Title |
A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients: a proof-of-concept study
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Published in |
Annals of Intensive Care, March 2017
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DOI | 10.1186/s13613-017-0253-x |
Pubmed ID | |
Authors |
Leyla Alegría, Magdalena Vera, Jorge Dreyse, Ricardo Castro, David Carpio, Carolina Henriquez, Daniela Gajardo, Sebastian Bravo, Felipe Araneda, Eduardo Kattan, Pedro Torres, Gustavo Ospina-Tascón, Jean-Louis Teboul, Jan Bakker, Glenn Hernández |
Abstract |
Persistent hyperlactatemia is particularly difficult to interpret in septic shock. Besides hypoperfusion, adrenergic-driven lactate production and impaired lactate clearance are important contributors. However, clinical recognition of different sources of hyperlactatemia is unfortunately not a common practice and patients are treated with the same strategy despite the risk of over-resuscitation in some. Indeed, pursuing additional resuscitation in non-hypoperfusion-related cases might lead to the toxicity of fluid overload and vasoactive drugs. We hypothesized that two different clinical patterns can be recognized in septic shock patients through a multimodal perfusion monitoring. Hyperlactatemic patients with a hypoperfusion context probably represent a more severe acute circulatory dysfunction, and the absence of a hypoperfusion context is eventually associated with a good outcome. We performed a retrospective analysis of a database of septic shock patients with persistent hyperlactatemia after initial resuscitation. We defined hypoperfusion context by the presence of a ScvO2 < 70%, or a P(cv-a)CO2 ≥6 mmHg, or a CRT ≥4 s together with hyperlactatemia. Ninety patients were included, of whom seventy exhibited a hypoperfusion-related pattern and 20 did not. Although lactate values were comparable at baseline (4.8 ± 2.8 vs. 4.7 ± 3.7 mmol/L), patients with a hypoperfusion context exhibited a more severe circulatory dysfunction with higher vasopressor requirements, and a trend to longer mechanical ventilation days, ICU stay, and more rescue therapies. Only one of the 20 hyperlactatemic patients without a hypoperfusion context died (5%) compared to 11 of the 70 with hypoperfusion-related hyperlactatemia (16%). Two different clinical patterns among hyperlactatemic septic shock patients may be identified according to hypoperfusion context. Patients with hyperlactatemia plus low ScvO2, or high P(cv-a)CO2, or high CRT values exhibited a more severe circulatory dysfunction. This provides a starting point to launch further prospective studies to confirm if this approach can lead to a more selective resuscitation strategy. |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 88 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Postgraduate | 13 | 15% |
Other | 9 | 10% |
Student > Ph. D. Student | 9 | 10% |
Student > Doctoral Student | 7 | 8% |
Researcher | 7 | 8% |
Other | 17 | 19% |
Unknown | 26 | 30% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 50 | 57% |
Biochemistry, Genetics and Molecular Biology | 2 | 2% |
Nursing and Health Professions | 2 | 2% |
Agricultural and Biological Sciences | 1 | 1% |
Computer Science | 1 | 1% |
Other | 5 | 6% |
Unknown | 27 | 31% |