Zoidl
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Paul Zajic
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
| | - Martin Rief
- Department of Anaesthesiology and Intensive Care Medicine 1, 31475 Medical University of Graz , Graz, Austria
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2
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De Simone B, Chouillard E, Podda M, Pararas N, de Carvalho Duarte G, Fugazzola P, Birindelli A, Coccolini F, Polistena A, Sibilla MG, Kruger V, Fraga GP, Montori G, Russo E, Pintar T, Ansaloni L, Avenia N, Di Saverio S, Leppäniemi A, Lauretta A, Sartelli M, Puzziello A, Carcoforo P, Agnoletti V, Bissoni L, Isik A, Kluger Y, Moore EE, Romeo OM, Abu-Zidan FM, Beka SG, Weber DG, Tan ECTH, Paolillo C, Cui Y, Kim F, Picetti E, Di Carlo I, Toro A, Sganga G, Sganga F, Testini M, Di Meo G, Kirkpatrick AW, Marzi I, déAngelis N, Kelly MD, Wani I, Sakakushev B, Bala M, Bonavina L, Galante JM, Shelat VG, Cobianchi L, Mas FD, Pikoulis M, Damaskos D, Coimbra R, Dhesi J, Hoffman MR, Stahel PF, Maier RV, Litvin A, Latifi R, Biffl WL, Catena F. The 2023 WSES guidelines on the management of trauma in elderly and frail patients. World J Emerg Surg 2024; 19:18. [PMID: 38816766 PMCID: PMC11140935 DOI: 10.1186/s13017-024-00537-8] [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] [Received: 01/05/2024] [Accepted: 02/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND The trauma mortality rate is higher in the elderly compared with younger patients. Ageing is associated with physiological changes in multiple systems and correlated with frailty. Frailty is a risk factor for mortality in elderly trauma patients. We aim to provide evidence-based guidelines for the management of geriatric trauma patients to improve it and reduce futile procedures. METHODS Six working groups of expert acute care and trauma surgeons reviewed extensively the literature according to the topic and the PICO question assigned. Statements and recommendations were assessed according to the GRADE methodology and approved by a consensus of experts in the field at the 10th international congress of the WSES in 2023. RESULTS The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage, including drug history, frailty assessment, nutritional status, and early activation of trauma protocol to improve outcomes. Acute trauma pain in the elderly has to be managed in a multimodal analgesic approach, to avoid side effects of opioid use. Antibiotic prophylaxis is recommended in penetrating (abdominal, thoracic) trauma, in severely burned and in open fractures elderly patients to decrease septic complications. Antibiotics are not recommended in blunt trauma in the absence of signs of sepsis and septic shock. Venous thromboembolism prophylaxis with LMWH or UFH should be administrated as soon as possible in high and moderate-risk elderly trauma patients according to the renal function, weight of the patient and bleeding risk. A palliative care team should be involved as soon as possible to discuss the end of life in a multidisciplinary approach considering the patient's directives, family feelings and representatives' desires, and all decisions should be shared. CONCLUSIONS The management of elderly trauma patients requires knowledge of ageing physiology, a focused triage based on assessing frailty and early activation of trauma protocol to improve outcomes. Geriatric Intensive Care Units are needed to care for elderly and frail trauma patients in a multidisciplinary approach to decrease mortality and improve outcomes.
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Affiliation(s)
- Belinda De Simone
- Department of Emergency Minimally Invasive Surgery, Academic Hospital of Villeneuve St Georges, Villeneuve St Georges, France.
- Department of General Minimally Invasive Surgery, Infermi Hospital, AUSL Romagna, Rimini, Italy.
- General Surgery Department, American Hospital of Paris, Paris, France.
| | - Elie Chouillard
- General Surgery Department, American Hospital of Paris, Paris, France
| | - Mauro Podda
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | - Nikolaos Pararas
- 3rd Department of Surgery, Attikon General Hospital, National and Kapodistrian University of Athens (NKUA), Athens, Greece
| | | | - Paola Fugazzola
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy
| | | | | | - Andrea Polistena
- Department of Surgery, Policlinico Umberto I Roma, Sapienza University, Rome, Italy
| | - Maria Grazia Sibilla
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Vitor Kruger
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Gustavo P Fraga
- Division of Trauma Surgery, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Giulia Montori
- Unit of General and Emergency Surgery, Vittorio Veneto Hospital, Via C. Forlanini 71, 31029, Vittorio Veneto, TV, Italy
| | - Emanuele Russo
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Tadeja Pintar
- UMC Ljubljana and Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Luca Ansaloni
- New Zealand Blood Service, Christchurch, New Zealand
| | - Nicola Avenia
- Endocrine Surgical Unit - University of Perugia, Terni, Italy
| | - Salomone Di Saverio
- General Surgery Unit, Madonna del Soccorso Hospital, AST Ascoli Piceno, San Benedetto del Tronto, Italy
| | - Ari Leppäniemi
- Division of Emergency Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Andrea Lauretta
- Department of Surgical Oncology, Centro Di Riferimento Oncologico Di Aviano IRCCS, Aviano, Italy
| | - Massimo Sartelli
- Department of General Surgery, Macerata Hospital, Macerata, Italy
| | - Alessandro Puzziello
- Dipartimento di Medicina, Chirurgia e Odontoiatria, Campus Universitario di Baronissi (SA) - Università di Salerno, AOU San Giovanni di Dio e Ruggi di Aragona, Salerno, Italy
| | - Paolo Carcoforo
- Department of Surgery, Unit of General Surgery, University Hospital of Ferrara and University of Ferrara, Ferrara, Italy
| | - Vanni Agnoletti
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Luca Bissoni
- Department of Anesthesia, Level I, Trauma Center, Bufalini Hospital, Cesena, Italy
| | - Arda Isik
- Istanbul Medeniyet University, Istanbul, Turkey
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Ernest E Moore
- Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado, Denver, CO, USA
| | - Oreste Marco Romeo
- Bronson Methodist Hospital/Western Michigan University, Kalamazoo, MI, USA
| | - Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, United Arab Emirates University, Al‑Ain, United Arab Emirates
| | | | - Dieter G Weber
- Department of General Surgery, Royal Perth Hospital and The University of Western Australia, Perth, Australia
| | - Edward C T H Tan
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Ciro Paolillo
- Emergency Department, Ospedale Civile Maggiore, Verona, Italy
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Fernando Kim
- University of Colorado Anschutz Medical Campus, Denver, CO, 80246, USA
| | - Edoardo Picetti
- Department of Anesthesia and Intensive Care, Parma University Hospital, Parma, Italy
| | - Isidoro Di Carlo
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Adriana Toro
- Department of Surgical Sciences and Advanced Technologies, General Surgery Cannizzaro Hospital, University of Catania, Catania, Italy
| | - Gabriele Sganga
- Fondazione Policlinico Universitario A. Gemelli IRCCS, Catholic University, Rome, Italy
| | - Federica Sganga
- Department of Geriatrics, Ospedale Sant'Anna, Ferrara, Italy
| | - Mario Testini
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Giovanna Di Meo
- Department of Precision and Regenerative Medicine and Ionian Area, Unit of Academic General Surgery, University of Bari "A. Moro", Bari, Italy
| | - Andrew W Kirkpatrick
- Departments of Surgery and Critical Care Medicine, University of Calgary, Foothills Medical Centre, Calgary, AB, Canada
| | - Ingo Marzi
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Frankfurt, Frankfurt, Germany
| | - Nicola déAngelis
- Unit of Colorectal and Digestive Surgery, DIGEST Department, Beaujon University Hospital, AP-HP, University of Paris Cité, Clichy, France
| | | | - Imtiaz Wani
- Department of Surgery, Government Gousia Hospital, DHS, Srinagar, India
| | - Boris Sakakushev
- General Surgery Department, Medical University, University Hospital St George, Plovdiv, Bulgaria
| | - Miklosh Bala
- Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Luigi Bonavina
- Division of General Surgery, IRCCS Policlinico San Donato, University of Milan, Milan, Italy
| | - Joseph M Galante
- Division of Trauma and Acute Care Surgery, Department of Surgery, University of California Davis, Sacramento, CA, USA
| | - Vishal G Shelat
- Department of General Surgery, Tan Tock Seng Hospital, Novena, Singapore
| | - Lorenzo Cobianchi
- Unit of General Surgery I, IRCCS San Matteo Hospital of Pavia, University of Pavia, Pavia, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Francesca Dal Mas
- Department of Management, Ca' Foscari University of Venice, Venice, Italy
- Collegium Medicum, University of Social Sciences, Łodz, Poland
| | - Manos Pikoulis
- Department of Surgical Science, Unit of Emergency Surgery, University of Cagliari, Cagliari, Italy
| | | | - Raul Coimbra
- Riverside University Health System Medical Center, Riverside, CA, USA
| | - Jugdeep Dhesi
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Melissa Red Hoffman
- Department of Surgery, University of North Carolina, Surgical Palliative Care Society, Asheville, NC, USA
| | - Philip F Stahel
- Department of Surgery, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Ronald V Maier
- Harborview Medical Center, University of Washington, Seattle, WA, USA
| | - Andrey Litvin
- Department of Surgical Diseases No. 3, Gomel State Medical University, University Clinic, Gomel, Belarus
| | - Rifat Latifi
- University of Arizona, Tucson, AZ, USA
- Abrazo Health West Campus, Goodyear, Tucson, AZ, USA
| | - Walter L Biffl
- Division of Trauma/Acute Care Surgery, Scripps Clinic Medical Group, La Jolla, CA, USA
| | - Fausto Catena
- Department of General and Emergency Surgery, Bufalini Hospital-Level 1 Trauma Center, AUSL Romagna, Cesena, Italy
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Azer Z, Leone M, Chatelon J, Abulfatth A, Ahmed A, Saleh R. Study of initial blood lactate and delta lactate as early predictor of morbidity and mortality in trauma patients. EGYPTIAN JOURNAL OF ANAESTHESIA 2023. [DOI: 10.1080/11101849.2023.2175871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
Affiliation(s)
- Zarif Azer
- Department of Anesthesia, Intensive Care and Trauma Center, Nord University Hospital, Aix Marseille University, APHM, Marseille, France
- Department of Anesthesia and Surgical Intensive Care, Alexandria Main University Hospitals, Azarita Medical Campus, Alexandria, Egypt
| | - Marc Leone
- Department of Anesthesia, Intensive Care and Trauma Center, Nord University Hospital, Aix Marseille University, APHM, Marseille, France
| | - Jeanne Chatelon
- Department of Anesthesia, Intensive Care and Trauma Center, Nord University Hospital, Aix Marseille University, APHM, Marseille, France
| | - Amr Abulfatth
- Department of Anesthesia and Surgical Intensive Care, Alexandria Main University Hospitals, Azarita Medical Campus, Alexandria, Egypt
| | - Ahmed Ahmed
- Department of Anesthesia and Surgical Intensive Care, Alexandria Main University Hospitals, Azarita Medical Campus, Alexandria, Egypt
| | - Rabab Saleh
- Department of Anesthesia and Surgical Intensive Care, Alexandria Main University Hospitals, Azarita Medical Campus, Alexandria, Egypt
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Kim TW, Ahn J, Ryu JA. Machine learning-based predictor for neurologic outcomes in patients undergoing extracorporeal cardiopulmonary resuscitation. Front Cardiovasc Med 2023; 10:1278374. [PMID: 38045915 PMCID: PMC10691482 DOI: 10.3389/fcvm.2023.1278374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/06/2023] [Indexed: 12/05/2023] Open
Abstract
Background We investigated the predictors of poor neurological outcomes in extracorporeal cardiopulmonary resuscitation (ECPR) patients using machine learning (ML) approaches. Methods This study was a retrospective, single-center, observational study that included adult patients who underwent ECPR while hospitalized between January 2010 and December 2020. The primary outcome was neurologic status at hospital discharge as assessed by the Cerebral Performance Categories (CPC) score (scores range from 1 to 5). We trained and tested eight ML algorithms for a binary classification task involving the neurological outcomes of survivors after ECPR. Results During the study period, 330 patients were finally enrolled in this analysis; 143 (43.3%) had favorable neurological outcomes (CPC score 1 and 2) but 187 (56.7%) did not. From the eight ML algorithms initially considered, we refined our analysis to focus on the three algorithms, eXtreme Gradient Boosting, random forest, and Stochastic Gradient Boosting, that exhibited the highest accuracy. eXtreme Gradient Boosting models exhibited the highest accuracy among all the machine learning algorithms (accuracy: 0.739, area under the curve: 0.837, Kappa: 0.450, sensitivity: 0.700, specificity: 0.740). Across all three ML models, mean blood pressure emerged as the most influential variable, followed by initial serum lactate, and arrest to extracorporeal membrane oxygenation (ECMO) pump-on-time as important predictors in machine learning models for poor neurological outcomes following successful ECPR. Conclusions In conclusion, machine learning methods showcased outstanding predictive accuracy for poor neurological outcomes in patients who underwent ECPR.
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Affiliation(s)
- Tae Wan Kim
- Department of Pulmonary and Critical Care Medicine, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Republic of Korea
| | - Joonghyun Ahn
- Biomedical Statistics Center, Samsung Medical Center, Data Science Research Institute, Seoul, Republic of Korea
| | - Jeong-Am Ryu
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
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Soriano Hervás M, Robles-Hernández D, Serra A, Játiva-Porcar R, Gómez Quiles L, Maiocchi K, Llorca S, Climent MT, Llueca A. Analysis of Intraoperative Variables Responsible for the Increase in Lactic Acid in Patients Undergoing Debulking Surgery. J Pers Med 2023; 13:1540. [PMID: 38003855 PMCID: PMC10672096 DOI: 10.3390/jpm13111540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/26/2023] Open
Abstract
Background: Cytoreductive surgery (CRS) is a complex procedure with a high incidence of perioperative complications. Elevated lactacidaemia levels have been associated with complications and perioperative morbidity and mortality. This study aims to analyse the intraoperative variables of patients undergoing CRS and their relationship with lactacidaemia levels. Methods: This retrospective, observational study included 51 patients with peritoneal carcinomatosis who underwent CRS between 2014 and 2016 at the Abdomino-Pelvic Oncological Surgery Reference Unit (URCOAP) of the General University Hospital of Castellón (HGUCS). The main variable of interest was the level of lactic acid at the end of surgery. Intraoperative variables, including preoperative haemoglobin, duration of surgery, intraoperative bleeding, fluid therapy administered, administration of blood products, and intraoperative peritoneal cancer index (PCI), were analysed. Results: Positive correlations were found between lactic acid levels and PCI, duration of intervention, fluid therapy, intraoperative bleeding, and transfusion of blood products. Additionally, a negative correlation was observed between haemoglobin levels and lactic acid levels. Notably, the strongest correlations were found with operative PCI (ρ = 0.532; p-value < 0.001) and duration of surgery (ρ = 0.518; p-value < 0.001). Conclusions: PCI and duration of surgery are decisive variables in determining the prognosis of patients undergoing debulking surgery. This study suggests that, for each minute of surgery, lactic acid levels increase by 0.005 mmol/L, and for each unit increase in PCI, lactic acid levels increase by 0.060 mmol/L.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Daniel Robles-Hernández
- Department of Anaesthesiology, University La Plana Hospital, Road from Vila-Real to Burriana, km 0.5, 12540 Castellón, Spain
| | - Anna Serra
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Rosa Játiva-Porcar
- Department of Anaesthesiology, University General Hospital of Castellon, 12004 Castellon, Spain;
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
| | - Luis Gómez Quiles
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Karina Maiocchi
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Sara Llorca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of General Surgery, University General Hospital of Castellon, 12004 Castellon, Spain
| | - María Teresa Climent
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
| | - Antoni Llueca
- MUAPOS (Multidisciplinary Unit of Abdomino-Pelvic Oncology Surgery), University General Hospital of Castellon, 12004 Castellon, Spain; (A.S.)
- Department of Obstetrics and Gynaecology, University General Hospital of Castellon, 12004 Castellon, Spain
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Gomes BC, Lobo SMA, Sá Malbouisson LM, de Freitas Chaves RC, Domingos Corrêa T, Prata Amendola C, Silva Júnior JM. Trends in perioperative practices of high-risk surgical patients over a 10-year interval. PLoS One 2023; 18:e0286385. [PMID: 37725600 PMCID: PMC10508595 DOI: 10.1371/journal.pone.0286385] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 05/16/2023] [Indexed: 09/21/2023] Open
Abstract
INTRODUCTION In Brazil, data show an important decrease in morbi-mortality of high-risk surgical patients over a 10-year high. The objective of this post-hoc study was to evaluate the mechanism explaining this trend in high-risk surgical patients admitted to Brazilian ICUs in two large Brazilian multicenter cohort studies performed 10 years apart. METHODS The patients included in the 2 cohorts studies published in 2008 and 2018 were compared after a (1:1) propensity score matching. Patients included were adults who underwent surgeries and admitted to the ICU afterwards. RESULTS After matching, 704 patients were analyzed. Compared to the 2018 cohort, 2008 cohort had more postoperative infections (OR 13.4; 95%CI 6.1-29.3) and cardiovascular complications (OR 1.5; 95%CI 1.0-2.2), as well as a lower survival ICU stay (HR = 2.39, 95% CI: 1.36-4.20) and hospital stay (HR = 1.64, 95% CI: 1.03-2.62). In addition, by verifying factors strongly associated with hospital mortality, it was found that the risk of death correlated with higher intraoperative fluid balance (OR = 1.03, 95% CI 1.01-1.06), higher creatinine (OR = 1.31, 95% CI 1.1-1.56), and intraoperative blood transfusion (OR = 2.32, 95% CI 1.35-4.0). By increasing the mean arterial pressure, according to the limits of sample values from 43 mmHg to 118 mmHg, the risk of death decreased (OR = 0.97, 95% CI 0.95-0.98). The 2008 cohort had higher fluid balance, postoperative creatinine, and volume of intraoperative blood transfused and lower mean blood pressure at ICU admission and temperature at the end of surgery. CONCLUSION In this sample of ICUs in Brazil, high-risk surgical patients still have a high rate of complications, but with improvement over a period of 10 years. There were changes in the management of these patients over time.
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Affiliation(s)
- Brenno Cardoso Gomes
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo-SP, Brasil
- Departamento de Medicina Integrada do Setor de Ciências da Saúde da Universidade Federal do Paraná, Curitiba-PR, Brasil
| | | | | | | | | | | | - João Manoel Silva Júnior
- Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo (USP), São Paulo-SP, Brasil
- Hospital Israelita Albert Einstein, São Paulo-SP, Brasil
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7
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Liu W, Zhang S, Li Q, Wu Y, Jia X, Feng W, Li Z, Shi Y, Hou Q, Ma J, Liu Y, Gao P, Ganz T, Liu S. Lactate modulates iron metabolism by binding soluble adenylyl cyclase. Cell Metab 2023; 35:1597-1612.e6. [PMID: 37480842 DOI: 10.1016/j.cmet.2023.06.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 04/18/2023] [Accepted: 06/27/2023] [Indexed: 07/24/2023]
Abstract
Overproduction of lactate (LA) can occur during exercise and in many diseases such as cancers. Individuals with hyperlactatemia often display anemia, decreased serum iron, and elevated hepcidin, a key regulator of iron metabolism. However, it is unknown whether and how LA regulates hepcidin expression. Here, we show LA binds to soluble adenylyl cyclase (sAC) in normal hepatocytes and affects systemic iron homeostasis in mice by increasing hepcidin expression. Comprehensive in vitro, in vivo, and in silico experiments show that the LA-sAC interaction raises cyclic adenosine monophosphate (cAMP) levels, which activates the PKA-Smad1/5/8 signaling pathway to increase hepcidin transcription. We verified this regulatory axis in wild-type mice and in mice with disordered iron homeostasis. LA also regulates hepcidin in humans at rest and subjected to extensive exercise that produce elevated LA. Our study links hyperlactatemia to iron deficiency, offering a mechanistic explanation for anemias seen in athletes and patients with lactic acidosis.
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Affiliation(s)
- Wei Liu
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China; State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China
| | - Shuping Zhang
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Quanjin Li
- University of Chinese Academy of Sciences, Beijing 100049, China; National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Yue Wu
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xuan Jia
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Wenya Feng
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhaolong Li
- University of Chinese Academy of Sciences, Beijing 100049, China; National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Yali Shi
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Qingzhi Hou
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China
| | - Juan Ma
- State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Yajun Liu
- National Center for Orthopaedics, Beijing Jishuitan Hospital, Beijing 100035, China; Beijing Research Institute of Traumatology and Orthopaedics, Beijing 100035, China
| | - Pu Gao
- University of Chinese Academy of Sciences, Beijing 100049, China; National Laboratory of Biomacromolecules, CAS Center for Excellence in Biomacromolecules, Institute of Biophysics, Chinese Academy of Sciences, Beijing 100101, China
| | - Tomas Ganz
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Sijin Liu
- Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250117, China; State Key Laboratory of Environmental Chemistry and Ecotoxicology, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, Beijing 100085, China; University of Chinese Academy of Sciences, Beijing 100049, China.
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8
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Ray CC, Pollack MM, Gai J, Patel AK. The Association of the Lactate-Albumin Ratio With Mortality and Multiple Organ Dysfunction in PICU Patients. Pediatr Crit Care Med 2023; 24:760-766. [PMID: 37171215 PMCID: PMC10523881 DOI: 10.1097/pcc.0000000000003272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
OBJECTIVES To compare the relative associations of lactate, albumin, and the lactate-albumin ratio (LAR) measured early in disease course against mortality and prevalence of multiple organ dysfunction syndrome (MODS) in a general sample of critically ill pediatric patients. DESIGN Retrospective analysis of the Health Facts (Cerner Corporation, Kansas City, MO) national database. SETTING U.S. hospitals with PICUs. PATIENTS Children admitted to the ICU ( n = 648) from 2009 to 2018 who had lactate and albumin measured within 6 hours of admission. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS A total of 648 admissions were included, with an overall mortality rate of 10.8% ( n = 70) and a MODS prevalence of 29.3% ( n = 190). Compared with survivors, deaths had higher initial lactates (7.3 mmol/L [2.6-11.7 mmol/L] vs 1.9 mmol/L [1.2-3.1 mmol/L]; p < 0.01), lower initial albumins (3.3 g/dL [2.7-3.8 g/dL] vs 4.2 g/dL [3.7-4.7 g/dL]; p < 0.01), and higher LARs (2.2 [1.0-4.2] vs 0.5 [0.3-0.8]; p < 0.01), with similar trends in patients with MODS versus those without MODS. LAR demonstrated a higher odds ratio (OR) for death than initial lactate alone (2.34 [1.93-2.85] vs 1.29 [1.22-1.38]) and a higher OR for MODS than initial lactate alone (2.10 [1.73-2.56] vs 1.22 [1.16-1.29]). Area under the receiver operating characteristic (AUROC) curve of LAR for mortality was greater than initial lactate (0.86 vs 0.82; p < 0.01). The LAR AUROC for MODS was greater than the lactate AUROC (0.71 vs 0.66; p < 0.01). Trends of lactate, albumin, and LAR for mortality were consistent across several diagnostic subgroups (trauma, primary respiratory failure, toxicology), but not all. CONCLUSIONS LAR measured early in the course of critical illness is significantly associated with mortality and development of MODS when compared with initial lactate or initial albumin alone in critically ill pediatric patients.
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Affiliation(s)
- Christopher C Ray
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System, Washington, DC
| | - Murray M Pollack
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jiaxiang Gai
- Department of Pediatrics, Children's National Health System, Washington, DC
| | - Anita K Patel
- Department of Pediatrics, Division of Critical Care Medicine, Children's National Health System and George Washington University School of Medicine and Health Sciences, Washington, DC
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9
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Çeleğen M, Çeleğen K. Lactate Clearance as an Early Prognostic Marker of Mortality for Pediatric Trauma. KLINISCHE PADIATRIE 2023; 235:270-276. [PMID: 36379454 DOI: 10.1055/a-1829-6305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background While lactate clearance (LC) has already been shown as a prognostic indicator in clinical studies, its certain character needs to be defined in pediatric trauma. This research aimed to evaluate the correlation between early lactate clearance and mortality in pediatric trauma.Patients and methods A retrospective cohort study was conducted in a university hospital. Repeated LC was measured at admission, at the 2nd, 6th, and 12th hours post-admission. The association of lactate clearance with mortality was analyzed and using receiver operating characteristic (ROC) to determine the threshold levels of lactate clearance and also logistic regression analysis was performed to determine whether LC was an independent risk factor.Results Seventy-eight patients were included and overall mortality was 13%. LC values of the non-survivors was significantly lower than survivors for LC0-2 h (28.60±14.26 vs 4.64±15.90), LC0-6 h (46.63±15.23 vs 3.33±18.07), LC0-12 h (56.97±15.53 vs 4.82±22.59) (p:<0.001, p:<0.001 and p:<0.001, respectively). Areas under the curve of lactate clearance at the 2nd, 6th, and 12th hours after therapy start were a significant predictor for mortality (p:<0.001, p:<0.001, and p:<0.001, respectively). Threshold values of LC were 12.9, 19.5 and 29.3%, respectively.Conclusion Lactate clearance was a beneficial tool to estimate outcomes of pediatric trauma. Poor lactate clearance was a significant marker for poor prognosis.
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Affiliation(s)
- Mehmet Çeleğen
- Department of Pediatrics, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Kübra Çeleğen
- Division of Pediatric Nephrology, Department of Pediatrics, Afyonkarahisar Health Sciences University Faculty of Medicine, Afyonkarahisar, Turkey
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10
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Butt W. The Lactate-Albumin Ratio Predicts Multiple Organ Dysfunction Syndrome and Death, But Is It Ready to Use? Pediatr Crit Care Med 2023; 24:785-787. [PMID: 37668501 DOI: 10.1097/pcc.0000000000003317] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- Warwick Butt
- Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
- Department of Critical Care, Faculty of Medicine, Melbourne University, Melbourne, VIC, Australia
- Faculty of Medicine, Monash University, Melbourne, VIC, Australia
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11
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Refaeli E, Zarour S, Lior Y, Herut M, Rabkin V, Aharonov M, Ben-Tov T, Cohen B, Matot I. Prevalence of preoperative metabolic disturbances in elderly patients with hip fracture and their association with mortality - A retrospective cohort study. J Clin Anesth 2023; 88:111137. [PMID: 37182398 DOI: 10.1016/j.jclinane.2023.111137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 04/25/2023] [Accepted: 04/26/2023] [Indexed: 05/16/2023]
Abstract
STUDY OBJECTIVES To assess the prevalence of preoperative acidosis and lactatemia in elderly patients having hip fracture surgery and their association with post-operative mortality. DESIGN Retrospective cohort study. SETTING Single tertiary medical center. PATIENTS Patients ≥65 years having first traumatic hip fracture surgery between 2018 and 2021. MEASUREMENTS 90-day postoperative mortality. MAIN RESULTS In total, 1267 patients were included in the primary analysis (mean (SD) age 83(8) years; 802 (69%) females; median [Interquartile Range (IQR)] American Society of Anesthesiologists (ASA) physical score 3 [2,3]). Of these, 1227 were available for the multivariable analyses. Median [IQR] time from hospitalization to surgery was 28 [20, 42] hours. All-cause 90-day mortality rate was 9% (N = 114). The incidence of preoperative acidosis (pH < 7.35) and lactatemia (>1.2 mmol/L) was significantly higher among non-survivors. Mortality was highest in patients with both acidosis and lactatemia (19.1% compared to 4.4% among patients with neither). In a multivariable model, pH <7.35 and lactate >1.2 mmol/L remained independent predictors of 90-day mortality, with adjusted odds ratio (aOR) (95%CI) of 1.99 (1.31 to 3.04) and 2.32 (1.44 to 3.74), respectively, p = 0.001 for both. Time from hospitalization to surgery was not associated with mortality after adjustment for metabolic indices, aOR 1.00 (0.99, 1.00). CONCLUSIONS Preoperative acidosis and lactatemia are common among patients ≥65 years having hip fracture surgery and are associated with 90-day all-cause mortality. Time from hospital admission to surgery is not an independent risk factor, once adjusted for metabolic indices. Future studies should evaluate whether the increased risk associated with preoperative metabolic disturbances is modifiable.
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Affiliation(s)
- E Refaeli
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - S Zarour
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - Y Lior
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - M Herut
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - V Rabkin
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - M Aharonov
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - T Ben-Tov
- Division of Orthopedic surgery, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel
| | - B Cohen
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel; Outcomes Research Consortium, Cleveland, OH, United States of America
| | - I Matot
- Division of Anesthesia, Intensive Care, and Pain, Tel-Aviv Medical Center, Tel-Aviv University, Tel-Aviv, Israel.
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12
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Yu R, Liang T, Li L, Bi Y, Meng X. Predictive role of arterial lactate in acute kidney injury associated with off-pump coronary artery bypass grafting. Front Surg 2023; 10:1089518. [PMID: 37009616 PMCID: PMC10060891 DOI: 10.3389/fsurg.2023.1089518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/23/2023] [Indexed: 03/18/2023] Open
Abstract
ObjectivesThis observational study aims to explore the predictive role of postoperative arterial lactate in off-pump coronary artery bypass grafting (CABG)-associated acute kidney injury (AKI).Materials and methodsA total of 500 consecutive patients who underwent off-pump CABG from August 2020 to August 2021 at the Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, were included. Logistic regression analysis was used to confirm the independent risk factors of off-pump CABG-associated AKI. Receiver operating characteristic (ROC) curve was performed to evaluate the discrimination ability and Hosmer–Lemeshow goodness of fit test was performed to evaluate the calibration ability.ResultsThe incidence of off-pump CABG-associated AKI was 20.6%. Female gender, preoperative albumin, baseline serum creatinine, 12 h postoperative arterial lactate and duration of mechanical ventilation were independent risk factors. The area under the ROC curve (AUC) of 12 h postoperative arterial lactate for predicting off-pump CABG-associated AKI was 0.756 and the cutoff value was 1.85. The prediction model that incorporated independent risk factors showed reliable predictive ability (AUC = 0.846). Total hospital stay, intensive care unit stay, occurrence of other postoperative complications, and 28-day mortality were all significantly higher in AKI group compared to non-AKI group.Conclusion12 h postoperative arterial lactate was a validated predictive biomarker for off-pump CABG-associated AKI. We constructed a predictive model that facilitates the early recognition and management of off-pump CABG-associated AKI.
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Affiliation(s)
- Ruiming Yu
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Tingyi Liang
- Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, China
| | - Longfei Li
- Shandong Institute of Medical Device and Pharmaceutical Packaging Inspection, Jinan, China
| | - Yanwen Bi
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
| | - Xiangbin Meng
- Department of Cardiovascular Surgery, Qilu Hospital of Shandong University, Jinan, China
- Correspondence: Xiangbin Meng
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13
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Darwen C, Bryan A, Quraishi-Akhtar T, Moore J. Postoperative hyperlactataemia and preoperative cardiopulmonary exercise testing in an elective noncardiac surgical cohort: a retrospective observational study. BJA OPEN 2023; 5:100124. [PMID: 37587998 PMCID: PMC10430863 DOI: 10.1016/j.bjao.2023.100124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 01/03/2023] [Indexed: 08/18/2023]
Abstract
Background Blood lactate concentration in the postoperative period is a marker of physiological stress and a predictor of complications and mortality. Cardiopulmonary exercise testing (CPET) is a common preoperative risk stratification tool. We aimed to investigate the association between preoperative CPET results and postoperative lactate concentration with postoperative mortality after major noncardiac surgery. Methods We analysed data from patients undergoing major noncardiac surgery in a tertiary UK centre between 2007 and 2014 who had preoperative CPET and postoperative lactate measurements. Univariate and multivariate analyses were performed to assess the association between lactate concentration, CPET results, or both and mortality. Results We analysed data from 1075 patients. A mean lactate concentration >2 mM in the first 12, 24, and 48 h after surgery was associated with odds ratios (ORs) and 95% confidence intervals (CIs) for 30-day mortality of 3.9 (2.1-7.3; P<0.005), 4.5 (2.4-8.4; P<0.005), and 6.1 (3.3-11.5; P<0.005), respectively. The dichotomous CPET variable, ventilatory equivalence for CO2 (V̇E/V̇co2; cut-off 34), was associated with increased risk of 30-day mortality (OR 2.5; 95% CI: 1.3-4.8; P<0.005). In a multivariable model, hyperlactataemia and poor V̇E/V̇co2 retained their significant associations with 30- and 90-day mortality when adjusted for age, BMI, and surgical risk. When looking at the combined effect of the dichotomous hyperlactataemia in the first 24 h (cut-off 2 mM) and preoperative V̇E/V̇co2, the OR for 30-day mortality was 11.53 (95% CI: 4.6-28.8; P≤0.005). Conclusions Our study suggests that postoperative hyperlactataemia and preoperative poor V̇E/V̇co2 are independently associated with an increased risk of mortality after major noncardiac surgery.
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Affiliation(s)
| | - Angella Bryan
- Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - Tanviha Quraishi-Akhtar
- Manchester University NHS Foundation Trust, Manchester, UK
- Cardiovascular Sciences, University of Manchester, Manchester, UK
| | - John Moore
- Manchester University NHS Foundation Trust, Manchester, UK
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14
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Klemcke HG, Calderon ML, Ryan KL, Xiang L, Hinojosa-Laborde C. Effects of extremity trauma on physiological responses to hemorrhage in conscious rats. J Appl Physiol (1985) 2023; 134:203-215. [PMID: 36519571 PMCID: PMC9829477 DOI: 10.1152/japplphysiol.00191.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 12/09/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022] Open
Abstract
Although physiological responses to hemorrhage are well-studied, hemorrhage is often accompanied by trauma, and it remains unclear how injury affects these responses. This study examined effects of extremity trauma on cardiorespiratory responses and survival to moderate (37%; H-37) or severe (50%; H-50) hemorrhage in rats. Transmitter and carotid catheter implantation and extremity trauma (fibular fracture and muscle injury) were conducted 2 wk, 24 h, and 90 min, respectively, before conscious hemorrhage. Mean arterial pressure (MAP) and heart rate (HR; via telemetry), and respiration rate (RR), minute volume (MV), and tidal volume (TV; via plethysmography) were measured throughout the 25 min hemorrhage and remainder of the 4 h observation period. There were four groups: 1) H-37, no trauma (NT; n = 17); 2) H-37, extremity trauma (T, n = 18); 3) H-50, NT (n = 20); and 4) H-50, T (n = 20). For H-37, during and after hemorrhage, T increased HR (P ≤ 0.031) and MV (P ≤ 0.048) compared with NT rats. During H-50, T increased HR (0.041) and MV (P = 0.043). After hemorrhage, T increased MV (P = 0.008) but decreased HR (P = 0.007) and MAP (P = 0.039). All cardiorespiratory differences between T and NT groups were intermittent. Importantly, both survival time (159.8 ± 78.2 min vs. 211.9 ± 60.3 min; P = 0.022; mean ± SD) and percent survival (45% vs. 80%; P = 0.048) were less in T versus NT rats after H-50. Trauma interacts with physiological systems in a complex manner and no single cardiorespiratory measure was sufficiently altered to indicate that it alone could account for increased mortality after H-50.NEW & NOTEWORTHY In both civilian and military settings, severe hemorrhage rarely occurs in the absence of tissue trauma, yet many animal models for the study of hemorrhage do not include significant tissue trauma. This study using conscious unrestrained rats clearly demonstrates that extremity trauma worsens the probability of survival after a severe hemorrhage. Although no single cardiorespiratory factor accounted for the increased mortality, multiple modest time-related cardiorespiratory responses to the trauma were observed suggesting that their combined dysfunction may have contributed to the reduced survival.
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Affiliation(s)
- Harold G Klemcke
- US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Mariam L Calderon
- US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Kathy L Ryan
- US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Lusha Xiang
- US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
| | - Carmen Hinojosa-Laborde
- US Army Institute of Surgical Research, Joint Base San Antonio-Fort Sam Houston, San Antonio, Texas
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15
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Coeckelenbergh S, Desebbe O, Carrier FM, Thepault F, De Oliveira C, Pellerin F, Le Canne C, Herboulier L, Laukaityte E, Moussa M, Toubal L, Kato H, Pham H, Roullet S, Lanteri Minet M, Amara Y, Naili S, Ciacio O, Cherqui D, Duranteau J, Vincent JL, Van der Linden P, Joosten A. Intraoperative measurement of the respiratory exchange ratio predicts postoperative complications after liver transplantation. BMC Anesthesiol 2022; 22:405. [PMID: 36577954 PMCID: PMC9795787 DOI: 10.1186/s12871-022-01949-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 12/16/2022] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND During surgery, any mismatch between oxygen delivery (DO2) and consumption (VO2) can promote the development of postoperative complications. The respiratory exchange ratio (RER), defined as the ratio of carbon dioxide (CO2) production (VCO2) to VO2, may be a useful noninvasive tool for detecting inadequate DO2. The primary objective of this study was to test the hypothesis that RER measured during liver transplantation may predict postoperative morbidity. Secondary objectives were to assess the ability of other variables used to assess the DO2/VO2 relationship, including arterial lactate, mixed venous oxygen saturation, and veno-arterial difference in the partial pressure of carbon dioxide (VAPCO2gap), to predict postoperative complications. METHODS This retrospective study included consecutive adult patients who underwent liver transplantation for end stage liver disease from June 27th, 2020, to September 5th, 2021. Patients with acute liver failure were excluded. All patients were routinely equipped with a pulmonary artery catheter. The primary analysis was a receiver operating characteristic (ROC) curve constructed to investigate the discriminative ability of the mean RER measured during surgery to predict postoperative complications. RER was calculated at five standardized time points during the surgery, at the same time as measurement of blood lactate levels and arterial and mixed venous blood gases, which were compared as a secondary analysis. RESULTS Of the 115 patients included, 57 developed at least one postoperative complication. The mean RER (median [25-75] percentiles) during surgery was significantly higher in patients with complications than in those without (1.04[0.96-1.12] vs 0.88[0.84-0.94]; p < 0.001). The area under the ROC curve was 0.87 (95%CI: 0.80-0.93; p < 0.001) with a RER value (Youden index) of 0.92 giving a sensitivity of 91% and a specificity of 74% for predicting the occurrence of postoperative complications. The RER outperformed all other measured variables assessing the DO2/VO2 relationship (arterial lactate, SvO2, and VAPCO2gap) in predicting postoperative complications. CONCLUSION During liver transplantation, the RER can reliably predict postoperative complications. Implementing this measure intraoperatively may provide a warning for physicians of impending complications and justify more aggressive optimization of oxygen delivery. Further studies are required to determine whether correcting the RER is feasible and could reduce the incidence of complications.
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Affiliation(s)
- Sean Coeckelenbergh
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France ,grid.512286.aOutcomes Research Consortium, Cleveland, OH USA
| | - Olivier Desebbe
- Department of Anesthesiology and Perioperative Medicine Sauvegarde Clinic, Ramsay Santé, Lyon, France
| | - François Martin Carrier
- grid.410559.c0000 0001 0743 2111Department of Anesthesiology and Department of Medicine, Critical Care Division, Centre hospitalier de l’Université de Montréal, Montréal, Québec, Canada
| | - Francois Thepault
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Cécile De Oliveira
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Florian Pellerin
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Cyril Le Canne
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Laurence Herboulier
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Edita Laukaityte
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Maya Moussa
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Leila Toubal
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Hiromi Kato
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Hung Pham
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Stephanie Roullet
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Marc Lanteri Minet
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Youssef Amara
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Salima Naili
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Oriana Ciacio
- grid.413133.70000 0001 0206 8146Department of Liver Hepatobiliary Surgery & Liver Transplantation, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Daniel Cherqui
- grid.413133.70000 0001 0206 8146Department of Liver Hepatobiliary Surgery & Liver Transplantation, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Jacques Duranteau
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
| | - Jean-Louis Vincent
- grid.4989.c0000 0001 2348 0746Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Alexandre Joosten
- grid.413133.70000 0001 0206 8146Department of Anesthesiology and Intensive Care, Paul Brousse Hospital, Assistance Publique - Hôpitaux de Paris, Université Paris-Saclay, Villejuif, France
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Gupta M, Agrawal N, Sharma SK, Ansari AK, Mahmood T, Singh L. Study of Utility of Basic Arterial Blood Gas Parameters and Lactate as Prognostic Markers in Patients With Severe Dengue. Cureus 2022; 14:e24682. [PMID: 35663676 PMCID: PMC9163704 DOI: 10.7759/cureus.24682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 01/15/2023] Open
Abstract
Background The importance of prognostication in critical care cannot be over-emphasized, especially in the context of diseases like dengue, as their presentation may vary from mild fever to critical life-threatening illness. With the help of prognostic markers, it is possible to identify patients at higher risk and thus improve their outcome with timely intervention. Basic arterial blood gas (ABG) parameters, i.e., potential of hydrogen (pH), partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2) and bicarbonate are useful parameters, especially in critical care medicine as they are known to vary with the severity of illness. Hyperlactatemia is often referred to as a “powerful predictor of mortality”. Basic ABG parameters and lactate have been used as an essential prognostic modality in critically ill patients for decades; however, the evidence remains limited for their role as prognostic markers in patients with severe dengue. Method We carried out an observational retrospective cohort study comprising 163 patients with severe dengue, admitted between July 2021 and November 2021 at Medical Intensive Care Unit (MICU) of Shri Ram Murti Smarak Institute of Medical Sciences (SRMS IMS), Bareilly, Uttar Pradesh, India. Basic ABG parameters and lactate levels at the time of admission to MICU were compared between survivor and non-survivor groups of patients with severe dengue in order to evaluate their prognostic utility as predictors of mortality. Results pH (p<0.0001), PO2 (p=0.01) and bicarbonate (<0.0001) levels were significantly lower, while PCO2 (p=0.002) and lactate (p<0.0001) levels were significantly higher in non-survivor group as compared to survivor group. Lactate was found to be the best prognostic marker with Area Under the Curve (AUC) of 88.7% on Receiver Operating Characteristics (ROC) analysis. Conclusion Basic arterial blood gas parameters and lactate can be used as feasible prognostic markers in patients with severe dengue.
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Jerkku T, Tsilimparis N, Banafsche R. Die Gefäßverletzung – eine unterschätzte Entität? GEFÄSSCHIRURGIE 2022; 27:156-169. [PMID: 35495898 PMCID: PMC9040697 DOI: 10.1007/s00772-022-00892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 11/28/2022]
Abstract
Hintergrund In der Traumatologie sind Gefäße eher selten betroffen und isolierte vaskuläre Traumata (VT) sind rar. Es existieren daher wenig belastbare und aktuelle Zahlen zu Inzidenz und Mortalität. Fragestellung Es wird anhand ausgewählter Referenzen sowie eigener abgeschlossener und laufender Studien aus Registerdaten des TraumaRegister DGU® (TR-DGU) zum VT im Rahmen der Schwerverletztenversorgung in Deutschland berichtet. Material und Methode Pointierte Literaturübersicht und Bericht über 2 retrospektive Auswertungen von Datensätzen des TraumaRegister DGU® (TR-DGU): Daten mit moderatem bis schwerem VT im Verletzungsmuster werden mit Daten ohne VT (non-VT) bei gleicher Verletzungsschwere verglichen. Zielgrößen sind Morbidität, Mortalität sowie Verlaufs- und Prognoseparameter. Ergebnisse In der Auswertung 2002–2012 (TR-DGU Projekt-ID 2013-011) zeichnete sich der Einfluss von Allokation und Versorgungsstufe der Traumazentren auf erwartete (EM) und beobachtete Mortalität (OM) von 2961 Fällen mit VT unter 42.326 Schwerverletzten (7 %) ab: Die Differenz von OM zu EM bei VT beträgt + 3,4 % vs. ± 0,1 % bei non-VT. Aufgrund der OM bei schwerem VT von 33,8 % vs. 16,4 % bei non-VT mit gleicher Verletzungsschwere wurde 2018 eine Folgeauswertung veranlasst (2008–2017; TR-DGU Projekt-ID 2018-045). Hier kann die Substratifizierung von isoliertem, führendem und begleitendem VT in der Versorgungsrealität signifikante Effekte von Versorgungsstufe, Allokation und Transport auf die OM zeigen. Nur bei VT zeigt sich eine relevante Nichtübereinstimmung von OM zu EM. Im Mittel etwa + 2 % und in Hochrisikokonstellationen mit VT bis zu + 29 % als Maß für die Relevanz von VT in der Traumaversorgung. Schlussfolgerungen Diese Ergebnisse legen eine weitere Optimierung der Schwerverletztenversorgung bei VT nahe, da sich VT-Vigilanz, Allokation, Transport und eine niedrigschwellige Frühverlegung als Ansatzpunkte ableiten lassen.
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Affiliation(s)
- Thomas Jerkku
- Abteilung Gefäßchirurgie und Endovaskuläre Chirurgie, Klinikum der Universität München, München, Deutschland
- Present Address: Abteilung für Gefäßchirurgie, Klinikum Landkreis Erding, Erding, Deutschland
| | - Nikolaos Tsilimparis
- Abteilung Gefäßchirurgie und Endovaskuläre Chirurgie, Klinikum der Universität München, München, Deutschland
| | - Ramin Banafsche
- Abteilung Gefäßchirurgie und Endovaskuläre Chirurgie, Klinikum der Universität München, München, Deutschland
- VASQLAR. Facharztzentrum für Gefäßmedizin, Hauptstr. 5 B, 82319 Starnberg, Deutschland
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18
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Kang MK, Oh SY, Lee H, Ryu HG. Pre and postoperative lactate levels and lactate clearance in predicting in-hospital mortality after surgery for gastrointestinal perforation. BMC Surg 2022; 22:93. [PMID: 35264127 PMCID: PMC8908642 DOI: 10.1186/s12893-022-01479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to compare the prognostic significance of pre and postoperative lactate levels and postoperative lactate clearance in the prediction of in-hospital mortality after surgery for gastrointestinal (GI) perforation. Methods Among patients who underwent surgery for GI perforation between 2013 and 2017, only patients whose lactate were measured before and after surgery were included and divided into an in-hospital mortality group and a survival group. Data on demographics, comorbidities, pre and postoperative laboratory test results, and operative findings were collected. Risk factors for in-hospital mortality were identified, and receiver-operating characteristic (ROC) curve analysis was performed for pre and postoperative lactate levels and postoperative lactate clearance. Results Of 104 included patients, 17 patients (16.3%) died before discharge. The in-hospital mortality group demonstrated higher preoperative lactate (6.3 ± 5.1 vs. 3.5 ± 3.2, P = 0.013), SOFA score (4.5 ± 1.7 vs. 3.4 ± 2.3, P = 0.004), proportions of patients with lymphoma (23.5% vs. 2.3%, P = 0.006), and rates of contaminated ascites (94.1% vs. 68.2%, P = 0.036) and lower preoperative hemoglobin (10.4 ± 1.6 vs. 11.8 ± 2.4, P = 0.018) compare to the survival group. Multivariate analysis revealed that postoperative lactate (HR 1.259, 95% CI 1.084–1.463, P = 0.003) and preoperative hemoglobin (HR 0.707, 95% CI 0.520–0.959, P = 0.026) affected in-hospital mortality. In the ROC curve analysis, the largest area under the curve (AUC) was shown in the postoperative lactate level (AUC = 0.771, 95% CI 0.678–0.848). Conclusion Of perioperative lactate levels in patients underwent surgery for GI perforation, postoperative lactate was the strongest predictor for in-hospital mortality. Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01479-1.
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Affiliation(s)
- Min Kyu Kang
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Young Oh
- Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. .,Department of Critical Care Medicine , Seoul National University Hospital, Seoul, Korea.
| | - Hannah Lee
- Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
| | - Ho Geol Ryu
- Department of Critical Care Medicine , Seoul National University Hospital, Seoul, Korea.,Department of Anesthesiology, Seoul National University College of Medicine, Seoul, Korea
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Chalumuri YR, Kimball JP, Mousavi A, Zia JS, Rolfes C, Parreira JD, Inan OT, Hahn JO. Classification of Blood Volume Decompensation State via Machine Learning Analysis of Multi-Modal Wearable-Compatible Physiological Signals. SENSORS (BASEL, SWITZERLAND) 2022; 22:1336. [PMID: 35214238 PMCID: PMC8963055 DOI: 10.3390/s22041336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 01/14/2022] [Accepted: 01/25/2022] [Indexed: 12/15/2022]
Abstract
This paper presents a novel computational algorithm to estimate blood volume decompensation state based on machine learning (ML) analysis of multi-modal wearable-compatible physiological signals. To the best of our knowledge, our algorithm may be the first of its kind which can not only discriminate normovolemia from hypovolemia but also classify hypovolemia into absolute hypovolemia and relative hypovolemia. We realized our blood volume classification algorithm by (i) extracting a multitude of features from multi-modal physiological signals including the electrocardiogram (ECG), the seismocardiogram (SCG), the ballistocardiogram (BCG), and the photoplethysmogram (PPG), (ii) constructing two ML classifiers using the features, one to classify normovolemia vs. hypovolemia and the other to classify hypovolemia into absolute hypovolemia and relative hypovolemia, and (iii) sequentially integrating the two to enable multi-class classification (normovolemia, absolute hypovolemia, and relative hypovolemia). We developed the blood volume decompensation state classification algorithm using the experimental data collected from six animals undergoing normovolemia, relative hypovolemia, and absolute hypovolemia challenges. Leave-one-subject-out analysis showed that our classification algorithm achieved an F1 score and accuracy of (i) 0.93 and 0.89 in classifying normovolemia vs. hypovolemia, (ii) 0.88 and 0.89 in classifying hypovolemia into absolute hypovolemia and relative hypovolemia, and (iii) 0.77 and 0.81 in classifying the overall blood volume decompensation state. The analysis of the features embedded in the ML classifiers indicated that many features are physiologically plausible, and that multi-modal SCG-BCG fusion may play an important role in achieving good blood volume classification efficacy. Our work may complement existing computational algorithms to estimate blood volume compensatory reserve as a potential decision-support tool to provide guidance on context-sensitive hypovolemia therapeutic strategy.
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Affiliation(s)
- Yekanth Ram Chalumuri
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; (A.M.); (J.D.P.)
| | - Jacob P. Kimball
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA; (J.P.K.); (J.S.Z.); (O.T.I.)
| | - Azin Mousavi
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; (A.M.); (J.D.P.)
| | - Jonathan S. Zia
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA; (J.P.K.); (J.S.Z.); (O.T.I.)
| | - Christopher Rolfes
- Global Center for Medical Innovation, Translational Training and Testing Laboratories, Inc. (T3 Labs), Atlanta, GA 30313, USA;
| | - Jesse D. Parreira
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; (A.M.); (J.D.P.)
| | - Omer T. Inan
- Department of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30308, USA; (J.P.K.); (J.S.Z.); (O.T.I.)
| | - Jin-Oh Hahn
- Department of Mechanical Engineering, University of Maryland, College Park, MD 20742, USA; (A.M.); (J.D.P.)
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20
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Multisystem Trauma. Perioper Med (Lond) 2022. [DOI: 10.1016/b978-0-323-56724-4.00036-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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21
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Assessment of Metabolic Dysfunction in Sepsis in a Retrospective Single-Centre Cohort. Crit Care Res Pract 2021; 2021:3045454. [PMID: 34966560 PMCID: PMC8712182 DOI: 10.1155/2021/3045454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/01/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Our primary aim was to assess selected metabolic dysfunction parameters, both independently and as a complement to the SOFA score, as predictors of short-term mortality in patients with infection admitted to the intensive care unit (ICU). Methods We retrospectively enrolled all consecutive adult patients admitted to the eight ICUs of Lille University Hospital, between January 2015 and September 2016, with suspected or confirmed infection. We selected seven routinely measured biological and clinical parameters of metabolic dysfunction (maximal arterial lactatemia, minimal and maximal temperature, minimal and maximal glycaemia, cholesterolemia, and triglyceridemia), in addition to age and the Charlson's comorbidity score. All parameters and SOFA scores were recorded within 24 h of admission. Results We included 956 patients with infection, among which 295 (30.9%) died within 90 days. Among the seven metabolic parameters investigated, only maximal lactatemia was associated with higher risk of 90-day hospital mortality in SOFA-adjusted analyses (SOFA-adjusted OR, 1.17; 95%CI, 1.10 to 1.25; p < 0.001). Age and the Charlson's comorbidity score were also statistically associated with a poor prognosis in SOFA-adjusted analyses. We were thus able to develop a metabolic failure, age, and comorbidity assessment (MACA) score based on scales of lactatemia, age, and the Charlson's score, intended for use in combination with the SOFA score. Conclusions The maximal lactatemia level within 24 h of ICU admission is the best predictor of short-term mortality among seven measures of metabolic dysfunction. Our combined "SOFA + MACA" score could facilitate early detection of patients likely to develop severe infections. Its accuracy requires further evaluation.
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22
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Yu C, Fan W, Shao M. Norepinephrine Dosage Is Associated With Lactate Clearance After Resuscitation in Patients With Septic Shock. Front Med (Lausanne) 2021; 8:761656. [PMID: 34950680 PMCID: PMC8688855 DOI: 10.3389/fmed.2021.761656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 11/16/2021] [Indexed: 12/25/2022] Open
Abstract
Background: Some septic shock patients have persistent hyperlactacidemia despite a normal systemic hemodynamics after resuscitation. Central venous oxygen saturation (ScvO2), mean arterial pressure (MAP), and central venous pressure (CVP) cannot be target in subsequent hemodynamic treatments. Vasoplegia is considered to be one of the main causes of oxygen metabolism abnormalities in septic shock patients, and norepinephrine (NE) is the first-line vasopressor in septic shock treatment; its dosage represents the severity of vasoplegia. This study was performed to determine whether vasoplegia, as assessed by NE dosage, can indicate patients' lactate clearance after the completion of resuscitation. Methods: A retrospective study was performed, and 106 patients with septic shock in an intensive care unit were analyzed. Laboratory values and hemodynamic variables were obtained upon completion of resuscitation (H 0) and 6 h after (H 6). Lactate clearance was defined as the percent decrease in lactate from H 0 to H 6. Student's t-test, Mann-Whitney U-test, Chi-square or Fisher's exact tests, logistic regression analysis, and receiver operating characteristic (ROC) curve analysis were performed for statistical analysis. Results: Patients with a mean age of 63.7 ± 13.8 years, baseline APACHE II score of 21.0 ± 5.1, and SOFA score of 12.7 ± 2.7 were enrolled. The study found that after 6-h of resuscitation, lactate clearance (LC) was <10% in 33 patients (31.1%). Patients with 6-h LC <10% compared with 6-h LC ≥ 10% had a higher NE dose (μg·kg−1·min−1) (0.55 [0.36–0.84] vs. 0.25 [0.18–0.41], p < 0.001). Multivariate logistic regression analysis of statistically significant univariate variables showed that NE dose had a significant inverse relationship with 6-h LC < 10%. The cutoff for NE was ≥ 0.32 μg·kg−1·min−1 for predicting 6-h lactate clearance after resuscitation, with a sensitivity of 75.76% and a specificity of 70.00%. Septic shock patients with an NE dose ≥ 0.32 μg·kg−1·min−1, relative to patients with an NE dose < 0.32 μg·kg−1·min−1, had a greater 30-day mortality rate (69.8% vs. 26.4% p < 0.001). Conclusion: Some patients with septic shock had persistent oxygen metabolism disorders after hemodynamic resuscitation. NE dose may indicate vasoplegia and oxygen metabolism disorder. After resuscitation, septic shock patients with high-dose NE have lower lactate clearance and a greater 30-day mortality rate than those with low-dose NE.
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Affiliation(s)
- Chao Yu
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Wenjing Fan
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Min Shao
- Department of Critical Care Medicine, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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23
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Belaunzaran M, Raslan S, Ali A, Newsome K, McKenney M, Elkbuli A. Utilization and Efficacy of Resuscitation Endpoints in Trauma and Burn Patients: A Review Article. Am Surg 2021; 88:10-19. [PMID: 34761698 DOI: 10.1177/00031348211060424] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Shock is a sequelae in trauma and burn patients that substantially increases the risk for morbidity and mortality. The use of resuscitation endpoints allows for improved management of these patients, with the potential to prevent further morbidity/mortality. We conducted a review of the current literature on the efficacy of hemodynamic, metabolic, and regional resuscitation endpoints for use in trauma and burn patients. Hemodynamic endpoints included mean arterial pressure (MAP), heart rate (HR), urinary output (UO), compensatory reserve index (CRI), intrathoracic blood volume, and stroke volume variation (SVV). Metabolic endpoints measure cellular responses to decreased oxygen delivery and include serum lactic acid (LA), base deficit (BD), bicarbonate, anion gap, apparent strong ion difference, and serum pH. Mean arterial pressure, HR, UO, and LA are the most established markers of trauma and burn resuscitation. The evidence suggests LA is a superior metabolic endpoint marker. Newer resuscitation endpoint technologies such as point-of-care ultrasound (PoCUS), thromboelastography (TEG), and rotational thromboelastometry (ROTEM) may improve patient outcomes; however, additional research is needed to establish the efficacy in trauma and burn patients. The endpoints discussed have situational strengths and weaknesses and no single universal resuscitation endpoint has yet emerged. This review may increase knowledge and aid in guideline development. We recommend clinicians continue to integrate multiple endpoints with emphasis on MAP, HR, UO, LA, and BD. Future investigation should aim to standardize endpoints for each clinical presentation. The search for universal and novel resuscitation parameters in trauma and burns should also continue.
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Affiliation(s)
- Miguel Belaunzaran
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Shahm Raslan
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Aleeza Ali
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Kevin Newsome
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
| | - Mark McKenney
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA.,University of South Florida, Tampa, FL, USA
| | - Adel Elkbuli
- Department of Surgery, Division of Trauma and Surgical Critical Care, Kendall Regional Medical Center, Miami, FL, USA
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24
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Pattharanitima P, Thongprayoon C, Petnak T, Srivali N, Gembillo G, Kaewput W, Chesdachai S, Vallabhajosyula S, O’Corragain OA, Mao MA, Garovic VD, Qureshi F, Dillon JJ, Cheungpasitporn W. Machine Learning Consensus Clustering Approach for Patients with Lactic Acidosis in Intensive Care Units. J Pers Med 2021; 11:jpm11111132. [PMID: 34834484 PMCID: PMC8623582 DOI: 10.3390/jpm11111132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Lactic acidosis is a heterogeneous condition with multiple underlying causes and associated outcomes. The use of multi-dimensional patient data to subtype lactic acidosis can personalize patient care. Machine learning consensus clustering may identify lactic acidosis subgroups with unique clinical profiles and outcomes. METHODS We used the Medical Information Mart for Intensive Care III database to abstract electronic medical record data from patients admitted to intensive care units (ICU) in a tertiary care hospital in the United States. We included patients who developed lactic acidosis (defined as serum lactate ≥ 4 mmol/L) within 48 h of ICU admission. We performed consensus clustering analysis based on patient characteristics, comorbidities, vital signs, organ supports, and laboratory data to identify clinically distinct lactic acidosis subgroups. We calculated standardized mean differences to show key subgroup features. We compared outcomes among subgroups. RESULTS We identified 1919 patients with lactic acidosis. The algorithm revealed three best unique lactic acidosis subgroups based on patient variables. Cluster 1 (n = 554) was characterized by old age, elective admission to cardiac surgery ICU, vasopressor use, mechanical ventilation use, and higher pH and serum bicarbonate. Cluster 2 (n = 815) was characterized by young age, admission to trauma/surgical ICU with higher blood pressure, lower comorbidity burden, lower severity index, and less vasopressor use. Cluster 3 (n = 550) was characterized by admission to medical ICU, history of liver disease and coagulopathy, acute kidney injury, lower blood pressure, higher comorbidity burden, higher severity index, higher serum lactate, and lower pH and serum bicarbonate. Cluster 3 had the worst outcomes, while cluster 1 had the most favorable outcomes in terms of persistent lactic acidosis and mortality. CONCLUSIONS Consensus clustering analysis synthesized the pattern of clinical and laboratory data to reveal clinically distinct lactic acidosis subgroups with different outcomes.
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Affiliation(s)
- Pattharawin Pattharanitima
- Department of Internal Medicine, Faculty of Medicine, Thammasat University, Pathum Thani 12121, Thailand
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
| | - Tananchai Petnak
- Division of Pulmonary and Pulmonary Critical Care Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand;
| | - Narat Srivali
- Division of Pulmonary Medicine, St. Agnes Hosipital, Baltimore, MD 21229, USA;
| | - Guido Gembillo
- Unit of Nephrology and Dialysis, Department of Clinical and Experimental Medicine, University of Messina, 98125 Messina, Italy;
| | - Wisit Kaewput
- Department of Military and Community Medicine, Phramongkutklao College of Medicine, Bangkok 10400, Thailand;
| | - Supavit Chesdachai
- Division of Infectious Disease, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA;
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA;
| | - Oisin A. O’Corragain
- Department of Thoracic Medicine and Surgery, Temple University Hospital, Philadelphia, PA 19140, USA;
| | - Michael A. Mao
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Vesna D. Garovic
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Fawad Qureshi
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - John J. Dillon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA; (V.D.G.); (F.Q.); (J.J.D.)
- Correspondence: (P.P.); (C.T.); (W.C.)
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25
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Song W, Mobli K, Jupiter DC, Radhakrishnan RS. CVP and echo Measurements are Associated with Improved Outcomes in Patients with Gastrointestinal (GI) Hemorrhage: A Retrospective Analysis of the MIMIC- IV Database. J Intensive Care Med 2021; 37:925-935. [PMID: 34636687 DOI: 10.1177/08850666211046175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Purpose: Mortality associated with acute Gastrointestinal (GI) hemorrhage in intensive care units (ICU) has remained high in patients suffering from hemodynamic instability. Prompt recognition and rapid assessment of bleeding severity are crucial to improve survival. Central venous pressure (CVP) monitoring is commonly used for early recognition of intravascular imbalances, but its effectiveness in predicting fluid responsiveness is often questioned. Echocardiography (echo) is a rapid, noninvasive method to repeatedly assess cardiac function and fluid responsiveness. This study investigated the impact of CVP and echo measurements on the outcomes of critically ill patients with GI hemorrhage. Methods: The study was based on the Medical Information Mart for Intensive Care IV (MIMIC- IV) database. Patients were divided into four groups according to the usage of CVP and/or echo. The primary outcomes were 7-day, 14-day, 28-day, and overall mortalities after ICU admission. Cox Proportional-Hazards Models were used to elucidate the relationship between CVP/ Echo monitoring and mortality. The severity of illness of patients were adjusted by qSOFA score, SOFA score and base deficit level at admission. Results: Among 1705 eligible patients, 82 patients had both CVP and echo, 85 had CVP only, and 116 had Echo only. The results of survival analysis indicated that, comparing with those without either CVP or echo, the echo utilization was associated with improved mortalities at all time points during ICU stay for patients with moderate GI hemorrhage, and the combined use of CVP and echo was associated with lower 7-day,14-day and overall mortalities for patients with severe GI hemorrhage. Conclusion: Early usage of CVP and echo monitoring or echo alone are associated with lower mortality in the short and long-term when compared to patients without either measurement. Clinicians should consider goal-directed resuscitation guided by echo with/without CVP in patients with GI hemorrhage early after admission to ICU.
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Affiliation(s)
- Wenye Song
- 12338 Department of Surgery and Pediatrics, University of Texas Medical Branch, Texas, USA.,12338 Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Texas, USA
| | - Keyan Mobli
- 12338 Department of Surgery and Pediatrics, University of Texas Medical Branch, Texas, USA
| | - Daniel C Jupiter
- 12338 Department of Preventive Medicine and Population Health, University of Texas Medical Branch, Texas, USA
| | - Ravi S Radhakrishnan
- 12338 Department of Surgery and Pediatrics, University of Texas Medical Branch, Texas, USA
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Taherinia A, Saba G, Ebrahimi M, Ahmadi K, Taleshi Z, Khademhosseini P, Soltanian A, Safaee A, Bahramian M, Gharakhani S, Nodoshan MAJ. Diagnostic value of intravenous oxygen saturation compared with arterial and venous base excess to predict hemorrhagic shock in multiple trauma patients. J Family Med Prim Care 2021; 10:2625-2629. [PMID: 34568146 PMCID: PMC8415661 DOI: 10.4103/jfmpc.jfmpc_2047_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/03/2020] [Accepted: 05/07/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction: In this study, with the help of peripheral vein sampling, Spvo2, and peripheral artery and vein sampling, we examined base excess (BE) in trauma patients and determined its diagnostic value for hemorrhagic shock. Methods: In this cross-sectional study, from 64 patients with abdominal, pelvic and chest Blunt trauma who have a score of 2 or higher trauma during treatment, blood samples were taken from peripheral vein to measure oxygen saturation and peripheral vein and artery for BE measurements and were compared in order to assess their diagnostic value in predicting the occurrence of hemorrhagic shock. Results: Out of 60 examined patients, 43 (71.67%) patients were diagnosed with hemorrhagic shock. The correlation for the percentage of oxygen saturation of the peripheral blood and the rate of arterial and venous BE for these r2patients were 17.0 and 09.0, respectively, with a P value greater than 0.005. In the case of the percentage of oxygen saturation of the peripheral blood, the sensitivity and specificity were 93.03 and 11.76%, respectively. The positive and negative likelihood ratios were 1.05 and 0.59, respectively. The positive and negative predictive values were 72.73 and 40%, respectively. Conclusion: In general, the results of this study showed that arterial and venous excess base levels had a proper correlation, specificity and sensitivity for diagnosing and predicting hemorrhagic shock, while the percentage of oxygen saturation of peripheral blood and BE arterial and venous levels had not proper correlation to detect and predict hemorrhagic shock.
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Affiliation(s)
- Ali Taherinia
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ghazal Saba
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mohsen Ebrahimi
- Department of Emergency Medicine, Faculty of Medicine, Mashhad University of Medical Science, Mashhad, Iran
| | - Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Zabihollah Taleshi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Peyman Khademhosseini
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Soltanian
- Department of Surgery, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Atie Safaee
- Department of Oral and Maxillofacial Radiology, School of Dentistry, Mashhad University of Medical Science, Mashhad, Iran
| | - Mehran Bahramian
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Shahin Gharakhani
- Researchers, General Practitioner, Alborz University of Medical Sciences, Karaj, Iran
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27
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Kim J, Park J, Kwon JH, Kim S, Oh AR, Jang JN, Choi JH, Sung J, Yang K, Kim K, Ahn J, Lee SH. Association between Intraoperative Hyperlactatemia and Myocardial Injury after Noncardiac Surgery. Diagnostics (Basel) 2021; 11:diagnostics11091656. [PMID: 34573997 PMCID: PMC8465750 DOI: 10.3390/diagnostics11091656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Oxygen demand–supply mismatch is supposed to be one of the major causes of myocardial injuries after noncardiac surgery (MINS). Impaired tissue oxygenation during the surgery can lead to intraoperative hyperlactatemia. Therefore, we aimed to evaluate the relationship between intraoperative lactate level and MINS. Methods: A total of 1905 patients divided into groups according to intraoperative hyperlactatemia: 1444 patients (75.8%) into normal (≤2.2 mmol/L) and 461 patients (24.2%) into hyperlactatemia (>2.2 mmol/L) groups. The primary outcome was the incidence of MINS, and all-cause mortality within 30 days was compared. Results: In the crude population, the risks for MINS and 30-day mortality were higher for the hyperlactatemia group than the normal group (17.7% vs. 37.7%, odds ratio [OR]: 2.83, 95% confidence interval [CI]: 2.24–3.56, p < 0.001 and 0.8% vs. 4.8%, hazard ratio [HR]: 5.86, 95% CI: 2.9–12.84, p < 0.001, respectively). In 365 propensity score-matched pairs, intraoperative hyperlactatemia was consistently associated with MINS and 30-day mortality (21.6% vs. 31.8%, OR: 1.69, 95% CI: 1.21–1.36, p = 0.002 and 1.1% vs. 3.8%, HR: 3.55, 95% CI: 1.71–10.79, p < 0.03, respectively). Conclusion: Intraoperative lactate elevation was associated with a higher incidence of MINS and 30-day mortality.
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Affiliation(s)
- Jeayoun Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Jungchan Park
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Ji-Hye Kwon
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Sojin Kim
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Ah Ran Oh
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Jae Ni Jang
- Department of Anesthesiology and Pain Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.K.); (J.P.); (J.-H.K.); (S.K.); (A.R.O.); (J.N.J.)
| | - Jin-Ho Choi
- Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.)
- Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Jidong Sung
- Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.)
| | - Kwangmo Yang
- Centers for Health Promotion, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea;
| | - Kyunga Kim
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (K.K.); (J.A.)
| | - Joonghyun Ahn
- Statistics and Data Center, Research Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea; (K.K.); (J.A.)
| | - Seung-Hwa Lee
- Department of Medicine, Division of Cardiology, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea; (J.-H.C.); (J.S.)
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul 06351, Korea
- Correspondence: ; Tel.: +82-2-3410-0360; Fax: +82-2-3410-5481
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Ider M, Naseri A, Ok M, Uney K, Erturk A, Durgut MK, Parlak TM, Ismailoglu N, Kapar MM. Biomarkers in premature calves with and without respiratory distress syndrome. J Vet Intern Med 2021; 35:2524-2533. [PMID: 34227155 PMCID: PMC8478053 DOI: 10.1111/jvim.16217] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Approaches to the evaluation of pulmonary arterial hypertension (PAH) in premature calves by using lung-specific epithelial and endothelial biomarkers are needed. OBJECTIVE To investigate the evaluation of PAH in premature calves with and without respiratory distress syndrome (RDS) by using lung-specific epithelial and endothelial biomarkers and determine the prognostic value of these markers in premature calves. ANIMALS Fifty premature calves with RDS, 20 non-RDS premature calves, and 10 healthy term calves. METHODS Hypoxia, hypercapnia, and tachypnea were considered criteria for RDS. Arterial blood gases (PaO2 , PaCO2 , oxygen saturation [SO2 ], base excess [BE], and serum lactate concentration) were measured to assess hypoxia. Serum concentrations of lung-specific growth differentiation factor-15 (GDF-15), asymmetric dimethylarginine (ADMA), endothelin-1 (ET-1), vascular endothelial growth factor (VEGF), and surfactant protein D (SP-D) were measured to assess PAH. RESULTS Arterial blood pH, PaO2 , SO2 , and BE of premature calves with RDS were significantly lower and PaCO2 and lactate concentrations higher compared to non-RDS premature and healthy calves. The ADMA and SP-D concentrations of premature calves with RDS were lower and serum ET-1 concentrations higher than those of non-RDS premature and healthy calves. No statistical differences for GDF-15 and VEGF were found among groups. CONCLUSIONS AND CLINICAL IMPORTANCE Significant increases in serum ET-1 concentrations and decreases in ADMA and SP-D concentrations highlight the utility of these markers in the diagnosis of PAH in premature calves with RDS. Also, we found that ET-1 was a reliable diagnostic and prognostic biomarker for PAH and predicting mortality in premature calves.
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Affiliation(s)
- Merve Ider
- Faculty of Veterinary Medicine, Department of Internal MedicineSelcuk UniversityKonyaTurkey
| | - Amir Naseri
- Faculty of Veterinary Medicine, Department of Internal MedicineSelcuk UniversityKonyaTurkey
| | - Mahmut Ok
- Faculty of Veterinary Medicine, Department of Internal MedicineSelcuk UniversityKonyaTurkey
| | - Kamil Uney
- Faculty of Veterinary Medicine, Department of Pharmacology and ToxicologySelcuk UniversityKonyaTurkey
| | - Alper Erturk
- Faculty of Veterinary Medicine, Department of Internal MedicineMustafa Kemal UniversityHatayTurkey
| | - Murat K. Durgut
- Faculty of Veterinary Medicine, Department of Internal MedicineSelcuk UniversityKonyaTurkey
| | - Tugba M. Parlak
- Faculty of Veterinary Medicine, Department of Pharmacology and ToxicologySelcuk UniversityKonyaTurkey
| | - Nimet Ismailoglu
- Faculty of Veterinary Medicine, Department of Internal MedicineSelcuk UniversityKonyaTurkey
| | - Muhammed M. Kapar
- Faculty of Veterinary Medicine, Department of Internal MedicineSelcuk UniversityKonyaTurkey
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29
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D'Abrantes R, Dunn L, McMillan T, Cornwell B, Bloom B, Harris T. Evaluation of the Prognostic Value of Lactate and Acid-Base Status in Patients Presenting to the Emergency Department. Cureus 2021; 13:e15857. [PMID: 34327084 PMCID: PMC8301278 DOI: 10.7759/cureus.15857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Lactate levels predict mortality in a wide range of patients presenting to the Emergency Department (ED); however, the effect of co-existing acidosis is unknown. Here, we investigated the effect of acidosis on in-hospital mortality for patients with hyperlactataemia. Methodology This is a retrospective cohort study of adults cared for in the resuscitation area of one ED who received a metabolic panel on arrival. The primary outcome was in-hospital mortality for patients with normal lactate (0.0-2.0 mmol/L), intermediate lactate (2.1-4.0 mmol/L), or high lactate (>4.0 mmol/L), with and without acidosis. Odds ratios (ORs) were calculated to assess the differences in mortality rates between groups stratified by lactate and acid-base status. Results A total of 4,107 metabolic panels were collected and 3,238 were assessed. In total, 510 (15.8%) and 784 (24.2%) patients had a normal lactate and acidosis/no acidosis; 587 (18.1%) and 842 (26.0%) had intermediate lactate and acidosis/no acidosis; and 388 (12.0%) and 127 (3.9%) had high lactate and acidosis/no acidosis, respectively. The overall mortality was 5%. Mortality was 4.3%/0.6% in the normal lactate, 5.6%/2.6% in the intermediate lactate, and 19.3%/3.9% in the high lactate groups, with and without acidosis, respectively. Combining base excess <-6 and lactate >4 mmol/L had a sensitivity of 39%, specificity of 96%, positive predictive value of 32%, and negative predictive value of 98% for in-hospital mortality (OR: 14.0; 95% confidence interval: 9.77-20.11). Conclusions In an undifferentiated cohort of ED patients presenting to the resuscitation area lactaemia associated with acidosis is a more accurate predictor of in-hospital mortality than hyperlactataemia.
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Affiliation(s)
| | - Laura Dunn
- Emergency Medicine, Barts Health NHS Trust, London, GBR
| | - Tim McMillan
- Emergency Medicine, Barts Health NHS Trust, London, GBR
| | | | - Ben Bloom
- Emergency Medicine, Barts Health NHS Trust, London, GBR.,Emergency Medicine, Queen Mary University of London, London, GBR
| | - Tim Harris
- Emergency Medicine, Queen Mary University of London, London, GBR.,Emergency Medicine, Barts Health NHS Trust, London, GBR
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30
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Bar S, Nguyen M, de Broca B, Bernard E, Dupont H, Guinot PG. Risk factors and determinants of intraoperative hyperlactatemia in major non-cardiac surgery. J Clin Anesth 2021; 74:110359. [PMID: 34083103 DOI: 10.1016/j.jclinane.2021.110359] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Stéphane Bar
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Rond-point du professeur Christian Cabrol, Amiens, France.
| | - Maxime Nguyen
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, Dijon, France; Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
| | - Bruno de Broca
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Rond-point du professeur Christian Cabrol, Amiens, France
| | - Eugénie Bernard
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, Dijon, France
| | - Hervé Dupont
- Anaesthesiology and Critical Care Department, Amiens University Hospital, Rond-point du professeur Christian Cabrol, Amiens, France
| | - Pierre-Grégoire Guinot
- Anaesthesiology and Critical Care Department, Dijon University Hospital, 2 Bd Maréchal de Lattre de Tassigny, Dijon, France; Lipness Team, INSERM Research Center LNC-UMR1231 and LabExLipSTIC, University of Burgundy, Dijon, France
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31
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Giustiniano E, Nisi F, Rocchi L, Zito PC, Ruggieri N, Cimino MM, Torzilli G, Cecconi M. Perioperative Management of Complex Hepatectomy for Colorectal Liver Metastases: The Alliance between the Surgeon and the Anesthetist. Cancers (Basel) 2021; 13:cancers13092203. [PMID: 34063684 PMCID: PMC8125060 DOI: 10.3390/cancers13092203] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/28/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Simple Summary Major high-risk surgery (HRS) exposes patients to potential perioperative adverse events. Hepatic resection of colorectal metastases can surely be included into the HRS class of operations. Limiting such risks is the main target of the perioperative medicine. In this context the collaboration between the anesthetist and the surgeon and the sharing of management protocols is of utmost importance and represents the key issue for a successful outcome. In our institution, we have been adopting consolidated protocols for patients undergoing this type of surgery for decades; this made our mixed team (surgeons and anesthetists) capable of achieving a safe outcome for the majority of our surgical population. In this narrative review, we report the most recent state of the art of perioperative management of hepatic resection of colorectal metastases along with our experience in this field, trying to point out the main issues. Abstract Hepatic resection has been widely accepted as the first choice for the treatment of colorectal metastases. Liver surgery has been recognized as a major abdominal procedure; it exposes patients to a high risk of perioperative adverse events. Decision sharing and the multimodal approach to the patients’ management are the two key items for a safe outcome, even in such a high-risk surgery. This review aims at addressing the main perioperative issues (preoperative evaluation; general anesthesia and intraoperative fluid management and hemodynamic monitoring; intraoperative metabolism; administration policy for blood-derivative products; postoperative pain control; postoperative complications), in particular, from the anesthetist’s point of view; however, only an alliance with the surgery team may be successful in case of adverse events to accomplish a good final outcome.
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Affiliation(s)
- Enrico Giustiniano
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
- Correspondence: (E.G.); (F.N.); Tel.: +39-02-8224-7459 (E.G.); +39-02-8224-4115 (F.N.); Fax: +39-02-8224-4190 (E.G. & F.N.)
| | - Fulvio Nisi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
- Correspondence: (E.G.); (F.N.); Tel.: +39-02-8224-7459 (E.G.); +39-02-8224-4115 (F.N.); Fax: +39-02-8224-4190 (E.G. & F.N.)
| | - Laura Rocchi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
| | - Paola C. Zito
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
| | - Nadia Ruggieri
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
| | - Matteo M. Cimino
- Hepato-Biliary & Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (M.M.C.); (G.T.)
| | - Guido Torzilli
- Hepato-Biliary & Pancreatic Surgery Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (M.M.C.); (G.T.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
| | - Maurizio Cecconi
- Department of Anesthesia and Intensive Care Units, IRCCS Humanitas Research Hospital, 20089 Milan, Italy; (L.R.); (P.C.Z.); (N.R.); (M.C.)
- Department of Biomedical Sciences, Humanitas University, 20090 Milan, Italy
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32
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DSouza D, Sunny A, Sima R, Ashwath G, Rozario AP. Lactate Measurement in Critically Injured—Prognostic Importance. Indian J Surg 2021. [DOI: 10.1007/s12262-020-02551-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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33
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Coggins AR, Vivekanandamoorthy N, Byth K, Aleemullah T, Selvendran ST, Watkins RJ, Shetty AL, Devjak L, Hsu JM. Utility of venous blood gases for the assessment of traumatic shock: a prospective observational study. Emerg Med J 2021; 38:711-717. [PMID: 33789938 DOI: 10.1136/emermed-2020-209751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND ABG samples are often obtained in trauma patients to assess shock severity. Venous blood gas (VBG) sampling, which is less invasive, has been widely used to assess other forms of shock. The study aim was to determine the agreement between VBG and ABG measurements in trauma. METHODS Patients were enrolled at an Australian trauma centre between October 2016 and October 2018. Bland-Altman limits of agreement (LOA) between paired blood gas samples taken <30 min apart were used to quantify the extent of agreement. The impact of using only VBG measurements was considered using an a priori plan. Cases where venous sampling failed to detect 'concerning levels' were flagged using evidence-based cut-offs: pH ≤7.2, base deficit (BD) ≤-6, bicarbonate <21 and lactate ≥4. Case summaries of these patients were assessed by independent trauma clinicians as to whether an ABG would change expected management. RESULTS During the study period 176 major trauma patients had valid paired blood gas samples available for analysis. The median time difference between paired measurements was 11 min (IQR 6-17). There was a predominance of men (81.8%) and blunt trauma (92.0%). Median Injury Severity Score was 13 (range 1-75) and inpatient mortality was 6.3%. Mean difference (ABG-VBG) and LOA between paired arterial and venous measurements were 0.036 (LOA -0.048 to 0.120) for pH, -1.27 mmol/L (LOA -4.35 to 1.81) for BD, -0.64 mmol/L (LOA -1.86 to 0.57) for lactate and -1.97 mmol/L (LOA -5.49 to 1.55) for bicarbonate. Independent assessment of the VBG 'false negative' cases (n=20) suggested an ABG would change circulatory management in two cases. CONCLUSIONS In trauma patients VBG and ABG parameters displayed suboptimal agreement. However, in cases flagged as VBG 'false negative' independent review indicated that the availability of an ABG was unlikely to change management.
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Affiliation(s)
- Andrew R Coggins
- Emergency Medicine, Westmead Hospital, Westmead, New South Wales, Australia .,Discipline of Emergency Medicine, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | | | - Karen Byth
- Biostatistics Department, NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Tabish Aleemullah
- Department of Trauma, Westmead Hospital, Westmead, New South Wales, Australia
| | - Selwyn T Selvendran
- Department of Trauma, Westmead Hospital, Westmead, New South Wales, Australia
| | - Rachel J Watkins
- Department of Trauma, Westmead Hospital, Westmead, New South Wales, Australia
| | - Amith L Shetty
- Discipline of Emergency Medicine, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
| | - Lorraine Devjak
- Nursing Resources, Westmead Hospital, Westmead, New South Wales, Australia
| | - Jeremy M Hsu
- Department of Trauma, Westmead Hospital, Westmead, New South Wales, Australia.,Discipline of Surgery, The University of Sydney Westmead Clinical School, Sydney, New South Wales, Australia
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34
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Beneru D, Hsu J, Coggins AR. The Use of Point-of-Care Blood Gases for Critically Injured Patients at a Level 1 Trauma Center. J Emerg Trauma Shock 2021; 14:53-54. [PMID: 33911439 PMCID: PMC8054810 DOI: 10.4103/jets.jets_30_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 03/09/2020] [Accepted: 03/15/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Demi Beneru
- Department of Trauma, Westmead Hospital, Sydney, Australia
| | - Jeremy Hsu
- Department of Trauma, Westmead Hospital, Sydney, Australia
| | - Andrew R Coggins
- Department of Emergency, Westmead Hospital, Sydney, Australia E-mail:
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35
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Korang SK, Safi S, Feinberg J, Nielsen EE, Gluud C, Jakobsen JC. Bicarbonate for acute acidosis. Hippokratia 2021. [DOI: 10.1002/14651858.cd014371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Steven Kwasi Korang
- Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Sanam Safi
- Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Joshua Feinberg
- Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Emil Eik Nielsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
- Department of Regional Health Research, The Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
| | - Janus C Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
- Cochrane Hepato-Biliary Group, Copenhagen Trial Unit, Centre for Clinical Intervention Research; The Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital; Copenhagen Denmark
- Department of Regional Health Research, The Faculty of Health Sciences; University of Southern Denmark; Odense Denmark
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36
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Liu W, Cheng M, Li J, Zhang P, Fan H, Hu Q, Han M, Su L, He H, Tong Y, Ning K, Long Y. Classification of the Gut Microbiota of Patients in Intensive Care Units During Development of Sepsis and Septic Shock. GENOMICS PROTEOMICS & BIOINFORMATICS 2021; 18:696-707. [PMID: 33607294 PMCID: PMC8377022 DOI: 10.1016/j.gpb.2020.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/21/2020] [Indexed: 12/11/2022]
Abstract
The gut microbiota of intensive care unit (ICU) patients displays extreme dysbiosis associated with increased susceptibility to organ failure, sepsis, and septic shock. However, such dysbiosis is difficult to characterize owing to the high dimensional complexity of the gut microbiota. We tested whether the concept of enterotype can be applied to the gut microbiota of ICU patients to describe the dysbiosis. We collected 131 fecal samples from 64 ICU patients diagnosed with sepsis or septic shock and performed 16S rRNA gene sequencing to dissect their gut microbiota compositions. During the development of sepsis or septic shock and during various medical treatments, the ICU patients always exhibited two dysbiotic microbiota patterns, or ICU-enterotypes, which could not be explained by host properties such as age, sex, and body mass index, or external stressors such as infection site and antibiotic use. ICU-enterotype I (ICU E1) comprised predominantly Bacteroides and an unclassified genus of Enterobacteriaceae, while ICU-enterotype II (ICU E2) comprised predominantly Enterococcus. Among more critically ill patients with Acute Physiology and Chronic Health Evaluation II (APACHE II) scores > 18, septic shock was more likely to occur with ICU E1 (P = 0.041). Additionally, ICU E1 was correlated with high serum lactate levels (P = 0.007). Therefore, different patterns of dysbiosis were correlated with different clinical outcomes, suggesting that ICU-enterotypes should be diagnosed as independent clinical indices. Thus, the microbial-based human index classifier we propose is precise and effective for timely monitoring of ICU-enterotypes of individual patients. This work is a first step toward precision medicine for septic patients based on their gut microbiota profiles.
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Affiliation(s)
- Wanglin Liu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Mingyue Cheng
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Jinman Li
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Peng Zhang
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Hang Fan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Qinghe Hu
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Maozhen Han
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China
| | - Longxiang Su
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Huaiwu He
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China
| | - Yigang Tong
- Beijing Advanced Innovation Center for Soft Matter Science and Engineering (BAIC-SM), College of Life Science and Technology, Beijing University of Chemical Technology, Beijing 100029, China.
| | - Kang Ning
- Key Laboratory of Molecular Biophysics of the Ministry of Education, College of Life Science and Technology, Huazhong University of Science and Technology, Wuhan 430074, China.
| | - Yun Long
- Department of Critical Care Medicine, Peking Union Medical College Hospital, Beijing 100730, China.
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Serum lactate level predicts 6-months mortality in patients with hepatitis B virus-related decompensated cirrhosis: a retrospective study. Epidemiol Infect 2021; 149:e26. [PMID: 33397544 PMCID: PMC8057512 DOI: 10.1017/s0950268820003143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
The prediction of prognosis is an important part of management in hepatitis B virus (HBV)-related decompensated cirrhosis patients with high long-term mortality. Lactate is a known predictor of outcome in critically ill patients. The aim of this study was to assess the prognostic value of lactate in HBV-related decompensated cirrhosis patients. We performed a single-centre, observational, retrospective study of 405 HBV-related decompensated cirrhosis patients. Individuals were evaluated within 24 h after admission and the primary outcome was evaluated at 6-months. Multivariable analyses were used to determine whether lactate was independently associated with the prognosis of HBV-related decompensated cirrhosis patients. The area under the ROC (AUROC) was calculated to assess the predictive accuracy compared with existing scores. Serum lactate level was significantly higher in non-surviving patients than in surviving patients. Multivariable analyses demonstrated that lactate was an independent risk factor of 6-months mortality (odds ratio: 2.076, P < 0.001). Receiver operating characteristic (ROC) curves were drawn to evaluate the discriminative ability of lactate for 6-months mortality (AUROC: 0.716, P < 0.001). Based on our patient cohort, the new scores (Model For End-Stage Liver Disease (MELD) + lactate score, Child–Pugh + lactate score) had good accuracy for predicting 6-months mortality (AUROC = 0.769, P < 0.001; AUROC = 0.766, P < 0.001). Additionally, the performance of the new scores was superior to those of existing scores (all P < 0.001). Serum lactate at admission may be useful for predicting 6-months mortality in HBV-related decompensated cirrhosis patients, and the predictive value of the MELD score and Child–Pugh score was improved by adjusting lactate. Serum lactate should be part of the rapid diagnosis and initiation of therapy to improve clinical outcome.
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Basil-Kway V, Castillo-Reyther R, Domínguez-Salgado LA, Espinosa-Tanguma R, Medina Ú, Gordillo-Moscoso A. Early prognostic capacity of serum lactate for severe postpartum hemorrhage. Int J Gynaecol Obstet 2020; 153:483-488. [PMID: 33119891 DOI: 10.1002/ijgo.13446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 07/23/2020] [Accepted: 10/27/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate whether the concentration of serum lactate during the diagnosis of postpartum hemorrhage (bleeding ≥500 mL during labor or ≥1000 mL during cesarean delivery) predicts severe hemorrhage (SPPH; blood loss ≥1500 mL at end of labor or in the following 24 h). METHODS A prospective cohort pilot study was conducted of women with a vaginal or cesarean delivery from February 2018 to March 2019 who presented with bleeding ≥500 mL measured by the gravimetric method in a reference hospital in San Luis Potosi, Mexico. Venous blood samples were taken for analysis of serum lactate. A receiver operating characteristic curve determined the serum lactate threshold value for SPPH and χ2 test assessed the difference in serum lactate elevation between SPPH and non-SPPH groups. Lastly, the prognostic capacity between the thresholds was compared. RESULTS SPPH developed in 43.33% of the 30 women in the study group. The best prognostic threshold was 2.68 mmol/L of serum lactate (odds ratio [OR] 17.88, 95% confidence interval [CI] 2.7-16.8, P < 0.001); sensitivity was 0.85 (95% CI 0.55-0.98); specificity was 0.76 (95% CI 0.50-0.93). CONCLUSION Serum lactate may be a useful prognostic marker for SPPH, more studies are needed to validate these findings.
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Affiliation(s)
- Venance Basil-Kway
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Roberto Castillo-Reyther
- Department of Obstetrics and Gynecology, Hospital Central Dr. Ignacio Morones Prieto, San Luis Potosi, Mexico.,School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - L Andrés Domínguez-Salgado
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Ricardo Espinosa-Tanguma
- Department of Physiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Úrsula Medina
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico.,Department of Pharmacology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
| | - Antonio Gordillo-Moscoso
- Department of Clinical Epidemiology, School of Medicine, Universidad Autonoma de San Luis Potosi, San Luis Potosi, Mexico
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Quantitative Assessment of Blood Lactate in Shock: Measure of Hypoxia or Beneficial Energy Source. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2608318. [PMID: 33150168 PMCID: PMC7603544 DOI: 10.1155/2020/2608318] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/18/2020] [Indexed: 12/16/2022]
Abstract
Blood lactate concentration predicts mortality in critically ill patients and is clinically used in the diagnosis, grading of severity, and monitoring response to therapy of septic shock. This paper summarizes available quantitative data to provide the first comprehensive description and critique of the accepted concepts of the physiology of lactate in health and shock, with particular emphasis on the controversy of whether lactate release is simply a manifestation of tissue hypoxia versus a purposeful transfer ("shuttle") of lactate between tissues. Basic issues discussed include (1) effect of nonproductive lactate-pyruvate exchange that artifactually enhances flux measurements obtained with labeled lactate, (2) heterogeneous tissue oxygen partial pressure (Krogh model) and potential for unrecognized hypoxia that exists in all tissues, and (3) pathophysiology that distinguishes septic from other forms of shock. Our analysis suggests that due to exchange artifacts, the turnover rate of lactate and the lactate clearance are only about 60% of the values of 1.05 mmol/min/70 kg and 1.5 L/min/70 kg, respectively, determined from the standard tracer kinetics. Lactate turnover reflects lactate release primarily from muscle, gut, adipose, and erythrocytes and uptake by the liver and kidney, primarily for the purpose of energy production (TCA cycle) while the remainder is used for gluconeogenesis (Cori cycle). The well-studied physiology of exercise-induced hyperlactatemia demonstrates massive release from the contracting muscle accompanied by an increased lactate clearance that may occur in recovering nonexercising muscle as well as the liver. The very limited data on lactate kinetics in shock patients suggests that hyperlactatemia reflects both decreased clearance and increased production, possibly primarily in the gut. Our analysis of available data in health and shock suggests that the conventional concept of tissue hypoxia can account for most blood lactate findings and there is no need to implicate a purposeful production of lactate for export to other organs.
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Corwin GS, Sexton KW, Beck WC, Taylor JR, Bhavaraju A, Davis B, Kimbrough MK, Jensen JC, Privratsky A, Robertson RD. Characterization of Acidosis in Trauma Patient. J Emerg Trauma Shock 2020; 13:213-218. [PMID: 33304072 PMCID: PMC7717465 DOI: 10.4103/jets.jets_45_19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/09/2019] [Accepted: 05/13/2020] [Indexed: 11/04/2022] Open
Abstract
Background Recent data suggest that acidosis alone is not a good predictor of mortality in trauma patients. Little data are currently available regarding factors associated with survival in trauma patients presenting with acidosis. Aims The aims were to characterize the outcomes of trauma patients presenting with acidosis and to identify modifiable risk factors associated with mortality in these patients. Settings and Design This is a retrospective observational study of University of Arkansas for Medical Sciences (UAMS) trauma patients between November 23, 2013, and May 21, 2017. Methods Data were collected from the UAMS trauma registry. The primary outcome was hospital mortality. Analyses were performed using t-test and Pearson's Chi-squared test. Simple and multiple logistic regressions were performed to determine crude and adjusted odds ratios. Results There were 532 patients identified and 64.7% were acidotic (pH < 7.35) on presentation: 75.9% pH 7.2-7.35; 18.5% pH 7.0-7.2; and 5.6% pH ≤ 7.0. The total hospital mortality was 23.7%. Nonsurvivors were older and more acidotic, with a base deficit >-8, Glasgow Coma Scale (GCS) ≤ 8, systolic blood pressure ≤ 90, International Normalized Ratio (INR) >1.6, and Injury Severity Score (ISS) >15. Mortality was significantly higher with a pH ≤ 7.2 but mortality with a pH 7.2-7.35 was comparable to pH > 7.35. In the adjusted model, pH ≤ 7.0, pH 7.0-7.2, INR > 1.6, GCS ≤ 8, and ISS > 15 were associated with increased mortality. For patients with a pH ≤ 7.2, only INR was associated with increase in mortality. Conclusions A pH ≤ 7.2 is associated with increased mortality. For patients in this range, only the presence of coagulopathy is associated with increased mortality. A pH > 7.2 may be an appropriate treatment goal for acidosis. Further work is needed to identify and target potentially modifiable factors in patients with acidosis such as coagulopathy.
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Affiliation(s)
- Gregory S Corwin
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Kevin W Sexton
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - William C Beck
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - John R Taylor
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Avi Bhavaraju
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Benjamin Davis
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Mary K Kimbrough
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Joseph C Jensen
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Anna Privratsky
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
| | - Rotnald D Robertson
- Department of Surgery, Division of Trauma and Acute Care Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Point-of-Care Analysis of Neutrophil Phenotypes: A First Step Toward Immuno-Based Precision Medicine in the Trauma ICU. Crit Care Explor 2020; 2:e0158. [PMID: 32766555 PMCID: PMC7371075 DOI: 10.1097/cce.0000000000000158] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Supplemental Digital Content is available in the text. Objectives: The amount of tissue damage and the amplitude of the immune response after trauma are related to the development of infectious complications later on. Changes in the neutrophil compartment can be used as read out of the amplitude of the immune response after trauma. The study aim was to test whether 24/7 point-of-care analysis of neutrophil marker expression by automated flow cytometry can be achieved after trauma. Design: A prospective cohort study was performed. Polytrauma patients who developed infectious complications were compared with polytrauma patients who did not develop infectious complications. Setting: The study was performed in a level 1 trauma center. Patients: All trauma patients presented in the trauma bay were included. Interventions: An extra blood tube was drawn from all patients. Thereafter, a member of the trauma team placed the blood tube in the fully automated flow cytometer, which was located in the corner of the trauma room. Next, a modified and tailored protocol for this study was automatically performed. Main Results: The trauma team was able to successfully start the point-of-care automated flow cytometry analysis in 156 of 164 patients, resulting in a 95% success rate. Polytrauma patients who developed infectious complications had a significantly higher %CD16dim/CD62Lbright neutrophils compared with polytrauma patients who did not develop infectious complications (p = 0.002). Area under the curve value for %CD16dim/CD62Lbright neutrophils is 0.90 (0.83–0.97). Conclusions: This study showed the feasibility of the implementation of a fully automated point-of-care flow cytometry system for the characterization of the cellular innate immune response in trauma patients. This study supports the concept that the assessment of CD16dim/CD62Lbright neutrophils can be used for early detection of patients at risk for infectious complications. Furthermore, this can be used as first step toward immuno-based precision medicine of polytrauma patients at the ICU.
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Hervás MS, Játiva-Porcar R, Robles-Hernández D, Rubert AS, Segarra B, Oliva C, Escrig J, Llueca JA. Evaluation of the relationship between lactacidemia and postoperative complications after surgery for peritoneal carcinomatosis. Korean J Anesthesiol 2020; 74:45-52. [PMID: 32434292 PMCID: PMC7862932 DOI: 10.4097/kja.20089] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 05/14/2020] [Indexed: 12/12/2022] Open
Abstract
Background Cytoreductive surgery was developed as a treatment for peritoneal carcinomatosis. However, this surgery is associated with important complications. The present study aimed to assess the relationship between lactacidemia and the rate of associated complications during the immediate postoperative period in the intensive care unit (ICU) in patients undergoing cytoreductive surgery. Methods This was a retrospective observational study. A total of 57 patients underwent cytoreductive surgery. All patients were admitted to the ICU immediately after the surgery. Data on lactic acid levels at the time of admission and discharge from the ICU were collected. Postsurgical complications that occurred during the ICU stay were recorded according to failure-to-rescue analysis and their severity stratified according to the Clavien-Dindo classification. Results The lactic acid levels at admission to the ICU were significantly higher in patients who developed complications, with an almost tripled unadjusted relative risk (2.9, 95% CI: 1.6, 5.3), than in those who did not develop complications for the lactacidemia threshold established in the cumulative sum curve graphs. After adjustment for confounding effects, the relative risk became even higher (3.1, 95% CI: 1.8, 3.6). Lactic acid levels were still significantly higher in this group at the time of discharge from the ICU. Conclusions Serum lactate level is a risk factor for postoperative complications in patients undergoing cytoreductive surgery for peritoneal carcinomatosis. This study suggests that the risk of developing severe complications almost triples with a lactic acid level of 2.5 mmol/L or higher at the time of admission in the ICU.
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Affiliation(s)
- Marta Soriano Hervás
- Department of Anesthesiology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Rosa Játiva-Porcar
- Department of Anesthesiology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Daniel Robles-Hernández
- Department of Anesthesiology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Anna Serra Rubert
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Blanca Segarra
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Cristina Oliva
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - Javier Escrig
- Department of General Surgery, University General Hospital of Castellon, Castellón de La Plana, Spain
| | - José Antonio Llueca
- Department of Obstetrics and Gynecology, University General Hospital of Castellon, Castellón de La Plana, Spain
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Moore TA, Simske NM, Vallier HA. Fracture fixation in the polytrauma patient: Markers that matter. Injury 2020; 51 Suppl 2:S10-S14. [PMID: 31879174 DOI: 10.1016/j.injury.2019.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Revised: 11/19/2019] [Accepted: 12/16/2019] [Indexed: 02/02/2023]
Abstract
Timing and type of fracture fixation in the multiply-injured trauma patient have been important and controversial topics. Ideal care for these patients come from providers who communicate well with one another in a team fashion and view the whole person, rather than focusing on injury to individual systems. This group encompasses a wide range of musculoskeletal and other injuries, further complicated by the broad spectrum of patients, with variability in age, medical and social comorbidities, all of which may have profound impact upon outcomes. The concept of Early Total Care arose from the realization that early definitive fixation of femur fractures provided pulmonary and systemic benefits to most patients. However, insufficient assessment and understanding of the physiological status of polytraumatized patients at the time of major orthopaedic procedures, potentially with inclusion of multiple other procedures in the same setting resulted in more morbidity, swinging the pendulum of care toward initial Damage Control Orthopaedics to minimize surgical insult. More recently, iterative assessment of response to resuscitation using Early Appropriate Care guidelines, suggests definitive fixation of most axial and femoral injuries within 36 h after injury appears safe in resuscitated patients, as measured by improvement of acidosis.
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Mishra M, Zeeshan Hakim M, Prakash Mishra S, Saxena S, Trivedi N. Evaluation of Lactate and Lactate Clearance as a Marker of Outcome in Trauma ICU. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2020. [DOI: 10.18311/ajprhc/2020/25642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Zhang Y, Huang L, Liu Y, Chen Q, Li X, Hu J. Prediction of mortality at one year after surgery for pertrochanteric fracture in the elderly via a Bayesian belief network. Injury 2020; 51:407-413. [PMID: 31870611 DOI: 10.1016/j.injury.2019.11.029] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2019] [Revised: 10/31/2019] [Accepted: 11/21/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pertrochanteric fractures in the elderly are common and associated with considerable mortality and disability. However, the predictors of the fracture mortality have been somewhat controversial. The aim of this study was to use univariate, multivariate analyses and a Bayesian belief network (BBN) model, which are graphic and intuitive to the clinician, to understand of the prognosis of pertrochanteric fractures. METHODS Records of patients undergoing surgery at our hospital between January 2013 and June 2018 were retrospectively reviewed. Univariate and multivariate regression as well as a machine-learned BBN model were used to estimate mortality at one year after surgery for pertrochanteric fracture in the elderly. RESULTS Complete data were available for 448 surgically treated patients who were followed up for 12 months (age ≥60 years). Multivariate regression analysis revealed that hypertension, diabetes mellitus, chronic obstructive pulmonary disease, albumin, serum potassium, blood urea nitrogen and blood lactate were independent risk factors for death in surgical treatment patients (P < 0.05). First-degree predictors of mortality following surgery were established: the number of comorbid diseases, serum albumin, blood lactate and blood urea nitrogen. Following cross-validation, the area under the ROC curve was 0.85 (95% CI: 0.76-0.91) for the one-year probability of postoperative mortality. CONCLUSION We believe cohesive models such as the Bayesian belief network can be useful as clinical decision-support tools and provide clinicians with information to the treatment of old pertrochanteric fracture. This method warrants further development and must be externally validated in other patient populations.
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Affiliation(s)
- Yu Zhang
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Guang Zhou Road 300, Nanjing 210029, China.
| | - Lili Huang
- Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Yuan Liu
- Department of Infectious Diseases, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China.
| | - Qun Chen
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Guang Zhou Road 300, Nanjing 210029, China
| | - Xiang Li
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Guang Zhou Road 300, Nanjing 210029, China
| | - Jun Hu
- Department of Orthopedics, the First Affiliated Hospital of Nanjing Medical University, Guang Zhou Road 300, Nanjing 210029, China.
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Afuwape OO, Ayandipo O, Aroso S. Base excess and pH as predictors of outcomes in secondary peritonitis in a resource limited setting - A prospective study. JOURNAL OF CLINICAL SCIENCES 2020. [DOI: 10.4103/jcls.jcls_18_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Peri-operative serum lactate level and postoperative 90-day mortality in a surgical ICU: A retrospective association study. Eur J Anaesthesiol 2019; 37:31-37. [PMID: 31724965 DOI: 10.1097/eja.0000000000001117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is inadequate information on the association of pre-operative and postoperative peak level of lactate with mortality of surgical ICU patients. OBJECTIVE To investigate the association between peri-operative lactate level and 90-day mortality in patients admtted to the surgical ICU. DESIGN Retrospective cohort study. SETTING ICUs in single tertiary academic hospital. PATIENTS Adult patients postoperatively admitted to the ICU between January 2012 and December 2017. INTERVENTION None. MAIN OUTCOME MEASURES Hazard ratios of 90-day mortality according to the following serum lactate levels were assessed: pre-operative lactate level; peak lactate levels on postoperative day (POD) 0 to 3; and delta values of the lactate level on POD 0 to 3 from pre-operative lactate level. Multivariable Cox regression and receiver operating characteristic analyses were used. RESULTS Overall 9248 patients were included, among whom 2511, 8690 and 1958 had measured pre-operative lactate levels, lactate levels within POD 0 to 3, and lactate levels measured at both timepoints, respectively. When the peak lactate level on POD 0 to 3 and delta lactate level all increased by 1 mmol l, 90-day mortality increased by 15% [hazard ratio: 1.15; 95% confidence interval (CI) 1.11 to 1.19; P < 0.001] and 14% (hazard ratio: 1.14; 95% CI 1.11 to 1.18; P < 0.001), respectively; the pre-operative lactate level was not significantly associated with 90-day mortality (P = 0.069). The area under the curve for peak level of lactate on POD 0 to 3 (0.72, 95% CI 0.70 to 0.74) was higher than that of pre-operative lactate level (0.58, 95% CI 0.56 to 0.60) in the receiver operating characteristic analysis. CONCLUSION In patients admitted postoperatively to the ICU, higher peri-operative lactate levels were associated with increased 90-day mortality. The peak level of lactate during POD 0 to 3 showed the most significant contribution to this association.
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Bozorgi F, Hedayatizadeh-Omran A, Alizadeh-Navaei R, Goli Khatir I, Amjadi O, Khademloo M, Banihashemi AA. Diagnostic value of serum lactate as a predictor and early outcome in multiple trauma patients. Chirurgia (Bucur) 2019. [DOI: 10.23736/s0394-9508.18.04916-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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Romano D, Deiner S, Cherukuri A, Boateng B, Shrivastava R, Mocco J, Hadjipanayis C, Yong R, Kellner C, Yaeger K, Lin HM, Brallier J. Clinical impact of intraoperative hyperlactatemia during craniotomy. PLoS One 2019; 14:e0224016. [PMID: 31647826 PMCID: PMC6812741 DOI: 10.1371/journal.pone.0224016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 10/02/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECT Patients often develop markedly elevated serum lactate levels during craniotomy although the reason for this is not entirely understood. Elevated lactate levels have been associated with poor outcomes in critically ill septic shock patients, as well as patients undergoing abdominal and cardiac surgeries. We investigated whether elevated lactate in craniotomy patients is associated with neurologic complications (new neurological deficits) as well as systemic complications. METHODS We performed a cohort study of elective craniotomy patients. Demographic and intraoperative data were collected, as well as three timed intraoperative arterial lactate values. Additional lactate, creatinine and troponin values were collected immediately postoperatively as well as 12 and 24 hours postoperatively. Assessment for neurologic deficit was performed at 6 hours and 2 weeks postoperatively. Hospital length-of-stay and 30-day mortality were collected. RESULTS Interim analysis of 81 patients showed that no patient had postoperative myocardial infarction, renal failure, or mortality within 30 days of surgery. There was no difference in the incidence of new neurologic deficit in patients with or without elevated lactate (10/26, 38.5% vs. 15/55 27.3%, p = 0.31). Median length of stay was significantly longer in patients with elevated lactate (6.5 vs. 3 days, p = 0.003). Study enrollment was terminated early due to futility (futility index 0.16). CONCLUSION Elevated intraoperative serum lactate was not associated with new postoperative neurologic deficits, other end organ events, or 30 day mortality. Serum lactate was related to longer hospital stay.
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Affiliation(s)
- Diana Romano
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Stacie Deiner
- Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
- Department of Geriatrics and Palliative Care, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Anjali Cherukuri
- University of Central Florida College of Medicine, Orlando, FL, United States of America
| | - Bernard Boateng
- Alabama College of Osteopathic Medicine, Dothan, AL, United States of America
| | - Raj Shrivastava
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - J. Mocco
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Constantinos Hadjipanayis
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Raymund Yong
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Kurt Yaeger
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Hung-Mo Lin
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Jess Brallier
- Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
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Parks J, Vasileiou G, Parreco J, Pust GD, Rattan R, Zakrison T, Namias N, Yeh DD. Validating the ATLS Shock Classification for Predicting Death, Transfusion, or Urgent Intervention. J Surg Res 2019; 245:163-167. [PMID: 31419641 DOI: 10.1016/j.jss.2019.07.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/19/2019] [Accepted: 07/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The Advanced Trauma Life Support (ATLS) shock classification has been accepted as the conceptual framework for clinicians caring for trauma patients. We sought to validate its ability to predict mortality, blood transfusion, and urgent intervention. MATERIALS AND METHODS We performed a retrospective review of trauma patients using the 2014 National Trauma Data Bank. Using initial vital signs data, patients were categorized into shock class based on the ATLS program. Rates for urgent blood transfusion, urgent operative intervention, and mortality were compared between classes. RESULTS 630,635 subjects were included for analysis. Classes 1, 2, 3, and 4 included 312,404, 17,133, 31, and 43 patients, respectively. 300,754 patients did not meet criteria for any ATLS shock class. Of the patients in class 1 shock, 2653 died (0.9%), 3123 (1.0%) were transfused blood products, and 7115 (2.3%) underwent an urgent procedure. In class 2, 219 (1.3%) died, 387 (2.3%) were transfused, and 1575 (9.2%) underwent intervention. In class 3, 7 (22.6%) died, 10 (32.3%) were transfused, and 13 (41.9%) underwent intervention. In class 4, 15 (34.9%) died, 19 (44.2%) were transfused, and 23 (53.5%) underwent intervention. For uncategorized patients, 21,356 (7.1%) died, 15,168 (5.0%) were transfused, and 23,844 (7.9%) underwent intervention. CONCLUSIONS Almost half of trauma patients do not meet criteria for any ATLS shock class. Uncategorized patients had a higher mortality (7.1%) than patients in classes 1 and 2 (0.9% and 1.3%, respectively). Classes 3 and 4 only accounted for 0.005% and 0.007%, respectively, of patients. The ATLS classification system does not help identify many patients in severe shock.
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Affiliation(s)
- Jonathan Parks
- Ryder Trauma Center, University of Miami, Miami, Florida.
| | | | - Joshua Parreco
- Ryder Trauma Center, University of Miami, Miami, Florida
| | - Gerd D Pust
- Ryder Trauma Center, University of Miami, Miami, Florida
| | - Rishi Rattan
- Ryder Trauma Center, University of Miami, Miami, Florida
| | - Tanya Zakrison
- The University of Chicago Medicine, Section for Trauma and Acute Care Surgery, Chicago, Illinois
| | | | - D Dante Yeh
- Ryder Trauma Center, University of Miami, Miami, Florida
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