A hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients : a proof-of-concept study

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dc.contributor.authorAlegría, Leyla.
dc.contributor.authorVera, Magdalena.
dc.contributor.authorDreyse, Jorge
dc.contributor.authorCastro, Ricardo
dc.contributor.authorCarpio Cordero, David
dc.contributor.authorHenríquez, Carolina.
dc.contributor.authorGajardo, Daniela.
dc.contributor.authorBravo-Grau, Sebastian.
dc.contributor.authorAraneda, Felipe.
dc.contributor.authorHernández P., Glenn
dc.date.accessioned2019-10-16T20:13:15Z
dc.date.available2019-10-16T20:13:15Z
dc.date.issued2017
dc.date.updated2019-10-14T19:16:27Z
dc.description.abstractAbstract Background 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. Results 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%). Conclusions 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.
dc.fuente.origenBiomed Central
dc.identifier.citationAnnals of Intensive Care. 2017 Mar 09;7(1):29
dc.identifier.doi10.1186/s13613-017-0253-x
dc.identifier.urihttps://repositorio.uc.cl/handle/11534/26559
dc.identifier.urihttps://doi.org/10.1186/s13613-017-0253-x
dc.issue.numeroNo. 29
dc.language.isoen
dc.pagina.final6
dc.pagina.inicio1
dc.revistaAnnals of Intensive Carees_ES
dc.rightsacceso abierto
dc.rights.holderThe Author(s)
dc.subject.ddc610
dc.subject.deweyMedicina y saludes_ES
dc.subject.otherHiperlactatemiaes_ES
dc.subject.otherDióxido de carbonoes_ES
dc.subject.otherArteriasShock sépticoes_ES
dc.subject.otherResucitaciónes_ES
dc.titleA hypoperfusion context may aid to interpret hyperlactatemia in sepsis-3 septic shock patients : a proof-of-concept studyes_ES
dc.typeartículo
dc.volumenVol. 7
sipa.codpersvinculados4537
sipa.codpersvinculados1015466
sipa.codpersvinculados1015696
sipa.codpersvinculados98874
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