Factors Predicting Early Major Adverse Events in the Intensive Care Unit After Successful Cardiac Surgery for Congenital Heart Disease in Full-Term Neonates

ABSTRACT Objective: In this study, we aimed to evaluate the factors affecting major adverse event (MAE) development after full-term neonatal cardiac surgery. Methods: This study was conducted retrospectively on newborns who underwent congenital heart surgery between June 1, 2020, and June 1, 2022. MAE was defined as the presence of at least one of the following: cardiac arrest, unplanned reoperation, emergency chest opening, admission to the advanced life support system, and death. The role of blood lactate level, vasoactive inotropic score (VIS), and cerebral near-infrared spectroscopy (NIRS) changes in predicting MAE was investigated. Results: A total of 240 patients (50% male) were operated during the study period. The median age of patients was seven days (interquartile range 3-10 days). MAE was detected in 19.5% of the cases. Peak blood lactate levels >7 mmol/liter (area under the curve [AUC] 0.72, 95% confidence interval [CI] [0.62-0.82], P<0.001, sensitivity 76%, specificity 82%, positive predictive value [PPV] 88%) was an independent risk factor for MAE (odds ratio [OR] 2.7 [95% CI 1.3-6]). More than 30% change in NIRS value during the operative period (AUC 0.84, 95% CI [0.80-0.88], P<0.001, sensitivity 65%, specificity 85%, PPV 90%) was a strong predictor of MAE. VIS > 10 was an independent risk factor (AUC 0.75, 95% CI [0.70-0.84], P<0.001, sensitivity 86%, specificity 80%, PPV 84%) and strongly predicted MAE (OR 1.4 [95% CI 0.9-5]). Conclusion: Cerebral NIRS changes > 30%, high blood lactate levels, and VIS score within the 48 hours may help to predict the development of MAE in the postoperative period.

A study on mean anion gap over 6 hours after admission as a predictor of pediatric mortality in pediatric intensive care unit

Background:The aims of the study was to correlate change in anion gap at 0 and 6 hours of admission with mortality in pediatric intensive care unit (PICU).Methods:Fifty children up to 12 years of age, admitted in PICU were included in the study. Blood gas anion gap levels were taken at 0 and 6 hours of admission and change in anion gap was calculated. Final outcome was recorded.Results:Out of 50 patients enrolled in the study, 18 (36%) patients died and 32 (64%) survived. Mortality was higher in group with increased anion gap after 6 hours of admission as compared to survived. Change in anion gap was higher in expired patient as compared to survivors.Conclusions:Mortality was higher in group with increased anion gap after 6 hours of admission

Behavior of cortisol, ck and lactate in a session of variable resistance / Comportamento do cortisol, cq e lactato em uma sessão de resistência variável / Comportamiento del cortisol, ck y lactato en una sesión de resistencia variable

ABSTRACT Introduction: Complex Training (CT) has been used to achieve Post-activation Potentiation (PAP) of physical capabilities and, in doing so, improve the sports performance of athletes. However, few studies have considered alterations in serum Cortisol, Metabolic Creatine Kinase (MB-CK), Total Creatine Kinase (Total-CK), and Lactate concentrations ([La]) resulting from this training method. Objective: This study determined the behavior of the following blood serum substances in a CT session: Cortisol, MB-CK, Total CK and [La]. Method: Ten military athlete volunteers aged 28.5 ± 4.8 years; 66.2 ± 2.8 kg, 171.4 ± 3.7 cm, 22.6 ± 1.2 kg/m2; 11.3 ± 2.9% of fat tissue took part in the study. The study had a quasi-experimental, intrasubject design. The variable measurements were: Cortisol, MB-CK, Total-CK, and [La], measured before physical exercise and 24 hours post-stress. The CT session consisted of: four series of five repetitions at 30% of 1RM, plus four repetitions at 60% of 1RM, plus three throws of a 575 g projectile, 15 seconds apart. The statistical analysis was carried out through repeated measure ANOVA for Lactate and a Wilcoxon Matched Pairs t-Test for Cortisol, MB-CK and Total-CK. Results: There was no evidence of alterations in the indicators for fatigue ([La] p = 0.36), and muscular injury (Cortisol p = 0.16; MB-CK p = 0.23; Total-CK p = 0.64) after the training sessions. Conclusion: Variables for muscular injury showed no evidence of alterations 24 hours after the CT sessions, hence confirming that the workload did not generate significant post-stress muscular injury. Level of Evidence I; Therapeutic Study: Investigating Treatment Results.

RESUMO Introdução: Os exercícios de Resistência Variável (RV) têm sido utilizados para aumentar a potencialização pós-ativação (PPA) das habilidades físicas e, com isso, melhorar o desempenho desportivo dos atletas, mas poucos estudos se referem às alterações sanguíneas do Cortisol, Creatina Quinase Metabólica (CQ-MB), Creatina Quinase Total (CQ-Total) e concentrações de Lactato ([La]), que provocam esse método de treinamento. Objetivo: Este estudo avaliou o comportamento sanguíneo do Cortisol, CQ-MB, CQ-Total e [La] em um treinamento de RV. Métodos: Dez atletas militares voluntários com 28,5 ± 4,8 anos; 66,2 ± 2,8 Kg; 171,4 ± 3,7 cm; 22,6 ± 1,2 Kg/m2 e 11,3 ± 2,9% de tecido adiposo fizeram parte do estudo. O projeto foi quase experimental intra-sujeito. As medidas variáveis foram: Cortisol, CQ-MB, CQ-Total e [La], medidos antes e 24 horas após o esforço. O treinamento de intervenção com RV consistia em: quatro séries de cinco repetições de 30% de 1RM, mais quatro repetições de 60% de 1 RM, mais três lançamentos de um projetil de 575g, separados por 15 segundos. A análise estatística foi realizada através de médias repetidas ANOVA para Lactato e um Teste t de Wilcoxon Matched para o Cortisol, CQ-MB e CQ-Total. Resultados: Aplicado o treinamento, não foram evidenciadas alterações nos indicadores de fadiga ([La] p = 0,36) e lesão muscular (Cortisol p = 0,16; MB-CQ p = 0,23; CQ-Total p = 0,64). Conclusão: O treinamento com RV não apresentou alterações nas variáveis de lesão muscular após 24 horas da sua aplicação, isso garante que as cargas de trabalho não gerem lesões musculares significativas pós-esforço. Nível de Evidência I; Estudo terapéutico: Investigação dos resultados do tratamento.

RESUMEN Introducción: La Resistencia Variable (VR) es un método de entrenamiento que ha sido utilizado para conseguir Potenciación Post Activación de las capacidades físicas y, con esto, mejorar el rendimiento deportivo de atletas, no obstante, pocos estudios se refieren a las alteraciones sanguíneas de Cortisol, Metabolic Creatine Kinase (CK-MB), Creatine Kinase Total (CK-Total) y concentraciones de Lactato ([La]) que este método provoca. Objetivo: Este estudio determinó el comportamiento sanguíneo del Cortisol, CK-MB, CK-Total y [La] en una sesión de VR. Método: Diez atletas militares voluntarios con 28,5 ± 4,8 años, 66,2 ± 2,8 Kg, 171,4 ± 3,7 cm, 22,6 ± 1,2 Kg/m2; 11,3 ± 2,9% de tejido graso, fueron parte del estudio. El diseño fue cuasi experimental intrasujeto. Las variables medidas fueron: Cortisol, CK-MB, CK-Total y [La], evaluadas 24 horas antes y 24 horas post esfuerzo. La sesión de intervención con VR consistió en: cuatro series de cinco repeticiones al 30% de 1RM más cuatro repeticiones al 60% de 1 RM más tres lanzamientos de un proyectil de 575 g separadas por 15 segundos. El análisis estadístico fue realizado a través de una ANOVA de medias repetidas para el Lactato y con un Test t de Wilcoxon Matched para el Cortisol, CK-MB y CK-Total. Resultados: Aplicado el tratamiento no se evidenciaron alteraciones en los indicadores de daño muscular (Cortisol p = 0,16; MB-CK p = 0,23; CK-Total p = 0,64) ni fatiga ([La] p = 0,36). Conclusiones: El tratamiento con VR no dejó en evidencia alteraciones en las variables de daño muscular a 24 horas de su aplicación, asegurando que las cargas de trabajo no generan daño muscular significativo post esfuerzo. Nivel de Evidencia I; Estudio terapéutico: Investigación de los resultados de un tratamiento.

What is the Clinical Significance of Initial Lactate Measurement Compared to Carboxyhemoglobin Measurement in Carbon Monoxide Poisoning?

PURPOSE: This study was performed to compare clinical significance between lactate and carboxyhemoglobin (COHb) in a patient with carbon monoxide (CO) poisoning. METHODS: We conducted a 13-year retrospective study on CO poisoning patients who visited the emergency departments of the Medical Center between October 2004 and January 2016. The patients were divided into two groups according to initial lactate levels. Patients with serum lactate levels of ≤2 mmol/L were classified as the normolactatemia group (n=14), and patients with serum lactate levels of >2 mmol/L were classified as the hyperlactatemia group (n=34). General characteristics, clinical features, and laboratory findings of the two groups were compared. In addition, we compared initial lactate levels with COHb levels according to complications, neurological disorder, myocardial enzyme elevation, and abnormal Glasgow Coma Scale (GCS) score in patients with CO poisoning. We also analyzed the correlation between laboratory parameters and lactate levels. RESULTS: Forty-eight patients were enrolled in this study. The hyperlactatemia group had significantly more neurological disorders and consciousness disorders than the normolactatemia group (p<0.001), and COHb, creatine phosphokinase MB, and troponin I levels were also significantly higher in the hyperlactatemia group (p<0.001, p=0.017, and p=0.007). Lactate levels were significantly elevated in patients with elevated cardiac enzymes (p=0.001), neurological disorders (p<0.001), complications (p=0.001), and abnormal GCS score (p<0.001), whereas COHb levels were not significantly increased in all subjects. The correlation between COHb and lactate levels was weak (r=0.313, p=0.030), and a positive correlation was found between lactate and bicarbonate (HCO3), white blood cell, and troponin I (p<0.001). The diagnostic value of lactate for severe CO poisoning was analyzed using a receiver operating characteristic curve. The optimal cut-off value of lactate was 2.2 mmol/L with 83.3% sensitivity and 91.7% specificity (p<0.001). CONCLUSION: Lactate has significant diagnostic efficacy in patients with CO poisoning. It is recommended that lactate level be measured for appropriate treatment and prognostic evaluation of CO poisoning.

How Do I Integrate Hemodynamic Variables When Managing Septic Shock? / 대한구급학회지

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

How Do I Integrate Hemodynamic Variables When Managing Septic Shock? / 대한중환자의학회지

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

O sangue venoso coletado do acesso femoral é adequado para estimar a saturação venosa central de oxigênio e os níveis de lactato arterial em pacientes graves? / Is venous blood drawn from femoral access adequate to estimate the central venous oxygen saturation and arterial lactate levels in critically ill patients?

RESUMO Objetivos: Testar se amostras de sangue venoso coletadas do acesso femoral podem ser utilizadas para estimar a saturação venosa central de oxigênio e os níveis de lactato arterial em pacientes graves. Métodos: Foram utilizadas a análise de Bland-Altman e correlações de Spearman para comparar a saturação venosa femoral de oxigênio e a saturação venosa central de oxigênio, assim como os níveis de lactato arterial e femoral. Foi conduzida uma análise predeterminada de subgrupos nos pacientes com sinais de hipoperfusão. Além disso, foi também investigada a concordância clínica. Resultados: Foram obtidas amostras sanguíneas de 26 pacientes. Em 107 amostras pareadas, observou-se correlação moderada (r = 0,686; p < 0,0001) entre a saturação venosa central de oxigênio e a saturação venosa femoral de oxigênio, com um viés de 8,24 ± 10,44 (limites de concordância de 95%: -12,23 a 28,70). Em 102 amostras pareadas, houve forte correlação entre os níveis arteriais de lactato e os níveis de lactato femoral (r = 0,72, p < 0,001) com um viés de -2,71 ± 9,86 (limites de concordância de 95%: -22,3 a 16,61). A presença de hipoperfusão não modificou de forma significante os resultados. A concordância clínica para saturação venosa foi inadequada, com diferentes decisões terapêuticas em 22,4% das situações; para o lactato, isto ocorreu em apenas 5,2% das situações. Conclusão: A saturação venosa de oxigênio femoral não deve ser utilizada em substituição da saturação venosa central de oxigênio. No entanto, os níveis femorais de lactato podem ser utilizados na prática clínica, mas com cautela.

ABSTRACT Objectives: The purpose of this study was to test if venous blood drawn from femoral access can be used to estimate the central venous oxygen saturation and arterial lactate levels in critically ill patients. Methods: Bland-Altman analysis and Spearman correlations were used to compare the femoral venous oxygen saturation and central venous oxygen saturation as well as arterial lactate levels and femoral lactate. A pre-specified subgroup analysis was conducted in patients with signs of hypoperfusion. In addition, the clinical agreement was also investigated. Results: Blood samples were obtained in 26 patients. In 107 paired samples, there was a moderate correlation (r = 0.686, p < 0.0001) between the central venous oxygen saturation and femoral venous oxygen saturation with a bias of 8.24 ± 10.44 (95% limits of agreement: -12.23 to 28.70). In 102 paired samples, there was a strong correlation between the arterial lactate levels and femoral lactate levels (r = 0.972, p < 0.001) with a bias of -2.71 ± 9.86 (95% limits of agreement: -22.03 to 16.61). The presence of hypoperfusion did not significantly change these results. The clinical agreement for venous saturation was inadequate, with different therapeutic decisions in 22.4% of the situation; for lactate, this was the case only in 5.2% of the situations. Conclusion: Femoral venous oxygen saturation should not be used as a surrogate of central venous oxygen saturation. However, femoral lactate levels can be used in clinical practice, albeit with caution.

A combination of early warning score and lactate to predict intensive care unit transfer of inpatients with severe sepsis/septic shock

BACKGROUND/AIMS: The modified early warning score (MEWS) is used to predict patient intensive care unit (ICU) admission and mortality. Lactate (LA) in the blood lactate (BLA) is measured to evaluate disease severity and treatment efficacy in patients with severe sepsis/septic shock. The usefulness of a combination of MEWS and BLA to predict ICU transfer in severe sepsis/septic shock patients is unclear. We evaluated whether use of a combination of MEWS and BLA enhances prediction of ICU transfer and mortality in hospitalized patients with severe sepsis/septic shock. METHODS: Patients with severe sepsis/septic shock who were screened or contacted by a medical emergency team between January 2012 and August 2012 were enrolled at a university-affiliated hospital with ~2,700 beds, including 28 medical ICU beds. RESULTS: One hundred patients were enrolled and the rate of ICU admittance was 38%. MEWS (7.37 vs. 4.85) and BLA concentration (5 mmol/L vs. 2.19 mmol/L) were significantly higher in patients transferred to ICU than those in patients treated in general wards. The combination of MEWS and BLA was more accurate than MEWS alone in terms of ICU transfer (C-statistics: 0.898 vs. 0.816, p = 0.019). The 28-day mortality rate was 19%. MEWS was the only factor significantly associated with 28-day mortality rate (odds ratio, 1.462; 95% confidence interval, 1.122 to 1.905; p = 0.005). CONCLUSIONS: The combination of MEWS and BLA may enhance prediction of ICU transfer in patients with severe sepsis/septic shock.

Bicarbonate-versus lactate-buffered solutions for hemodiafiltration in acute renal failure:a meta-analysis / 中国组织工程研究

BACKGROUND:Hemodialysis therapy is an important means for the treatment of acute renal failure, which aims to remove excess water and toxins and maintain acid-base balance of a patient, creating conditions for medication and nutrition therapy while avoiding multiple organ failure. OBJECTIVE:To compare bicarbonate-and lactate-buffered solutions for acute continuous hemodiafiltration in acute renal failure. METHODS:A computer-based search was performed in PubMed, EMBASE, SCI, Cochrane Library, Chinese Biomedical Literature Database, China Journal Ful Text Database, Chinese Medical Association Journals for randomized control trials related to bicarbonate-versus lactate-buffered solutions for hemodiafiltration in acute renal failure published before January 2014. The quality of the included studies was evaluated by Cochrane Handbook, and data were analyzed by RevMan 5.1 from the Cochrane Col aboration. RESULTS AND CONCLUSION:Four studies (171 patients) met inclusion criteria. Overal , patients treated with bicarbonate-buffered solutions had fewer cardiovascular complications and symptomatic hypotension events as wel as lower serum lactate levels than patients who received lactate-buffered solutions (P<0.05). There were no differences in mortality, serum bicarbonate levels, serum creatinine, serum pH, carbon dioxide partial pressure. The current evidence shows that patients undergoing bicarbonate-buffered solutions may experience fewer cardiovascular complications and symptomatic hypotension. Given the limited research, it is insufficient to recommend for clinical use.

Inclusão do equivalente do lactato sanguíneo O2 na regressão de intensidade de exercício VO2 aumenta o gasto energético de corrida e diminui sua precisão / Inclusion of blood lactate O2 equivalent in the VO2 exercise intensity regression increases the energy cost of running and lowers its precision / La inclusión del equivalente del lactato sanguíneo O2 en la regresión de intensidad de ejercicio VO2 aumenta el gasto energético de la carrera y disminuye su precisión

INTRODUÇÃO E OBJETIVOS: Investigar se a inclusão do equivalente energético de lactato sanguíneo (LS) em intensidades submáximas alteraria o gasto energético de corrida (Gc) estimado para corrida supramáxima de alta intensidade assim como sua precisão MÉTODOS: O Gc foi determinado a partir da curva de regressão de velocidade do VO2. Para cada sujeito, uma regressão alternativa foi estabelecida em que energia equivalente a 3 ml de O2 kg-1∙mM-1 de LS foi adicionada ao VO2. Testes t pareados, correlações pareadas e plotagem de Bland-Altman foram utilizados para investigar se os dois métodos representam os mesmos fenômenos. RESULTADOS: Os principais achados foram que o Gc previsto para intensidades supramáximas incluídos entre 110 e 160% ao correspondente ao pico de VO2 dos indivíduos aumentou significativamente quando as medidas de LS foram incluídas nas regressões. A inclusão das medidas de LS também aumentaram a imprecisão do Gc a 110, 120, 130, 150 e 160%. CONCLUSÃO: Nossos resultados indicam que a inclusão do equivalente do lactato de O2 na regressão de intensidade de VO2-exercício aumenta o gasto energético e diminui sua precisão.

INTRODUCTION AND OBJECTIVES: Investigate whether the inclusion of the blood lactate (BL) energy equivalent at submaximal intensities would change the energy cost of running (CR) predicted to supramaximal high-intensity running as well as its precision. METHODS: The CR was determined from the slope of the VO2-speed regression. For each subject an alternative regression was established where an energy equivalent of 3 ml O2 kg-1∙mM-1 BL was added to the VO2. Paired t-tests, pairwise correlations and Bland-Altman plots were used to investigate whether the two methods represent the same phenomena. RESULTS: The main findings were that CR predicted to supramaximal intensities comprised between 110% and 160% of that corresponding to the individuals' peak VO2, increased significantly when the BL measurements were included in the regressions. The inclusion of BL measurements also increased the imprecision of the CR at 110%, 120%, 130%, 150% and 160%. CONCLUSIONS: Our results indicate that inclusion of lactate O2 equivalent in the VO2-exercise intensity regression increases the energy cost of running and lowers its precision.

INTRODUCCIÓN Y OBJETIVOS: Investigar si la inclusión del equivalente energético de lactato sanguíneo (LS), en intensidades submáximas, modificaría el gasto energético de la carrera (Gc), estimado para carrera supramáxima de alta intensidad, así como su precisión. MÉTODOS: El Gc fue determinado a partir de la curva de regresión de velocidad del VO2. Para cada individuo, se estableció una regresión alternativa en la cual energía equivalente a 3 ml de O2 kg-1∙mM-1 de LS fue adicionada al VO2. Pruebas t por pares, correlaciones por pares y plotaje de Bland-Altman fueron utilizados para investigar si los dos métodos representan los mismos fenómenos. RESULTADOS: Los hallazgos principales fueron que el Gc previsto para intensidades supramáximas, incluidos 110% y 160% de lo que corresponde al pico de VO2 de los individuos, aumentó significativamente cuando las medidas de LS fueron incluidas en las regresiones. La inclusión de las medidas de LS también aumentó la imprecisión del Gc a 110%, 120%, 130%, 150% y 160%. CONCLUSIÓN: Nuestros resultados indican que la inclusión del equivalente del lactato de O2, en la regresión de intensidad de VO2-ejercicio, aumenta el gasto energético y disminuye su precisión.

An Examination of Serum Ammonia and Lactate for Differentiating Seizure and Syncope

PURPOSE: Seizure and syncope are main causes of patient visits to an emergency department (ED). However, differentiating two diseases through history taking and several ancillary tests is difficult in an ED. Some reports have claimed that ammonia or lactate could differentiate between seizure and other medical diseases. Therefore, this study evaluated the ability of ammonia and lactate to differentiate seizure and syncope. METHODS: We reviewed the medical records of 388 patients who visited an ED with seizure or syncope. There were 271 patients in the seizure group (69.8%) and 117 patients in the syncope group (30.2%). Ammonia and lactate levels were compared between the two groups. The optimal level of ammonia and lactate, and their sensitivity and specificity, were evaluated to determine their ability to differentiate seizure and syncope. RESULTS: There were more male in seizure group (66%), but the average age was higher in the syncope group (51+/-21 yrs) (p<0.05). The time interval from symptom to ED was similar between the two groups (seizure group: 213+/-803 min and syncope group: 184+/-512 min, p=0.724). The mean ammonia level in the seizure group was higher than the syncope group (85+/-86 microg/dl and 49+/-29 microg/dl, respectively, p<0.001). The mean lactate level was also higher in the seizure group than the syncope group (3.5+/-2.9 mmol/L and 1.6+/-1.5 mmol/L, respectively, p<0.05). When the cutoff value for ammonia was 50 microg/dL [Area under curve (AUC): 0.617, 95% CI: 0.556-0.678] the sensitivity was 61% and the specificity was 52%. When the cut-off value for lactate was 2 mmol/L [AUC: 0.745, 95% CI: 0.692-0.798] the sensitivity was 60% and the specificity was 76%. CONCLUSION: Serum ammonia or lactate may serve as an ancillary method for differentiating seizure and syncope, but their sole application is unacceptable due to their low sensitivity and specificity.

Evolução de variáveis hemodinâmicas e perfusionais durante o choque séptico experimental tratado com ressuscitação volêmica guiada por metas / Hemodynamic and perfusion variables during experimental septic shock treated with goal-directed fluid resuscitation

OBJETIVOS: Apesar da ressuscitação volêmica guiada por saturação venosa central de oxigênio (SvcO2) ser considerada atualmente padrão ouro no tratamento da sepse, poucos estudos caracterizaram o perfil evolutivo de variáveis hemodinâmicas e perfusionais durante esta abordagem terapêutica. Este estudo teve por objetivo descrever evolutivamente estes parâmetros durante o choque séptico experimental sem ressuscitação e após 12 horas de ressuscitação guiada por metas. MÉTODOS: Treze porcos (35-45 kg) anestesiados foram submetidos a peritonite por inoculação fecal (0,75g/kg). Após desenvolverem hipotensão persistente, ambos os grupos receberam antibióticos e foram randomizados em dois grupos: controle (n=7), com suporte hemodinâmico otimizado para pressão venosa central entre 8-12mmHg, diurese acima de 0,5ml/kg/h e pressão arterial média maior que 65mmHg; e SvO2 (n=6), com os objetivos acima e SvO2 acima de 65 por cento. As intervenções incluíram ringer lactato e noradrenalina nos 2 grupos e dobutamina no grupo SvO2. Os animais foram tratados durante doze horas ou óbito. RESULTADOS: A sepse não tratada associou-se a uma significante redução da SvO2, PvO2, débito cardíaco e pressão venosa central e aumento da diferença arterio-venosa da saturação de oxigênio e veno-arterial de CO2. Após ressuscitação, esses parâmetros foram corrigidos em ambos os grupos. A ressuscitação guiada por metas associou-se a um melhor perfil hemodinâmico caracterizado por maiores SvO2, débito cardíaco e pressão venosa central. CONCLUSÕES: A sepse não ressuscitada apresenta um perfil hemodinâmico sugestivo de hipovolemia, com piora perfusional e hemodinâmica revertida após ressuscitação volêmica. A ressuscitação guiada por metas associa-se a uma significante melhora dos parâmetros hemodinâmicos e perfusionais.

OBJECTIVES: Although fluid resuscitation guided by central venous oxygen saturation (SvcO2) is currently considered the gold standard in sepsis therapy, few studies have described hemodynamic and perfusion parameters during this procedure. This study aims to describe these parameters during septic shock without resuscitation and after 12 hours of goal-directed resuscitation. METHODS: Thirteen anesthetized pigs (35-45 kg) had peritonitis caused by fecal inoculation (0.75 g/kg). After developing persistent hypotension, both groups were given antibiotics and randomized either to the control group (n=7) or the experimental group (n=6). In the control group, hemodynamic control was optimized to maintain a central venous pressure of 8-12 mmHg, a urinary output above 0.5 mL/kg/hour and a mean arterial blood pressure above 65 mmHg. The experimental group received the above target therapy in addition to maintaining a SvO2 above 65 percent. The interventions included lactated Ringer's solution and norepinephrine for both groups and dobutamine in the SvO2 group. The animals were treated for 12 hours or until death. RESULTS: Untreated sepsis was associated with significant reductions in SvO2, PvO2, cardiac output and central venous pressure in addition to increased arteriovenous oxygen saturation and veno-arterial CO2 differences. Following resuscitation, these parameters were corrected in both groups. Goal-directed resuscitation was associated with a better hemodynamic profile, characterized by higher SvO2, cardiac output and central venous pressure. CONCLUSIONS: Non-resuscitated sepsis showed a hemodynamic profile suggesting hypovolemia, with worsened perfusion and hemodynamics, which is reversed upon fluid resuscitation. Goal-directed resuscitation is associated with significantly improved hemodynamic and perfusion parameters.

A medida do lactato arterial intraoperatório não é determinante de mortalidade em pacientes cirúrgicos de alto risco / Intraoperative lactate measurements are not predictive of death in high risk surgical patients

OBJETIVOS: Classicamente, lactato elevado é considerado como marcador de pior prognóstico, entretanto poucos dados existem a respeito da cinética do lactato no periodo intraoperatório e sua associação com o prognóstico. O objetivo deste estudo foi avaliar em qual momento do período perioperatório o valor do lactato apresenta maior importância prognóstica. MÉTODOS: Estudo prospectivo observacional de um hospital terciário. Foram incluídos pacientes com solicitação de pós-operatório em unidade de terapia intensiva com idade >18 anos, submetidos a cirurgias de grande porte. Pacientes de cirurgias paliativas, com insuficiência cardíaca e/ou hepática grave foram excluídos. Valores de lactato arterial foram mensurados imediatamente antes do início da cirurgia (T0), após indução anestésica (T1), após 3hs de cirurgia (T2), na admissão da unidade de terapia intensiva (T3) e após 6 h da admissão na unidade de terapia intensiva (T4). RESULTADOS: Foram incluídos 67 pacientes. Os valores médios do lactato dos pacientes no T0, T1, T2, T3 e T4 foram respectivamente 1,5 ± 0,8mmol/L, 1,5 ± 0,7mmol/L, 1,8 ± 1,2mmol/L, 2,7 ± 1,7mmol/L e 3,1 ± 2,0mmol/L. A taxa de mortalidade hospitalar foi 25,8 por cento e as dosagens de lactato dos pacientes sobreviventes e dos não sobreviventes 6 h após admissão na unidade de terapia intensiva foram 2,5 ± 1,3 e 4,8 ± 2,8 mmol/L (p<0,0001), respectivamente. As medidas nos demais períodos não demonstraram diferenças estatisticamente significativas dentre estes grupos. CONCLUSÕES: Em pacientes cirúrgicos o lactato arterial no período intraoperatório não apresentou valor prognóstico, entretanto quando avaliado no pós-operatório, ele foi melhor para determinar mortalidade hospitalar.

OBJECTIVES: An increased lactate level is classically considered a marker for poorer prognosis, however little information is available on intraoperative lactate's kinetics and its connection with prognosis. This study aimed to evaluate the time when perioperative lactate is most relevant for prognosis. METHODS: This was an observational prospective study conducted in a tertiary hospital. Patients with requested intensive care unit postoperative stay, aged > 18 years, undergoing major surgery were included. Palliative surgery patients and those with heart and/or severe liver failure were excluded. Arterial lactate levels were measured immediately before the surgery start (T0), after anesthesia induction (T1), 3 hours after the surgery start (T2), intensive care unit admission (T3) and 6 hours after the intensive care unit admission (T4). RESULTS: Sixty seven patients were included. The mean lactate values for the patients' T0, T1, T2 and T4 were 1.5 ± 0.8 mmol/L, 1.5 ± 0.7 mmol/L, 1.8 ± 1.2 mmol/L, 2.7 ± 1.7 mmol/L and 3.1 ± 2.0 mmol/L, respectively. The hospital mortality rate was 25.8 percent, and surviving and non-surviving patients lactate values in the intensive care unit were 2.5 ± 1. and 4.8 ± 2.8 mmol/L (P < 0.0001), respectively. The other times measurements showed no statistically significant differences between the groups. CONCLUSIONS: In surgical patients, intraoperative arterial lactate levels failed to show a predictive value; however during the postoperative period, this assessment was shown to be useful for hospital mortality prediction.

Effect of Different Concentrations of Dextrose Transfusion on Cerebral Glucose Metabolism in Pediatric Neurosurgical Operations / 天津医药

Objective: To investigate the effect of different concentrations of dextrose transfusion on cerebral glucose metabolism in pediatric neurosurgical operations. Methods: Sixty anesthetized children undergoing selective cerebral tumor resection were randomly divided into three groups: Ringer lactate solution group (A, n = 20), 2.5% dextrose lactated Ringer's solution group(B, n = 20), 1% dextrose lactated Ringer's solution group (C, n = 20). All the hemodynamic data were recorded during anesthesia. The values of blood glucose and lactic acid were collected before intubation(T_a), 2 hours after opening cerebral dura mater (T_b) and the end of operation (T_c). The catheters for microdialysis were punctured into normal brain tissue. The contents of glucose and lactic acid were determined in the collected intercellular fluid by biochemical analysis instruments at T_A and T_B respectively. Results: There were no differences in heart rate(HR), mean arterial pressure(MAP) and arterial oxygen saturation (SpO_2) among three groups(P > 0.05). There were no differences in blood glucose at T_a between three groups(P > 0.05). The values of blood glucose at T_b and T_c were B group＞C group＞A group(P 0.05). There were no significant differences in values of glucose and lactic acid in the collected intercellular fluid among three groups(P > 0.05). Conclusion: Transfusion of Ringer lactate solution or low concentration dextrose solution will increase blood glucose in pediatric neurosurgical operations, but still in the normal range, which has a little influence on blood lactic acid, glucose and lactic acid in brain intercellular fluid. It is a safe choice during neurosurgical operation.

C-reactive protein is not a useful indicator for infection in surgical intensive care units / Proteína C-reativa não é um marcador útil de infecção em unidade de terapia intensiva cirúrgica

CONTEXT AND OBJECTIVE: C-reactive protein (CRP) is commonly used as a marker for inflammatory states and for early identification of infection. This study aimed to investigate CRP as a marker for infection in patients with postoperative septic shock. DESIGN AND SETTING: Prospective, single-center study, developed in a surgical intensive care unit at Hospital das Clínicas, Faculdade de Medicina da Universidade de São Paulo. METHODS: This study evaluated 54 patients in the postoperative period, of whom 29 had septic shock (SS group) and 25 had systemic inflammatory response syndrome (SIRS group). All of the patients were monitored over a seven-day period using the Sequential Organ Failure Assessment (SOFA) score and daily CRP and lactate measurements. RESULTS: The daily CRP measurements did not differ between the groups. There was no correlation between CRP and lactate levels and the SOFA score in the groups. We observed that the plasma CRP concentrations were high in almost all of the patients. The patients presented an inflammatory state postoperatively in response to surgical aggression. This could explain the elevated CRP measurements, regardless of whether the patient was infected or not. CONCLUSIONS: This study did not show any correlation between CRP and infection among patients with SIRS and septic shock during the early postoperative period.

CONTEXTO E OBJETIVO: A proteína C reativa (PCR) é muito usada como marcador de estados inflamatórios e na identificação precoce de infecção. Este estudo teve como proposta investigar a PCR como marcadora de infecção em pacientes em choque séptico no período pós-operatório. TIPO DE ESTUDO E LOCAL: Estudo prospectivo, monocêntrico, desenvolvido numa unidade de terapia intensiva pós-operatória do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. MÉTODOS: Foram avaliados 54 pacientes no pós-operatório, sendo 29 deles com choque séptico (grupo SS) e 25 com síndrome da resposta inflamatória sistêmica (grupo SI). Todos os pacientes foram acompanhados durante sete dias pelo escore SOFA (Sequential Organ Failure Assessment) e com dosagens diárias de PCR e lactato. RESULTADOS: As dosagens de PCR não diferiram entre os grupos. Não foi observada correlação entre dosagem de PCR e lactato ou escore SOFA nos grupos estudados. Observamos que as concentrações plasmáticas de PCR estavam elevadas em quase todos os pacientes avaliados. Os pacientes no pós-operatório apresentam estado inflamatório em resposta à agressão cirúrgica, sendo este fato capaz de explicar as dosagens de PCR elevadas, independentemente de o paciente estar ou não infectado. CONCLUSÕES: Este estudo não evidenciou correlação entre PCR e infecção nos pacientes com síndrome da resposta inflamatória sistêmica e choque séptico no período pós-operatório precoce.

The effect of glucose, lactate and pyruvate on the dynamic adaptation of cardiac mitochondrial oxygen consumption / 中国病理生理杂志

AIM: To understand the effect of exogenous carbon substrate on the dynamic regulation of cardiac oxidative phosphorylation. METHODS: Method of mean response time measurement of the myocardial mitochondrial O 2 consumption (t mito ) was developed by van Beek. Glucose, lactate, or pyruvate as carbon substrate respectively for myocardial energy supply was perfused in isolated rabbit hearts with Tyrode solution at 37℃. RESULTS: When heart rate was stepped up from 120 to 140 and 220 (beat?min -1 ) respectively the t mito . We have measured was: (6.3?1.0) s and (7 4?0.9) s for glucose; (5.4?1.2) s and (7.0?0.9) s for lactate; (4.0?0.7)s and (6 5?0 6) s for pyruvate (two way ANOVA, P

The preparation of biodegradable intravascular stent and the studies of its properties / 中华放射学杂志

Objective To investigate the preparation of a biodegradable intravascular stent (BIS) with poly-l-lactic acid (PLLA), and to evaluate its physical and mechanical properties, as well as its biocompatibility. Methods The study of this BIS was first prepared by PLLA with molecular weight of 100 000 unit as the strut, and then the micro-porous structure was fabricated and the film was coated at the struts. Following the solidified shaping of BIS, the primary physical and mechanical properties of the BIS were tested, and 22 zigzag type BISs were implanted into the aorta and iliac arteries of 11 canines, then they were euthanized according to a fixed timetable for histopathological assessment. Results Two types of BIS (spiral and zigzag) were prepared, and the strut diameter of the BIS was 0.1-0.6 mm, stent diameter of BIS was 6-15 mm, and stent length was 30-80 mm. Of this BIS, the radial strength was 1.6-2.0 kPa (1 kPa=7.5 mm Hg), the dilatable rate was 6.0-6.5, the shortening rate was smaller than 8%-10%, and the proportion of stent surface area to open surface area was 0.16-0.18 (

Damag to gut mucosal barrier and intestinal bacteria-endotoxin translocation in acute necrotizing pancreatitis rats / 中国普通外科杂志

Objective To observe the changes in gut mucosal barrier and gut-origin bacteria-endotoxin translocation in acute necrotizing pancreatitis (ANP) rats. Methods Wistar rats were divided randomly into normal group (n=6), sham operation group (n=30) and ANP group (n=39). ANP was introduced by infusion of artificial bile into biliopancreatic duct. Morphology of pancreas and intestine were observed and tight junction on ileum epithelia were assessed by cryofracture replicas electroscopy. Plasma levels of D-lactic acid and endotoxin were examined at various time points. The rates of bacterial translocation to abdominal organs were also calculated. Results Mucosal and tight junction damages of the gut were found during early stage of ANP. Simultaneously, plasma D-lactate levels increased and endotoxemia occurred. The rate of bacterial translocation to organs was 59.5% 72h after ANP occurred. Conclusions Gut barrier function can be injured in the early stage of ANP, and resulting in gut origin bacteria-endotoxin translocation, which may be the originator of systemic inflammatory reaction and secondary infection of the pancreas.

Effect of shengmai injection on cytotoxicity of lactate-buffered peritoneal dialysis solutes to human peritioneal mesothelial cells / 中华肾脏病杂志

Objective To study the effect of shengmai injection on the cytotoxicity of lactate-buffered peritoneal dialysis solutes (L-PDS) to human peritoneal mesothelial cells (HPMC). Methods HPMC was separated with trypsin-EDTA. HPMC proliferation and the concentration of lactate dehydrogenase (LDH) in supernatants were detected by MTT assay and automatic biochemical analyzer respectively. Results LDH levels of supernatants increased and prolifernation of HPMC was inhibited in L-PDS groups ( P

Pharmacokinetics and pharmacodynamics of bupivacaine polylactic acid microspheres in rabbits / 中华麻醉学杂志

Objective To evaluate the pharmacokinetics and pharmacodynamics of bupivacaine polylactic acid microspheres in rabbits. Methods Sixteen New Zealand rabbits weighing (2.58?0.17) kg were randomly divided into two groups:in group A a bolus of bupivacaine solution 5 mg?kg-1 was injected subcutaneously, in group B a bolus of bupivacaine polylactic acid microspheres 5 mg ? kg-1 was implanted in subcutaneous tissue. Blood samples were obtained for determination of plasma bupivacaine concentration at 5,10,20,30,45 min and 1,2,3,4, 6,8,12,24h after subcutaneous injection in group A and at 0.5,1,2,3,4,5,6,8,12,24,36,48 and 60 h after subcutaneous implantation in group B. Pharmacodynamics study was conducted using a model evaluating the efficacy of regional anesthesia by skin incision and needle pricking. Results In group A plasma bupivacaine concentration peaked quickly at about 0. 34h after subcutaneous injection, then quickly declined and became indetectable in plasma within 12 h. In group B plasma bupivacaine concentration reached a peak much slowly at about 13h after subcutaneous implantation. Cmax was 0.7781 ? 0.3573 ?g?ml-1 significantly lower than that in group A [Cmax = (2.4664 ? 0.7822) ?g?ml-1 ] . The mean retention time (MRT) was 25.2667 ? 2.4857 h, significantly longer than that in group A [MRT= (5.5580 ? 1.3843)h] . Pharmacodynamic study showed that the duration of regional sensory block was significantly longer in group B than that in group A( P