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Lactate and hypotension

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https://www.readbyqxmd.com/read/28403066/non-hemodynamic-effects-of-catecholamines
#1
Clair Hartmann, Peter Radermacher, Martin Wepler, Benedikt Nubaum
Circulatory shock is defined as an imbalance between tissue oxygen supply and demand, and mostly results from a loss of blood volume, cardiac pump failure and/or reduction of vasomotor tone. The clinical hallmarks of circulatory shock are arterial hypotension and lactate acidosis. Since the degree and duration of hypotension are major determinants of outcome, vasopressor administration represents a cornerstone therapy to treat these patients. Current guidelines recommend the use of catecholamines as the drug of first choice...
April 11, 2017: Shock
https://www.readbyqxmd.com/read/28358631/survival-analysis-of-hypotensive-cats-admitted-to-an-intensive-care-unit-with-or-without-hyperlactatemia-39-cases-2005-2011
#2
Emily K Shea, Stefan C Dombrowski, Deborah C Silverstein
OBJECTIVE To examine the association between blood lactate concentration and survival to hospital discharge in critically ill hypotensive cats. DESIGN Retrospective case series. ANIMALS 39 cats admitted to an intensive care unit of a university veterinary hospital between January 2005 and December 2011 for which blood lactate concentration was recorded ≤ 1 hour before or after a Doppler-derived arterial blood pressure measurement ≤ 90 mm Hg (ie, hypotension) was obtained. PROCEDURES Medical records of each cat were reviewed to assess survival to hospital discharge, illness severity, duration of hospitalization, age, body weight, and PCV...
April 15, 2017: Journal of the American Veterinary Medical Association
https://www.readbyqxmd.com/read/28343448/hemoadsorption-by-cytosorb-in-septic-patients-a-case-series
#3
Klaus Kogelmann, Dominik Jarczak, Morten Scheller, Matthias Drüner
BACKGROUND: Septic shock, defined as life-threatening organ dysfunction caused by a dysregulated host response to infection, is a highly lethal condition that causes substantial morbidity and mortality among critically ill patients. One of the hallmarks of sepsis is the excessive release of cytokines and other inflammatory mediators causing refractory hypotension, tissue damage, metabolic acidosis and ultimately multiple organ failure. In this context, cytokine reduction by hemoadsorption represents a new concept for blood purification, developed to attenuate the overwhelming systemic levels of pro-inflammatory and anti-inflammatory mediators released in the early phase of sepsis...
March 27, 2017: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/28320242/early-goal-directed-therapy-for-septic-shock-a-patient-level-meta-analysis
#4
(no author information available yet)
Background After a single-center trial and observational studies suggesting that early, goal-directed therapy (EGDT) reduced mortality from septic shock, three multicenter trials (ProCESS, ARISE, and ProMISe) showed no benefit. This meta-analysis of individual patient data from the three recent trials was designed prospectively to improve statistical power and explore heterogeneity of treatment effect of EGDT. Methods We harmonized entry criteria, intervention protocols, outcomes, resource-use measures, and data collection across the trials and specified all analyses before unblinding...
March 21, 2017: New England Journal of Medicine
https://www.readbyqxmd.com/read/28255987/a-randomised-double-blind-trial-of-phenylephrine-and-metaraminol-infusions-for-prevention-of-hypotension-during-spinal-and-combined-spinal-epidural-anaesthesia-for-elective-caesarean-section
#5
N J McDonnell, M J Paech, N A Muchatuta, S Hillyard, E A Nathan
Prophylactic vasopressor administration is commonly recommended to reduce maternal hypotension during spinal anaesthesia for caesarean section. Metaraminol has undergone limited investigation in obstetric anaesthesia for this purpose, particularly in comparison with phenylephrine. In this multicentre, randomised, double-blind, non-inferiority study, we compared prophylactic phenylephrine or metaraminol infusions, started immediately after spinal anaesthesia, in 185 women who underwent elective caesarean section...
May 2017: Anaesthesia
https://www.readbyqxmd.com/read/28251580/experimental-assessment-of-oxygen-homeostasis-during-acute-hemodilution-the-integrated-role-of-hemoglobin-concentration-and-blood-pressure
#6
Tiffanie Kei, Nikhil Mistry, Albert K Y Tsui, Elaine Liu, Stephen Rogers, Allan Doctor, David F Wilson, Jean-Francois Desjardins, Kim Connelly, C David Mazer, Gregory M T Hare
BACKGROUND: Low hemoglobin concentration (Hb) and low mean arterial blood pressure (MAP) impact outcomes in critically ill patients. We utilized an experimental model of "normotensive" vs. "hypotensive" acute hemodilutional anemia to test whether optimal tissue perfusion is dependent on both Hb and MAP during acute blood loss and fluid resuscitation, and to assess the value of direct measurements of the partial pressure of oxygen in tissue (PtO2). METHODS: Twenty-nine anesthetized rats underwent 40% isovolemic hemodilution (1:1) (or sham-hemodilution control, n = 4) with either hydroxyethyl starch (HES) (n = 14, normotensive anemia) or saline (n = 11, hypotensive anemia) to reach a target Hb value near 70 g/L...
December 2017: Intensive Care Medicine Experimental
https://www.readbyqxmd.com/read/28248722/mortality-is-greater-in-septic-patients-with-hyperlactatemia-than-with-refractory-hypotension
#7
Robert Gotmaker, Sandra L Peake, Andrew Forbes, Rinaldo Bellomo
BACKGROUND: In septic patients, it is uncertain whether isolated hyperlactatemia (lactate ≥ 4 mmol/L without refractory hypotension) can be used to diagnose septic shock and whether mortality rate differs from that of isolated refractory hypotension (refractory to 1000 ml or greater fluid bolus). AIMS: To compare baseline characteristics, treatments and outcomes of participants enrolled into the Australian Resuscitation in Sepsis Evaluation (ARISE) trial according to the presence of isolated hyperlactatemia or isolated refractory hypotension...
February 28, 2017: Shock
https://www.readbyqxmd.com/read/28243715/volume-replacement-during-trauma-resuscitation-a-brief-synopsis-of-current-guidelines-and-recommendations
#8
REVIEW
M Maegele, M Fröhlich, M Caspers, S Kaske
INTRODUCTION: Intravascular volume and fluid replacement are still cornerstones to correct fluid deficits during early trauma resuscitation, but optimum strategies remain under debate. METHODS: A synopsis of best current knowledge with reference to the following guidelines and recommendations is presented: (1) The European Guideline on Management of Major Bleeding and Coagulopathy following Trauma (fourth edition), (2) S3 Guideline on Treatment of Patients with Severe and Multiple Injuries [English Version of the German Guideline S3 Leitlinie Polytrauma/Schwerverletzten-Behandlung/AWMF Register-Nr...
February 27, 2017: European Journal of Trauma and Emergency Surgery: Official Publication of the European Trauma Society
https://www.readbyqxmd.com/read/28225738/pneumatosis-intestinalis-predictive-evaluation-study-a-multicenter-epidemiologic-study-of-the-american-association-for-the-surgery-of-trauma
#9
Paula Ferrada, Rachael Callcut, Graciela Bauza, Karen R O'Bosky, Xian Luo-Owen, Nicky J Mansfield, Kenji Inaba, Jason Pasley, Nikolay Bugaev, Bruno Pereira, Forrest O Moore, Jinfeng Han, Amelia Pasley, Joseph DuBose
BACKGROUND: Our group has previously published a retrospective review defining variables predictive of transmural bowel ischemia in the setting of pneumatosis intestinalis (PI). We hypothesize this prospective study will confirm the findings of the retrospective review, enhancing legitimacy to the predictive factors for pathologic PI previously highlighted. METHODS: Data were collected using the Research Electronic Data Capture. Forward logistic regression was utilized to identify independent predictors for pathologic PI...
March 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28220227/prediction-of-pediatric-sepsis-mortality-within-1%C3%A2-h-of-intensive-care-admission
#10
Luregn J Schlapbach, Graeme MacLaren, Marino Festa, Janet Alexander, Simon Erickson, John Beca, Anthony Slater, Andreas Schibler, David Pilcher, Johnny Millar, Lahn Straney
PURPOSE: The definitions of sepsis and septic shock have recently been revised in adults, but contemporary data are needed to inform similar approaches in children. METHODS: Multicenter cohort study including children <16 years admitted with sepsis or septic shock to ICUs in Australia and New Zealand in the period 2012-2015. We assessed septic shock criteria at ICU admission to define sepsis severity, using 30-day mortality as outcome. Through multivariable logistic regression, a pediatric sepsis score was derived using variables available within 60 min of ICU admission...
February 20, 2017: Intensive Care Medicine
https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#11
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28165882/role-of-combined-post-operative-venous-lactate-and-48-hours-c-reactive-protein-values-on-the-etiology-and-predictive-capacity-of-organ-space-surgical-site-infection-after-elective-colorectal-operation
#12
Montserrat Juvany, Xavier Guirao, Joan Carles Oliva, Jose M Badía Pérez
BACKGROUND: C-reactive protein (CRP) has been assessed to detect organ-space surgical site infection (OSI). Nevertheless, data about peri-operative oxygen debt and surgical stress-elicited biologic markers to explain and allow for the early detection of OSI are lacking. We analyzed immediate post-operative venous lactate, early CRP levels, and intra-operative hemodynamic values on the capacity to predict OSI after elective colorectal operation. PATIENTS AND METHODS: Patients undergoing an elective colorectal surgical procedure with anastomosis between March 2013 and August 2014 were included and assessed prospectively...
April 2017: Surgical Infections
https://www.readbyqxmd.com/read/28152199/investigation-of-perioperative-and-anesthetic-variables-affecting-short-term-survival-of-horses-with-small-intestinal-strangulating-lesions
#13
Pablo Espinosa, Sarah S Le Jeune, Alessia Cenani, Philip H Kass, Robert J Brosnan
OBJECTIVE: To determine if preoperative and intraoperative physiologic variables, and surgical factors correlate with survival to anesthetic recovery or hospital discharge, repeat celiotomy, and postoperative nasogastric intubation (NGT) in horses undergoing exploratory celiotomy for small intestinal (SI) strangulating lesions. STUDY DESIGN: Retrospective case series. ANIMALS: Horses that had surgical correction of SI strangulating lesions (n = 258)...
April 2017: Veterinary Surgery: VS
https://www.readbyqxmd.com/read/28140511/comparison-of-cephalic-and-jugular-plasma-lactate-concentrations-in-sick-cats-a-pilot-study
#14
Emily K J Sachs, Tracy M Julius, Sean-Paul A Claypool, Monica C Clare
OBJECTIVES: To compare plasma lactate concentration (PLC) in paired cephalic and jugular blood samples from sick cats. An additional objective was to determine whether hypotensive cats (Doppler blood pressure < 90 mm Hg) have a significant difference between cephalic and jugular PLC. DESIGN: Prospective observational pilot study performed from December 2013 to August 2014. SETTING: Private veterinary referral center. ANIMALS: Twenty client-owned cats...
March 2017: Journal of Veterinary Emergency and Critical Care
https://www.readbyqxmd.com/read/28129900/-atypical-and-rare-cardiac-revelation-about-sheehan-s-syndrome-a-report-of-three-cases
#15
N Bouznad, G El Mghari, M El Hattaoui, N El Ansari
Sheehan syndrome is a potentially serious complication in the postpartum period corresponding to ischemic necrosis of the anterior pituitary related to postpartum haemorrhage. We report three original observations showing an unusual mode of revelation of this syndrome. The first observation is that of a 46-year-old patient admitted initially to resuscitation for a recovered cardiorespiratory arrest, severe hypoglycemia and profound hyponatremia. The second is that of a 45-year-old patient, admitted for recurrent cardiac tamponade after pericardial and pleural puncture and pericardial drainage; clinical survey found signs of slight panhypopituitarism...
January 24, 2017: Annales de Cardiologie et D'angéiologie
https://www.readbyqxmd.com/read/28126452/early-sepsis-bundle-compliance-for-non-hypotensive-patients-with-intermediate-versus-severe-hyperlactemia
#16
Daniel E Leisman, Jason A Zemmel D'Amore, Jeanie L Gribben, Mary Frances Ward, Kevin D Masick, Andrea R Bianculli, Kathryn H Bradburn, John K D'Angelo, Martin E Doerfler
OBJECTIVE: To compare the association of 3-h sepsis bundle compliance with hospital mortality in non-hypotensive sepsis patients with intermediate versus severe hyperlactemia. METHODS: This was a cohort study of all non-hypotensive, hyperlactemic sepsis patients captured in a prospective quality-improvement database, treated October 2014 to September 2015 at five tertiary-care centers. We defined sepsis as 1) infection, 2) ≥2 SIRS criteria, and 3) ≥1 organ dysfunction criterion...
January 15, 2017: American Journal of Emergency Medicine
https://www.readbyqxmd.com/read/28067685/association-between-initial-emergency-department-lactate-and-use-of-vasoactive-medication-in-children-with-septic-shock
#17
Michael J Miescier, Roni D Lane, Xiaoming Sheng, Gitte Y Larsen
OBJECTIVES: Current guidelines emphasize early recognition of pediatric septic shock using clinical examination findings. Elevated serum lactate has been associated with increased mortality in adult patients with septic shock. Our objective was to determine the association between the initial serum lactate obtained in the pediatric emergency department (PED) from patients treated for septic shock and the use of vasoactive medication within 24 hours. METHODS: This was a retrospective study from 2008 through 2012 of PED patients at a tertiary care children's hospital...
January 6, 2017: Pediatric Emergency Care
https://www.readbyqxmd.com/read/28059837/complications-risk-factors-and-staffing-patterns-for-noncardiac-surgery-in-patients-with-left-ventricular-assist-devices
#18
Michael R Mathis, Subramanian Sathishkumar, Sachin Kheterpal, Matthew D Caldwell, Francis D Pagani, Elizabeth S Jewell, Milo C Engoren
BACKGROUND: Patients with left ventricular assist devices presenting for noncardiac surgery are increasingly commonplace; however, little is known about their outcomes. Accordingly, the authors sought to determine the frequency of complications, risk factors, and staffing patterns. METHODS: The authors performed a retrospective study at their academic tertiary care center, investigating all adult left ventricular assist device patients undergoing noncardiac surgery from 2006 to 2015...
March 2017: Anesthesiology
https://www.readbyqxmd.com/read/28041825/sodium-nitrite-and-sodium-thiosulfate-are-effective-against-acute-cyanide-poisoning-when-administered-by-intramuscular-injection
#19
Vikhyat S Bebarta, Matthew Brittain, Adriano Chan, Norma Garrett, David Yoon, Tanya Burney, David Mukai, Michael Babin, Renate B Pilz, Sari B Mahon, Matthew Brenner, Gerry R Boss
STUDY OBJECTIVE: The 2 antidotes for acute cyanide poisoning in the United States must be administered by intravenous injection. In the out-of-hospital setting, intravenous injection is not practical, particularly for mass casualties, and intramuscular injection would be preferred. The purpose of this study is to determine whether sodium nitrite and sodium thiosulfate are effective cyanide antidotes when administered by intramuscular injection. METHODS: We used a randomized, nonblinded, parallel-group study design in 3 mammalian models: cyanide gas inhalation in mice, with treatment postexposure; intravenous sodium cyanide infusion in rabbits, with severe hypotension as the trigger for treatment; and intravenous potassium cyanide infusion in pigs, with apnea as the trigger for treatment...
December 29, 2016: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/27979471/changes-in-kidney-perfusion-and-renal-cortex-metabolism-in-septic-shock-an-experimental-study
#20
Emiel Hendrik Post, Fuhong Su, Koji Hosokawa, Fabio Silvio Taccone, Antoine Herpain, Jacques Creteur, Jean-Louis Vincent, Daniel De Backer
BACKGROUND: The etiology of renal dysfunction in sepsis is currently attributed to altered perfusion, microcirculatory abnormalities and cellular alterations. To clarify these mechanisms, we characterized the changes in renal perfusion and cortex metabolism in a large animal model of sepsis. METHODS: We studied 12 adult female sheep randomized to peritonitis-induced sepsis (n = 8) or to sham procedure (n = 4). A flow probe was positioned around the renal artery to measure renal blood flow (RBF)...
January 2017: Journal of Surgical Research
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