normolactatemic septic shock: caution - lethal none the less
TRANSCRIPT
Normal Lactate Levels in Septic Shock
CAUTION –Lethal Non The Less
56 patients with clinical signs of shock:
Hypovolemia (17), Sepsis (9), cardiac failure
(7), neural dys. & endocrine def. (4),
vascular obs. (2), mixed (9), unclassified (8)
1 Broder G, Weil MH.
Science 1964;143:1457-1459
Background
3 Mizock, Dis Mon, 1989 2 Weil, Circulation, 1970
Lactate
Sudden Cardiopulmonary
Complications
Lactate is equivalent
to ScvO2
2012 Surviving Sepsis Campaign Guidelines
Group IAlactemic
Lactate < 2
and
SBP < 90
Group IIIntermediate
Lactate 2-4
and
SBP < 90
Group IIIHigh Lactate
Lactate > 4
and
SBP < 90
Group IVHigh Lactate
Lactate > 4
and
SPB > 90
Group IAlactemic
Lactate < 2
and
SBP < 90
Group IIIntermediate
Lactate 2-4
and
SBP < 90
Group IIIHigh Lactate
Lactate > 4
and
SBP < 90
Group IVHigh Lactate
Lactate > 4
and
SPB > 90
N, % 414 (22.8) 467 (25.5) 472 (25.8) 475 (25.9)
Age, Mean (SD) 61.5 (16.5) 64.4 (16.2) 63.5 (16.9) 64.0 (16.5)
Gender N (%)
Male
Female
203 (49)
211 (51)
248 (53)
219 (47)
260 (55)
212 (45)
309 (65)
166 (35)
Ethnicity N (%)
African American
Caucasian
Other
227 (55)
123 (30)
64 (15)
257 (55)
126 (27)
84 (18 )
283 (60)
116 (25)
73 (15)
309 (65)
104 (22)
62 (13)
Group IAlactemic
Lactate < 2
and
SBP < 90
Group IIIntermediate
Lactate 2-4
and
SBP < 90
Group IIIHigh Lactate
Lactate > 4
and
SBP < 90
Group IVHigh Lactate
Lactate > 4
and
SPB > 90
Initial APACHE II 17.9 (6.7) 19.2 (7.2) 21.1 (7.8) 19.2 (7.7)
Treatment
Started N, (%)
ED
GPU
MICU
SICU
Other
187 (45)
0 (0)
155 (37)
30 (7)
42(11)
230 (49)
0 (0)
124 (27)
33 (7)
80 (17)
287 (58)
21 (4)
88 (18)
41 (8)
31 (12)
336 (68)
16 (3)
63 (13)
28 (6)
32 (10)
Group I Group II Group III Group IV
Alactemic
Lactate < 2
and
SBP < 90
Intermediate
Lactate 2-4
and
SBP < 90
High Lactate
Lactate > 4
and
SBP < 90
High Lactate
Lactate > 4
and
SPB > 90
Mortality
21.1 % 30.6 % 37.9 % 29.5 %
Group IAlactemic
Lactate < 2
and
SBP < 90
Group IIIntermediate
Lactate 2-4
and
SBP < 90
Group IIIHigh Lactate
Lactate > 4
and
SBP < 90
Group IVHigh Lactate
Lactate > 4
and
SPB > 90
ICU Length of
Stay, Days 6.1 (6.7) 6.6 (6.5) 6.1 (6.1) 5.1 (5.1)
Hospital Length
of Stay, Days 15.2 (13.3) 13.3 (11.3) 12.8 (12.7) 12.2 (11.6)
Actual
Mortality (%)21.1 30.6 37.9 29.5
Journal of Intensive Care Medicine, 2012
Alactemic patients have higher mortalities and
benefit less because of lack of recognition.
•These results reflect other studies which suggest that aggressive resuscitation may be beneficial even in the setting of a normal-range lactate concentration.
http://crashingpatient.com/medical-surgical/metabolic-disorders/acidbase-disorders.htm/
http://emedicine.medscape.com/article/167027-overview
