Acute and Critical Care

Original Articles

CPR/Resuscitation
Prognostic significance of respiratory quotient in patients undergoing extracorporeal cardiopulmonary resuscitation in Korea: Yun Im Lee, Ryoung-Eun Ko, Soo Jin Na, Jeong-Am Ryu, Yang Hyun Cho, Jeong Hoon Yang, Chi Ryang Chung, Gee Young Suh; Acute Crit Care. 2023;38(2):190-199. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2022.01438

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Background
Respiratory quotient (RQ) may be used as a tissue hypoxia marker in various clinical settings but its prognostic significance in patients undergoing extracorporeal cardiopulmonary resuscitation (ECPR) is not known. Methods: Medical records of adult patients admitted to the intensive care units after ECPR in whom RQ could be calculated from May 2004 to April 2020 were retrospectively reviewed. Patients were divided into good neurologic outcome and poor neurologic outcome groups. Prognostic significance of RQ was compared to other clinical characteristics and markers of tissue hypoxia. Results: During the study period, 155 patients were eligible for analysis. Of them, 90 (58.1%) had a poor neurologic outcome. The group with poor neurologic outcome had a higher incidence of out-of-hospital cardiac arrest (25.6% vs. 9.2%, P=0.010) and longer cardiopulmonary resuscitation to pump-on time (33.0 vs. 25.2 minutes, P=0.001) than the group with good neurologic outcome. For tissue hypoxia markers, the group with poor neurologic outcome had higher RQ (2.2 vs. 1.7, P=0.021) and lactate levels (8.2 vs. 5.4 mmol/L, P=0.004) than the group with good neurologic outcome. On multivariable analysis, age, cardiopulmonary resuscitation to pump-on time, and lactate levels above 7.1 mmol/L were significant predictors for a poor neurologic outcome but not RQ. Conclusions: In patients who received ECPR, RQ was not independently associated with poor neurologic outcome.

Citations

Citations to this article as recorded by

Risk factors for neurological disability outcomes in patients under extracorporeal membrane oxygenation following cardiac arrest: An observational study
Amir Vahedian-Azimi, Ibrahim Fawzy Hassan, Farshid Rahimi-Bashar, Hussam Elmelliti, Anzila Akbar, Ahmed Labib Shehata, Abdulsalam Saif Ibrahim, Ali Ait Hssain
Intensive and Critical Care Nursing.2024; 83: 103674. CrossRef
Extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest and in-hospital cardiac arrest with return of spontaneous circulation: be careful when comparing apples to oranges
Hwa Jin Cho, In Seok Jeong, Jan Bělohlávek
Acute and Critical Care.2023; 38(2): 242. CrossRef

CPR/Resuscitation
Utility of the early lactate area score as a prognostic marker for septic shock patients in the emergency department: Gina Yu, Seung Joon Yoo, Sang-Hun Lee, June Sung Kim, Sungmin Jung, Youn-Jung Kim, Won Young Kim, Seung Mok Ryoo; Acute Crit Care. 2019;34(2):126-132. Published online April 12, 2019; DOI: https://doi.org/10.4266/acc.2018.00283

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Abstract PDF

Background
The current Surviving Sepsis Campaign guidelines recommend the remeasurement of lactate levels if the initial lactate level is elevated; however, the prognostic value of lactate kinetics is limited and inconsistent. We attempted to determine the efficacy of the lactate area score (calculated from repeated lactate measurements during initial resuscitation) as a prognostic marker of septic shock in the emergency department (ED).
Methods
We performed a retrospective study of adult patients with septic shock in the ED of a single tertiary medical center. Serial lactate levels were measured five times within 12 hours. We also compared the initial lactate level, maximum lactate level, and lactate area score. The lactate area score was defined as the sum of the area under the curve measured at 2, 4, 6, and 12 hours following the initial measurement.
Results
A total of 362 patients were enrolled in this study, and the overall 28-day mortality was 31.8%. The lactate area score of serial lactate levels as well as the initial (median [interquartile range], 4.9 [3.4 to 10.5]; P=0.003) and maximum (7.3 [4.2 to 13.2]; P<0.001) lactate levels were significantly higher in the non-survivor group. However, in multivariate analysis, only the lactate area score (odds ratio, 1.013; 95% confidence interval, 1.007 to 1.019) was significantly associated with 28-day mortality.
Conclusions
The early lactate area score may be a possible prognostic marker for predicting the 28-day mortality of adult septic shock patients. Further prospective interventional studies should be conducted to validate our results.

Citations

Citations to this article as recorded by

Association between normalized lactate load and in-hospital mortality in patients with acute myocardial infarction
Yue Wu, Nannan Huang, Tienan Sun, Biyang Zhang, Shiyu Zhang, Pengyu Zhang, Chunxia Zhang
International Journal of Cardiology.2024; 399: 131658. CrossRef
Electrochemical Detection of Biomarkers Via Affinity Binding with Functionalized Nanocomposite for Assessment of Tissue-Perfusion
Ariadna Schuck, Minhee Kang, Yong-Sang Kim
Journal of Electrical Engineering & Technology.2024;[Epub] CrossRef
Role of lactate level in predicting admission need to intensive care unit and short term outcomes in patients with acute gastrointestinal bleeding
Hekmat Nashat Shawky, Hala Mostafa Kamel, Zain Elabdeen Ahmed Sayed, Hossam Mahmoud Abdelwahab
The Egyptian Journal of Internal Medicine.2024;[Epub] CrossRef
Hierarchical Capability in Distinguishing Severities of Sepsis via Serum Lactate: A Network Meta-Analysis
Binlu Zhu, Ruixi Zhou, Jiangwei Qin, Yifei Li
Biomedicines.2024; 12(2): 447. CrossRef
Serial evaluation of the serum lactate level with the SOFA score to predict mortality in patients with sepsis
Heemoon Park, Jinwoo Lee, Dong Kyu Oh, Mi Hyeon Park, Chae-Man Lim, Sang-Min Lee, Hong Yeul Lee
Scientific Reports.2023;[Epub] CrossRef
Using time-course as an essential factor to accurately predict sepsis-associated mortality among patients with suspected sepsis
Shih-Chieh Yen, Chin-Chieh Wu, Yi-Ju Tseng, Chih-Huang Li, Kuan-Fu Chen
Biomedical Journal.2023; : 100632. CrossRef
Increased normalized lactate load is associated with higher mortality in both sepsis and non-sepsis patients: an analysis of the MIMIC-IV database
Han Chen, Shu-Rong Gong, Rong-Guo Yu
BMC Anesthesiology.2022;[Epub] CrossRef
An integrated wearable microneedle array for the continuous monitoring of multiple biomarkers in interstitial fluid
Farshad Tehrani, Hazhir Teymourian, Brian Wuerstle, Jonathan Kavner, Ravi Patel, Allison Furmidge, Reza Aghavali, Hamed Hosseini-Toudeshki, Christopher Brown, Fangyu Zhang, Kuldeep Mahato, Zhengxing Li, Abbas Barfidokht, Lu Yin, Paul Warren, Nickey Huang,
Nature Biomedical Engineering.2022; 6(11): 1214. CrossRef
Association between normalized lactate load and mortality in patients with septic shock: an analysis of the MIMIC-III database
Han Chen, Shu-Rong Gong, Rong-Guo Yu
BMC Anesthesiology.2021;[Epub] CrossRef
Mortality prediction using a novel combination of biomarkers in the first day of sepsis in intensive care units
Junkun Liu, Chengwen Bai, Binbin Li, Aijun Shan, Fei Shi, Can Yao, Yu Zhang, Jin Wang, Weibu Chen, Manying Xie, Dehui Deng
Scientific Reports.2021;[Epub] CrossRef
A Graphene-Based Enzymatic Biosensor Using a Common-Gate Field-Effect Transistor for L-Lactic Acid Detection in Blood Plasma Samples
Ariadna Schuck, Hyo Eun Kim, Júlia Konzen Moreira, Priscila Schmidt Lora, Yong-Sang Kim
Sensors.2021; 21(5): 1852. CrossRef
Usefulness of presepsin in predicting the prognosis of patients with sepsis or septic shock: a retrospective cohort study
Jeong Suk Koh, Yoon Joo Kim, Da Hyun Kang, Jeong Eun Lee, Song-I Lee
Yeungnam University Journal of Medicine.2021; 38(4): 318. CrossRef
Non-enzymatic lactic acid sensor based on AuPtNPs functionalized MoS2 nanosheet as electrode modified materials
Haolin Xiao, Liangli Cao, Huishan Qin, Shanshan Wei, Miao Gu, Feijun Zhao, Zhencheng Chen
Journal of Electroanalytical Chemistry.2021; 903: 115806. CrossRef
Early lactate area scores and serial blood lactate levels as prognostic markers for patients with septic shock: a systematic review
Rozita Khodashahi, Soroush Sarjamee
Infectious Diseases.2020; 52(7): 451. CrossRef
Recent lactate findings: is repeated serum lactate testing necessary in septic shock patients?
Moo Suk Park
Acute and Critical Care.2019; 34(2): 155. CrossRef

Case Report

A Case of Metformin-Induced Acute Kidney Injury without Lactic Acidosis: A Case Report: Hae Ryong Jeong, Jeong Im Choi, Jung Hwan Park, Sang Mo Hong, Joon Sung Park, Chang Beom Lee, Yong Soo Park, Dong Sun Kim, Woong Hwan Choi, You Hern Ahn; Korean J Crit Care Med. 2012;27(4):283-285.; DOI: https://doi.org/10.4266/kjccm.2012.27.4.283

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Abstract PDF: Metformin is an oral antidiabetic drug in the biguanide class, which is used for type 2 diabetes. The side effects of metformin are mostly limited to digestive tract symptoms, such as diarrhea, flatulence and abdominal discomfort. The most serious potential adverse effect of metformin is lactic acidosis. A 51-year-old man was admitted due to hypoglycemia as a result of an overdose of antidiabetic drugs. He took massive dose of metformin. Conservative treatment failed for metabolic acidosis without lactic acidosis accompanied by acute kidney injury. Hemodialysis was executed to correct the high anion gap metabolic acidosis and acute kidney injury, and the patient recovered fully from metabolic acidosis. This case illustrates that the presence of clinical conditions, such as metformin-induced acute kidney injury and metabolic acidosis, can be developed without lactic acidosis. Prompt recognition of metabolic acidosis and early intervention with hemodialysis can result in a successful clinical outcome.

Original Articles

Lactate Clearance and Outcome in Septic Shock Patients with Low Level of Initial Lactate: Yun Su Sim, Cho Rom Hahm, So Yeon Lim, Gee Young Suh, Kyeongman Jeon; Korean J Crit Care Med. 2011;26(2):78-82.; DOI: https://doi.org/10.4266/kjccm.2011.26.2.78

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Abstract PDF: BACKGROUND
Serum lactate is a potentially useful biomarker to risk-stratify patients with severe sepsis and septic shock. However, there are only a few studies on the association of serum lactate levels and prognosis in septic shock patients with initial low lactate levels.
METHODS
To evaluate whether initial and follow-up lactate levels associated with mortality in septic shock patients with low lactate level, we conducted a retrospective observational study of patients with septic shock, who were hospitalized through the emergency department in February-July 2008. Initial lactate level was stratified as low (<4 mmol/L) or high (> or =4 mmol/L). The primary outcome was 28-day mortality and multiple logistic regression analysis was used to adjust for potential confounders in the association between lactate clearance and mortality.
RESULTS
Of 90 patients hospitalized with septic shock during the study period, 68 (76%) patients had low initial lactate. Mortality at 28 days was 18% in patients with low lactate level. In these patients, initial lactate level was not associated with mortality (p = 0.590). However, increased lactate at follow-up and lactate clearance were associated with mortality (p = 0.006, p = 0.002, respectively). In a multiple logistic regression analysis, increased mortality rate independently associated with age (OR 1.162, 95% CI 1.041-1.298) and lactate clearance (OR 0.654, 95% CI 0.498-0.859).
CONCLUSIONS
In septic shock patients with a low lactate level, lactate clearance independently associated with a decreased mortality rate. Therefore, lactate clearance could be useful for predicting the outcome in these patients.

Clinical Characteristics of Acute Brain Swelling in Patients Successfully Resuscitated from Non-traumatic Out-of-hospital Cardiac Arrest: Wonhyun Ryu, Young Joo Lee, Eun Jung Park, Yoon Seok Jung, Young Gi Min; Korean J Crit Care Med. 2010;25(4):219-223.; DOI: https://doi.org/10.4266/kjccm.2010.25.4.219

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Abstract PDF

BACKGROUND
The number of cardiac arrest patients who are resuscitated has increased with the development of emergency medical services. Brain swelling is often found in these patients, following return of spontaneous circulation. This study identifies risk factors for brain swelling, describes it's frequency, analyzes the effect of brain swelling on neurological outcome, and compares the results with other studies.
METHODS
A retrospective analysis had been conducted on cardiac arrest patients who visited the emergency room at a university hospital during a 24 month period since 2007. Thirty-seven successfully resuscitated patients were divided into 2 groups based on computed tomography findings; these groups consisted of 14 patients with brain swelling and 23 patients without brain swelling. Comparative studies were conducted on post-lab findings and several additional factors.
RESULTS
The 14 patients with brain swelling were significantly younger and showed a higher clinical performance category score than patients without brain swelling. Initial serum lactic acid levels showed good correlation with brain swelling.
CONCLUSIONS
An urgent CT should be conducted and aggressive treatment pursued when brain swelling is suspected, after consideration of various prognostic factors.

Citations

Citations to this article as recorded by

Cerebral Edema After Cardiopulmonary Resuscitation: A Therapeutic Target Following Cardiac Arrest?
Erik G. Hayman, Akil P. Patel, W. Taylor Kimberly, Kevin N. Sheth, J. Marc Simard
Neurocritical Care.2018; 28(3): 276. CrossRef
Prognostic values of gray matter to white matter ratios on early brain computed tomography in adult comatose patients after out-of-hospital cardiac arrest of cardiac etiology
Byung Kook Lee, Kyung Woon Jeung, Kyoung Hwan Song, Yong Hun Jung, Wook Jin Choi, Soo Hyun Kim, Chun Sung Youn, In Soo Cho, Dong Hun Lee
Resuscitation.2015; 96: 46. CrossRef

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