scholarly journals Persistent Sepsis-Induced Hypotension without Hyperlactatemia: A Distinct Clinical and Physiological Profile within the Spectrum of Septic Shock

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Glenn Hernandez ◽  
Alejandro Bruhn ◽  
Ricardo Castro ◽  
Cesar Pedreros ◽  
Maximiliano Rovegno ◽  
...  
Keyword(s):  
Septic Shock ◽  
Physiological Profile ◽  
Induced Hypotension ◽  
Flow Parameters ◽  
Severity Scores ◽  
Risk Patients ◽  
Lower Severity ◽  
Circulatory Stress ◽  
Lactate Levels ◽  
Organ Dysfunctions

Introduction. A subgroup of septic shock patients will never develop hyperlactatemia despite being subjected to a massive circulatory stress. Maintenance of normal lactate levels during septic shock is of great clinical and physiological interest. Our aim was to describe the clinical, hemodynamic, perfusion, and microcirculatory profiles associated to the absence of hyperlactatemia during septic shock resuscitation.Methods. We conducted an observational study in septic shock patients undergoing resuscitation. Serial clinical, hemodynamic, and perfusion parameters were registered. A single sublingual microcirculatory assessment was performed in a subgroup. Patients evolving with versus without hyperlactatemia were compared.Results. 124 septic shock patients were included. Patients without hyperlactatemia exhibited lower severity scores and mortality. They also presented higher platelet counts and required less intensive treatment. Microcirculation was assessed in 45 patients. Patients without hyperlactatemia presented higher PPV and MFI values. Lactate was correlated to several microcirculatory parameters. No difference in systemic flow parameters was observed.Conclusion. Persistent sepsis-induced hypotension without hyperlactatemia is associated with less organ dysfunctions and a very low mortality risk. Patients without hyperlactatemia exhibit less coagulation and microcirculatory derangements despite comparable macrohemodynamics. Our study supports the notion that persistent sepsis-induced hypotension without hyperlactatemia exhibits a distinctive clinical and physiological profile.

Sepsis-Induced Myocardial Dysfunction in Pediatric Septic Shock: Prevalence, Predictors, and Outcome—A Prospective Observational Study

2021 ◽  
Author(s):  
Viresh S. Swami ◽  
Lalitha A. V. ◽  
Santu Ghosh ◽  
Mounika Reddy
Keyword(s):  
Septic Shock ◽  
Observational Study ◽  
Patient Outcomes ◽  
Prospective Observational Study ◽  
Point Of Care ◽  
Myocardial Dysfunction ◽  
Severity Of Illness ◽  
Serum Lactate ◽  
Lactate Levels ◽  
Organ Dysfunctions

AbstractThere is a paucity of literature on the prevalence, predictors, prognostic markers, and outcomes of sepsis-induced myocardial dysfunction (SMD) in pediatric septic shock. The objectives of our study were to estimate the prevalence of SMD in pediatric septic shock by point-of-care functional echocardiography (POCFE) and to study the association of SMD with severity of illness, organ dysfunctions, and outcomes. This prospective, observational study was conducted over a period of 1 year (from July 2018 to July 2019) in a 12-bed, tertiary pediatric intensive care unit (PICU) of an academic and referral hospital in South India. Children presenting with septic shock were enrolled in the study. POCFE was done within 6 hours of PICU admission and patients were categorized as having SMD based on POCFE findings. The prevalence of SMD (left ventricle ± right ventricle) was 32% (32/100). More than half of the children (54.5%) died in SMD group, whereas only 7.5% died in non-SMD group (p < 0.001). SMD was associated with higher organ dysfunctions, worse patient outcomes, and was found to be an independent predictor of mortality. The median lactate levels were higher in SMD group (3.15 [2.7, 5] vs. 2 [1.3, 2.7], p < 0.001) as compared with non-SMD group. We observed significantly lower median lactate clearance at 6 hours in SMD than non-SMD (30.0% [−14.44, 44.22] vs. 59.8% [45.83, 71.43], p < 0.001). Lactate levels at 6 hours with a threshold of 2.4 mmol/L was a good predictor of SMD with sensitivity and specificity of 73 and 80%, respectively. SMD is not an uncommon entity in children with septic shock. SMD was associated with worse patient outcomes, organ dysfunction, and mortality. Serum lactate trends may predict SMD and can be used as prognosticate markers as well.

scholarly journals Necrotizing Soft Tissue Infections in Intensive Care

2021 ◽  
pp. 088506662110101
Author(s):  
Alexandru Ogica ◽  
Christoph Burdelski ◽  
Holger Rohde ◽  
Stefan Kluge ◽  
Geraldine de Heer
Keyword(s):  
Septic Shock ◽  
Intensive Care ◽  
Soft Tissue ◽  
Sofa Score ◽  
Laboratory Data ◽  
Serum Lactate ◽  
Soft Tissue Infections ◽  
Necrotizing Soft Tissue Infections ◽  
The Mean ◽  
Organ Dysfunctions

Background: Necrotizing soft tissue infections (NSTIs) are typically characterized by extensive soft tissue destruction with systemic signs of toxicity, ranging from sepsis to septic shock. Our aim was to analyze the clinical characteristics, microbiological results, laboratory data, therapies, and outcome of patients with NSTIs admitted to an intensive care unit (ICU). Methods: A monocentric observational study of patients admitted to the ICU of a university hospital between January 2009 and December 2017. The demographic characteristics, comorbidities, clinical features, microbiology and laboratory results, organ dysfunctions, therapies, and outcome were retrospectively analyzed. Results: There were 59 patients and 70% males. The mean age (± SD) was 55 ± 18; type II (monomicrobial) NSTI was present in 36 patients (61%); the most common isolated pathogen was Streptococcus pyogenes in 28 patients (48%). Septic shock was diagnosed in 41 patients (70%). The most common organ dysfunctions were circulatory and renal in 42 (71%) and 38 patients (64%). The mean value (± SD) of serum lactate at admission to the ICU was 4.22 ± 5.42 mmol/l, the median SOFA score and SAPS II were 7 (IQR 4 - 10) and 46 (IQR 30.5 - 53). ICU mortality rate was 25%. Both SOFA score and serum lactate demonstrated a good prognostic value regarding ICU outcome (OR 1.29, 95%CI 1.07-1.57, P < 0.007 and OR 1.53, 95%CI 1.19-1.98, P < 0.001). A cut-off value for serum lactate of 6.55 mmol/L positively predicted mortality with 67% sensitivity and 97% specificity. Conclusion: NSTIs carry a high risk of septic shock and multiple organ dysfunction syndrome and thus are still associated with high mortality. In our study, the value of serum lactate at admission to the ICU correlated well with mortality. This easy-to-measure parameter could play a role in the decision-making process regarding prognosis and continuation of care.

scholarly journals The Clinical Value of Red Blood Cell Distribution Width as a Prognosis Factor and Severity Marker in Sepsis and Septic Shock

2019 ◽  
Vol 2 (1) ◽  
pp. 58-66
Author(s):  
Emanuel Moisă ◽  
Silvius Negoiţă ◽  
Dan Corneci
Keyword(s):  
Septic Shock ◽  
Blood Cell ◽  
Red Blood Cell ◽  
Hematological Parameter ◽  
Component Part ◽  
Cell Distribution ◽  
Prognosis Factor ◽  
Distribution Width ◽  
Severity Scores ◽  
Red Blood Cell Distribution

AbstractRed blood cell distribution width (RDW) is a hematological parameter usually measured with every complete blood count. Its place in daily practice is mainly in the differential diagnosis of anemia, but nowadays, researchers are focused on different approaches for the erythrocyte’s changes in function and morphology.Sepsis and its most advanced form, septic shock, induces profound disturbances into organ system’s function and morphology. The red blood cells physiology and structure are directly and indirectly altered by these im balances produced in sepsis. RDW was studied in many diseases, like acute heart failure, acute stroke, inflammatory bowel diseases, chronic lung diseases and cancer, but also in sepsis. Its changes are seen to be mainly associated with prognosis. Higher values of RDW are correlated with mortality and severity of illnes in septic and all-cause critically ill patients. RDW was studied also as an independent variable in different predictive scores and some studies suggest it should be introduced in the scores use on a daily basis in critical care settings and emergency departments.In this review we will focus on how RDW was associated with mortality and severity of illness in the recent literature, as an independent prognosis factor and as a component part in different predictive and severity scores.

scholarly journals Plasma lactate levels and lactate clearance as predictors of outcome in patients with sepsis and septic shock

2020 ◽  
Vol 7 (6) ◽  
pp. 1213
Author(s):  
Rashmi Patil ◽  
Chikkanarasareddy P. S. ◽  
Mallesh K.
Keyword(s):  
Septic Shock ◽  
Clinical Decision Making ◽  
Early Recognition ◽  
Early Stage ◽  
Therapeutic Option ◽  
Lactate Clearance ◽  
Plasma Lactate ◽  
Risk Of Death ◽  
Lactate Levels ◽  
Sepsis And Septic Shock

Background: Severe sepsis and septic shock are the major causes of admission and deaths in the ICU, killing one in four (and often more) and increasing in incidence. In order to improve the clinical outcomes in these patients, it is crucial to obtain early recognition of patients who are at risk of death and to optimize the clinical decision making in a timely manner. In order to monitor the metabolic consequences of shock and hemodynamic management, plasma lactate levels can be used in critical illness. Objective of the study is to estimate plasma lactate and lactate clearance in sepsis and septic shock patients and to correlate plasma lactate and lactate clearance as predictors of mortality.Methods: This study is a prospective observational study conducted over 18months. Children with age of 1 month to 18 years admitted to the Paediatric intensive care unit with sepsis and septic shock were enrolled in the study. ABG at admission to document plasma lactate and lactate repeated at 6 and 24 hrs. Lactate clearance calculated at 6 and 24 hrs. The final outcome in terms of survival or death will be recorded.Results: Majority of the children fall in the class between 1-6 months 51(48.11%). Male comprises 69(65.09%). Among these, Sepsis 36(33.96%); followed by Pneumonia 34(32.07%). Survivors group were 35(33.02%) and non-survivor was 71(66.98%). The Non survivor group was observed to have lower mean values of lactate clearance and found to be statistically significant. Specificity of Lactate clearance was 63.52% and Sensitivity 76.02% respectively. The results were positively associated with lactate level at 24 hours found to be significant effect of survivability when compared to non-survivor.Conclusions: Lactate clearance is vital and markable sign for screening of septic shock at early stage for therapeutic option. Further, 24-hours lactate estimation (cut off values) clearance appears superior to 6 h lactate clearance in predicting mortality in such patients.

scholarly journals Unfractionated Heparin Improves the Intestinal Microcirculation in a Canine Septic Shock Model

2021 ◽  
Vol 2021 ◽  
pp. 1-11
Author(s):  
Heng Zhang ◽  
Yini Sun ◽  
Xin An ◽  
Xiaochun Ma
Keyword(s):  
Septic Shock ◽  
Unfractionated Heparin ◽  
Flow Index ◽  
Shock Model ◽  
Microcirculatory Perfusion ◽  
Basic Therapy ◽  
E Coli ◽  
Intestinal Microcirculation ◽  
Hemodynamic Variables ◽  
Lactate Levels

Background. Alterations of microcirculation are associated with organ hypoperfusion and high mortality in septic shock. This study is aimed at investigating the effects of unfractionated heparin (UFH) on intestinal microcirculatory perfusion and systemic circulation in a septic shock model. Methods. Twenty-four beagle dogs were randomly allocated into four groups: (a) sham group: healthy controls, (b) shock group: septic shock induced by Escherichia coli, (c) basic therapy group: septic shock animals treated with antibiotics and 10 ml/kg/h saline, and (d) heparin group: septic shock animals treated with basic therapy plus UFH. Hemodynamic variables were measured within 24 h after E. coli administration. The intestinal microcirculation was simultaneously investigated with a sidestream dark-field imaging technique. Additionally, the function of vital organs was evaluated at 12 h postadministration (T12). Results. E. coli induced a progressive septic shock in which the mean arterial pressure (MAP) decreased and lactate levels sharply increased, accompanied by deteriorated microvessel perfusion. While basic therapy partially improved the microvascular flow index and the perfused microvessel density in the jejunal villi, UFH significantly restored major microcirculation variables at T12. Physiological variables, including MAP, urine output, and lactate levels, were improved by UFH, whereas some hemodynamic indices were not affected by UFH. With respect to organ function, UFH increased the platelet count and decreased the creatinine level. Conclusions. UFH improves microcirculatory perfusion of the small intestine independently of the changes in systemic hemodynamic variables in a canine model of septic shock, thereby improving coagulation and renal function.

Low Lactic Acid and Hypercholesterolemia Reduce 90-day Mortality in Patients Suffering From Septic Shock According to the Sepsis-3 Definition

2021 ◽  
Author(s):  
Dong Wang ◽  
Yali Sun ◽  
Huan Liu ◽  
Xiaojuan Zhang ◽  
Xianfei Ding ◽  
...  
Keyword(s):  
Septic Shock ◽  
Lactic Acid ◽  
Total Cholesterol ◽  
Cox Model ◽  
Health Assessment ◽  
Binary Logistic Regression ◽  
Apache Ii ◽  
Binary Logistic Regression Model ◽  
Cholesterol Levels ◽  
Lactate Levels

Abstract Background: Dyslipidemia and lactic acid levels are associated with poor prognosis of septic shock. After the revised definition of sepsis and septic shock (Sepsis-3) in 2016, data on the prognostic value of lactic acid levels and hypocholesterolemia were lacked. This study aimed to evaluate whether lactic acid and cholesterol can be used to predict mortality in ICU patients suffering from septic shock.Methods: Prospective observational study, 349 patients suffering from septic shock as defined by Sepsis-3. The COX model and the binary logistic regression model evaluate the correlation between lactic acid or total cholesterol and death from septic shock, and are adjusted according to the demographics, chronic diseases, and biomarkers of the participants.Results: Total cholesterol, total protein, and albumin levels were significantly lower, and lactic acid, acute physiology, and chronic health assessment (APACHE II) were significantly higher in the surviving group compared to those in the non-surviving group. Lactate levels < 4.4 mmol/L and total cholesterol levels < 2.42 mmol/L were associated with mortality after adjusting for confounders (odd ratio, 3.06 [95% CI, 1.78-5.27] and 1.99 [95% CI, 1.15-3.46]). In multivariate analysis, urogenital origin, albumin levels < 25 g/L, age < 60 years, and APACHE II < 20 were independent risk factors for death from septic shock.Conclusions: In those suffering from septic shock, increased blood lactate levels and decreased total cholesterol levels were associated with higher mortality. Furthermore, it was found that lactic acid and total cholesterol are sensitive markers of mortality in an ICU setting.

Sign in / Sign up

Export Citation Format

Share Document