Document Detail


Prolonged lactate clearance is associated with increased mortality in the surgical intensive care unit.
MedLine Citation:
PMID:  11754855     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Failure of arterial serum lactate to achieve normal levels has been associated with an increased mortality among medical and trauma patients. At our institution the ability of the patient to normalize arterial serum lactate has been utilized as an end point of resuscitation. In this study, we examine the correlation between length of time to lactate normalization and mortality. METHODS: The charts of 95 consecutive surgical intensive care unit (SICU) patients requiring hemodynamic monitoring or therapy were reviewed retrospectively. Hemodynamic, demographic, and laboratory data were recorded. Patients were stratified by lactate normalization time, and a subgroup analysis of survivors and nonsurvivors was performed by univariate and multivariate analysis. RESULTS: Patients not achieving a normal lactate level sustained a 100% hospital mortality rate. Those clearing between 48 and 96 hours sustained a 42.5% mortality rate. Patients normalizing in 24 to 48 hours had a 13.3% mortality rate, and those clearing in less than 24 hours had a mortality rate of 3.9%. Subgroup analysis by survival revealed differences in time to lactate clearance, initial blood pressure, and initial lactate on univariate analysis. On multivariate analysis only time of lactate clearance was found to differ. CONCLUSIONS: Prolongation of lactate clearance is associated with increasing mortality. Failure of a patient to normalize lactate is associated with 100% mortality. Measurement of arterial serum lactate is a simple and effective predictor of outcome and end point of therapy.
Authors:
J McNelis; C P Marini; A Jurkiewicz; S Szomstein; H H Simms; G Ritter; I M Nathan
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  American journal of surgery     Volume:  182     ISSN:  0002-9610     ISO Abbreviation:  Am. J. Surg.     Publication Date:  2001 Nov 
Date Detail:
Created Date:  2001-12-28     Completed Date:  2002-01-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0370473     Medline TA:  Am J Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  481-5     Citation Subset:  AIM; IM    
Affiliation:
Department of Surgery, Long Island Jewish-Northshore Health Systems, Albert Einstein College of Medicine, New Hyde Park, NY 11040, USA. jmcnelis@lij.edu
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MeSH Terms
Descriptor/Qualifier:
APACHE
Aged
Critical Illness / mortality*
Endpoint Determination
Humans
Intensive Care*
Intensive Care Units
Lactic Acid / blood*
Multivariate Analysis
Postoperative Care
Resuscitation
Retrospective Studies
Survival Rate
Chemical
Reg. No./Substance:
50-21-5/Lactic Acid

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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