scholarly journals Serum lactate: Role in the assessment of microhemodynamics in critically ill patients

2016 ◽  
Vol 63 (2) ◽  
pp. 41-47
Author(s):  
Jelena Velickovic ◽  
Guillaume Thiery ◽  
Dejan Velickovic ◽  
Goran Rakic ◽  
Krstina Doklestic ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Aerobic Glycolysis ◽  
Multiorgan Failure ◽  
Late Phase ◽  
Glucose Production ◽  
Tissue Perfusion ◽  
Serum Lactate ◽  
Oxygen Debt ◽  
Adrenergic Stimulation

Many critically ill patients with stabilized hemodynamics die with signs of multiorgan failure. One of the reasons is the derangement of microcirculation and tissue perfusion. It has been shown that microcirculatory distress left uncorrected for 24 hours is single independent predictor of mortality in sepsis. Serum lactate is the only indicator of microcirculatory changes that is monitored routinely in all critically ill patients. It has been widely believed that hyperlactatemia in sepsis is marker of tissue hypoxia and indicates the existence of oxygen debt resulting from tissue hypoperfusion and anaerobic glycolysis. Attempts to correct hyperlactatemia by delivering supranormal oxygen amounts have failed in septic patients. The term ?shock? lactate refers to hyperlactatemia originating from oxygen debt. Human studies failed to demonstrate the relationship between hyperlactatemia and tissue hypo-perfusion in the late phase of sepsis. Adrenergic stimulation in sepsis and accelerated aerobic glycolysis have been proposed as a likely mechanism of hyperlactatemia. Both exogenous and endogenous catecholamines are correlated with septic hyperlactatemia. Aerobically generated lactate mediated by cytokines is called ?stress? lactate and may serve as a marker of hypermetabolism rather than tissue hyperperfusion. Many studies and guidelines recommend targeting resuscitation to normalize lactate in septic patients. These recommendations need to be taken with reserve. Since lactate serves, under stress, as a source of energy and can be used as a fuel for oxidation as well as for glucose production, attempts to normalize lactate might be even harmful. Although high lactate clearance, due to a correction of oxygen debt contributes to a better prognosis in sepsis, the unusual complexity of lactate makes it almost impossible to make an unambiguous therapeutic decision, when comes to a lactate-guided treatment in sepsis.

Serum lactate level accurately predicts mortality in critically ill patients with cirrhosis with acute kidney injury

2018 ◽  
Vol 30 (11) ◽  
pp. 1361-1367 ◽  
Author(s):  
Dan-Qin Sun ◽  
Chen-Fei Zheng ◽  
Feng-Bin Lu ◽  
Sven Van Poucke ◽  
Xiao-Ming Chen ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Lactate Level ◽  
Kidney Injury ◽  
Serum Lactate ◽  
Serum Lactate Level

scholarly journals Regulation and Prognostic Relevance of Symmetric Dimethylarginine Serum Concentrations in Critical Illness and Sepsis

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Alexander Koch ◽  
Ralf Weiskirchen ◽  
Jan Bruensing ◽  
Hanna Dückers ◽  
Lukas Buendgens ◽  
...  
Keyword(s):  
Critical Illness ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Multiorgan Failure ◽  
Microvascular Dysfunction ◽  
Serum Levels ◽  
Serum Concentrations ◽  
Symmetric Dimethylarginine ◽  
Term Survival ◽  
Severity Scores

In systemic inflammation and sepsis, endothelial activation and microvascular dysfunction are characteristic features that promote multiorgan failure. As symmetric dimethylarginine (SDMA) impacts vascular tension and integrity via modulating nitric oxide (NO) pathways, we investigated circulating SDMA in critical illness and sepsis. 247 critically ill patients (160 with sepsis, 87 without sepsis) were studied prospectively upon admission to the medical intensive care unit (ICU) and on day 7, in comparison to 84 healthy controls. SDMA serum levels were significantly elevated in critically ill patients at admission to ICU compared to controls and remained stably elevated during the first week of ICU treatment. The highest SDMA levels were found in patients with sepsis. SDMA levels closely correlated with disease severity scores, biomarkers of inflammation, and organ failure (renal, hepatic, and circulatory). We identified SDMA serum concentrations at admission as an independent prognostic biomarker in critically ill patients not only for short-term mortality at the ICU but also for unfavourable long-term survival. Thus, the significant increase of circulating SDMA in critically ill patients indicates a potential pathogenic involvement in endothelial dysfunction during sepsis and may be useful for mortality risk stratification at the ICU.

Prognostic relevance of serum lactate kinetics in critically ill patients

2018 ◽  
Vol 45 (1) ◽  
pp. 55-61 ◽  
Author(s):  
Maryna Masyuk ◽  
Bernhard Wernly ◽  
Michael Lichtenauer ◽  
Marcus Franz ◽  
Bjoern Kabisch ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Serum Lactate ◽  
Lactate Kinetics ◽  
Prognostic Relevance

PRELIMINARY USE OF NONINVASIVE, NIRS-MEASURED TISSUE PERFUSION IN CRITICALLY ILL PATIENTS.

2005 ◽  
Vol 33 ◽  
pp. A126
Author(s):  
Jacqueline Wu ◽  
Olusola Soyemi ◽  
Matthias Walz ◽  
Ye Yang ◽  
Babs Soller ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Tissue Perfusion

scholarly journals Safety and efficacy of tracheotomy for critically ill patients with coronavirus disease 2019 (COVID-19) in Wuhan: a case series of 14 patients

2020 ◽  
Vol 58 (4) ◽  
pp. 745-751
Author(s):  
Surita Aodeng ◽  
Weiqing Wang ◽  
Yu Chen ◽  
Guodong Feng ◽  
Jian Wang ◽  
...  
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Staff ◽  
Late Phase ◽  
Case Series ◽  
Prolonged Intubation ◽  
Artificial Airway ◽  
Global Pandemic ◽  
Progressive Respiratory Failure ◽  
Key Steps

Abstract OBJECTIVES Coronavirus disease 2019 (COVID-19) is a global pandemic. Critically ill patients often require prolonged intubation for mechanical ventilation to support breathing; thus, the artificial airway must be managed by tracheotomy. Therefore, studies exploring appropriate and safe methods for tracheotomy that minimize the risks of nosocomial transmission are important. METHODS A retrospective analysis of the clinical characteristics of 14 critically ill patients with COVID-19, who underwent bedside tracheotomy from March to April 2020 was conducted to summarize the indications for tracheotomy and key points related to personal protective equipment and surgical procedures. RESULTS All 14 patients were diagnosed with COVID-19 and were critically ill. All tracheotomies were performed in the late phase of the infection course. The interval between the infection and tracheotomy was 33 days, and the median interval between intubation and tracheotomy was 25.5 days. The reverse transcription-polymerase chain reaction results of secretions from the operative incision and inside the tracheotomy tube were negative. Twelve patients improved after tracheotomy, with SpO2 levels maintained above 96%. One patient died of progressive respiratory failure; another patient died of uncontrolled septic shock. No medical staff who participated in the tracheotomy was infected. CONCLUSIONS Tracheotomy in critically ill patients with COVID-19 who meet the indications for tracheotomy potentially represents a safer approach to manage the airway and help improve the treatment outcomes. A tracheotomy performed in the late phase of the disease has a relatively low risk of infection. Adherence to key steps in the tracheotomy procedure and donning adequate personal protection will help medical staff avoid infection.

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