Lactic Acid Utilization Compliance and Outcomes in Sepsis. Ammar A Saati Dr.Budder Siddiqui & Dr.Nashat Rabadi
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1 Lactic Acid Utilization Compliance and Outcomes in Sepsis Ammar A Saati Dr.Budder Siddiqui & Dr.Nashat Rabadi
2 Contents Introduction Objective Methods Results Conclusion Acknowledgment References
3 Definitions SIRS (Systemic Inflammatory Response Syndrome) Sepsis Severe Sepsis Septic Shock
4 Incidence of Severe Sepsis Mortality of Severe Sepsis ,000 Cases/100, CHF Severe 0 AIDS* Colon Breast Cancer Sepsis Deaths/Year 200, , ,000 50,000 0 AIDS* Breast Cancer AMI Severe Sepsis National Center for Health Statistics, American Cancer Society, *American Heart Association Angus DC et al. Crit Care Med. 2001;29(7):
5 Introduction Severe Sepsis is common, Expensive, and frequently fatal 28 50%.* To risk stratify patients in the proximal phase of illness, may assist clinicians to more effectively manage these patients and improve out comes. * Angus DC, Linde Zwirble WT, Lidicker J, Clermont G, Carcillo J, Pinsky MR. Epidemiology of severe sepsis in the United States: analysis of incidence, outcome, and associated costs of care. Crit Care Med Jul;29(7):
6 Elevated Lactic Acid (LA) is strongly associated with Morbidity and Mortality for sepsis patients.* Elevated LA is simply a manifestation of organ dysfunction: Impaired lactate clearance Excessive production *Mikkelsen M. Miltides A. Gaieski D. Goyal M. Fuchs B. Shah C. Bellamy S. Christie J. Serum lacate is associated with mortalilty in severe sepsis independent of organ failure and shock. Crti Care Med 2009 Vol.37 No5;
7 *Mikkelsen M. Miltides A. Gaieski D. Goyal M. Fuchs B. Shah C. Bellamy S. Christie J. Serum lacate is associated with mortalilty in severe sepsis independent of organ failure and shock. Crti Care Med 2009 Vol.37 No5;
8 *Mikkelsen M. Miltides A. Gaieski D. Goyal M. Fuchs B. Shah C. Bellamy S. Christie J. Serum lacate is associated with mortalilty in severe sepsis independent of organ failure and shock. Crti Care Med 2009 Vol.37 No5;
9 A systematic review supported blood lactate monitoring as being useful for risk assessment in patients admitted acutely to the hospital.* For every 1 mmol/l increment of LA the hazard of dying were expected to increase 1.5 times. ** *Kruse O. Grunnet N. Barfod C. Blood lactate as a predictor for in hospital mortality in patients admitted acutely to hospital: a systematic review; Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011; 19:74 **Hisamuddin N, Azlan K,The Use of Laboratory and physiological Parameters in Predicting Mortality in Sepsis Induced Hypotensionand Septic Shock Patients attending the Emergency. Med J Malaysia Vol 67 No 3 June 2012:
10 Early Directed Goal Therapy EGDT and Surviving Sepsis Guidelines included measuring Lactic Acid. EGDT begins with early identification of high risk patients based: Hypotension LA>36mg/dl
11
12 *Dellinger R. Levy M. Rhodes A. Annane D. Gerlach H. Opal S. Sevransky J. Sprung C. Douglas I. Jaeschke R. Osborn T. Nunnally M. Townsend S. Reinhart K. Kleinpell R. Angus D. Deutschman C. Machado F. Rubenfeld G. Webb S. Beale R. Vincent J. Moreno R. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic shock; 2012; Crit Care Med Feb 2013 Vol 41 No 2;
13 Objective To determine physicians compliance in measuring lactic acid levels in patients admitted with Sepsis. To review the mortality outcome associated with elevated lactic acid level. To determine the association between elevated lactic acid levels and prolonged hospitalization.
14 Methodology Observational Cohort Study Total 200 patients (100 SOCH, 100 MHOB) Inclusion: Age 18 or older Sepsis Criteria Exclusion Any patients not fulfilling Sepsis (WBC, Temp) Surgical patient SAS (Statistical Analysis Software)
15 SOCH MHOB
16
17 Male Age
18 Demographics HTN CAD DM CHF COPD Malignancy HIV
19 LA Requested
20
21 Control Shock
22 LA & Mortality
23 Logistic Regression
24 LA & Stay
25 Conclusion 57.5% Physicians were compliance with ordering LA. High LA level was significantly associated with higher Mortality.
26 Considering the low volume population we could not statistically measure the difference in length of stay.
27 Acknowledgment Kholoud My Wife. Abdulrahman Abudawood MD. Dr Henri Woodman MD.
28 References Rivers E. Katranji M. Jaehne K. Brown S. AbouDagher G. Cannon C. Coba V. Early intervention in severe sepsis and septic shock: a review of the evidence one decade later; Minerva Anesteiol June 2012 Vol 78; Kruse O. Grunnet N. Barfod C. Blood lactate as a predictor for in hospital mortality in patients admitted acutely to hospital: a systemic review; Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine 2011; 19:74 Dellinger R. Levy M. Rhodes A. Annane D. Gerlach H. Opal S. Sevransky J. Sprung C. Douglas I. Jaeschke R. Osborn T. Nunnally M. Townsend S. Reinhart K. Kleinpell R. Angus D. Deutschman C. Machado F. Rubenfeld G. Webb S. Beale R. Vincent J. Moreno R. Surviving Sepsis Campaign: International Guidelines for Management of Severe Sepsis and Septic shock; 2012; Crit Care Med Feb 2013 Vol 41 No 2; Hisamuddin N. Azlam K. The Use of Laboratory and Physiological Parameters in Predicting Mortality in Sepsis Induced Hypotension and Septic Shock Patients attending The Emergency Department. Med J Malaysia Vol 67 No 3 June 2012; Nguyen H. Rivers E. Knoblich B. Jacobsen G. Muzzin A. Ressler J. Tomlanovich M. Early lactate clearance is associated with improved out come in severe sepsis and septic shock. Crit Care Med 2004 Vol. 32, No.8; Mikkelsen M. Miltides A. Gaieski D. Goyal M. Fuchs B. Shah C. Bellamy S. Christie J. Serum lacate is associated with mortalilty in severe sepsis independent of organ failure and shock. Crti Care Med 2009 Vol.37 No5; Wacharasint P. Nakada T. Boyd J. Russell J. Walley K. Normal Range blood lactate concentration in Seotic Shock is Prognostic and Predictive; SHOCK Mar 2012 Vol 38 No 1; National Center for Health Statistics, American Cancer Society, *American Heart Association Angus DC et al. Crit Care Med. 2001;29(7):
29 THANK YOU Ammar Saati
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