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Ho SF, Tan SJ, Mazlan MZ, Iberahim S, Lee YX, Hassan R. Exploring Extended White Blood Cell Parameters for the Evaluation of Sepsis among Patients Admitted to Intensive Care Units. Diagnostics (Basel) 2023; 13:2445. [PMID: 37510189 PMCID: PMC10378205 DOI: 10.3390/diagnostics13142445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 07/08/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Sepsis is a major cause of mortality and morbidity in intensive care units. This case-control study aimed to investigate the haematology cell population data and extended inflammatory parameters for sepsis management. The study included three groups of patients: sepsis, non-sepsis, and healthy controls. Patients suspected of having sepsis underwent a Sequential Organ Failure Assessment (SOFA) evaluation and had blood drawn for blood cultures, complete peripheral blood counts (CBC), and measurements of various markers such as C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6). We observed significant changes in numerous CBC parameters and extended inflammation parameters (EIPs), in addition to significant biochemical analysis markers CRP and IL-6 in sepsis cohorts. Multiple logistic regression analyses showed that combining different CBC parameters and EIPs were effective to profile these patients. Two different models have been developed using white blood cell counts and their extended parameters. Our findings indicate that the absolute counts of white blood cells, and the EIPs which reflect their activation states, are important for the prediction and assessment of sepsis, as the body responds to an insult that triggers an immune response. In an emergency situation, having timely updates on patient conditions becomes crucial for guiding the management process. Identifying trends in these specific patient groups will aid early diagnosis, complementing clinical signs and symptoms, especially as CBC is the most commonly ordered test in a diagnostic workup.
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Affiliation(s)
- Sook Fong Ho
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Swee Jin Tan
- Sysmex Asia Pacific Pte Ltd., Singapore 528735, Singapore
| | - Mohd Zulfakar Mazlan
- Department of Anaesthesiology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Salfarina Iberahim
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
| | - Ying Xian Lee
- Sysmex Asia Pacific Pte Ltd., Singapore 528735, Singapore
| | - Rosline Hassan
- Department of Haematology, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
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Guirguis N, Machuca-Parra AI, Matoori S. Portable Near-Infrared Fluorometer for a Liposomal Blood Lactate Assay. ACS Pharmacol Transl Sci 2023; 6:907-912. [PMID: 37325442 PMCID: PMC10262319 DOI: 10.1021/acsptsci.3c00055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Indexed: 06/17/2023]
Abstract
In sepsis, plasma lactate is a key biomarker of disease severity, prognosis, and treatment success. However, the median time to result for clinical lactate tests is 3 h. We recently reported a near-infrared fluorescent (NIRF) blood lactate assay that relies on a two-step enzymatic reaction in a liposomal reaction compartment. This assay was optimized in human blood and was capable of quantifying lactate in fresh capillary blood from human volunteers at clinically relevant concentrations in 2 min. However, these studies were performed with a tabletop fluorescence plate reader. For translation to the point of care, the liposomal lactate assay needs to be combined with a small portable NIR fluorometer. Portable NIR fluorometers were successfully used for the analysis of skin and soil samples, but reports for blood metabolite assays are scarce. We aimed at testing the performance of the liposomal lactate assay in combination with a commercial small portable NIR fluorometer. First, we tested the fluorophore of the liposomal lactate assay using the NIR dye sulfo-cyanine 7; we observed strong fluorescence signals and high linearity. Second, we performed the liposomal lactate assay in lactate-spiked human arterial blood using the portable fluorometer as the detector and observed strong and highly linear lactate sensing at clinically relevant lactate concentrations after 2 min. Finally, spiking fresh mouse blood with three clinically relevant lactate concentrations led to a significantly different response to all three concentrations after 5 min. These results highlight the usefulness of the tested portable NIR fluorometer for the liposomal lactate assay and motivate a clinical evaluation of this rapid and easy-to-use lactate assay.
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Affiliation(s)
- Natalie Guirguis
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Arturo Israel Machuca-Parra
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
| | - Simon Matoori
- Faculté de Pharmacie, Université de Montréal, 2940 Chemin de Polytechnique, Montreal, Quebec H3T 1J4, Canada
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Guarino M, Perna B, Cesaro AE, Spampinato MD, Previati R, Costanzini A, Maritati M, Contini C, De Giorgio R. Comparison between Capillary and Serum Lactate Levels in Predicting Short-Term Mortality of Septic Patients at the Emergency Department. Int J Mol Sci 2023; 24:ijms24119121. [PMID: 37298080 DOI: 10.3390/ijms24119121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Revised: 05/18/2023] [Accepted: 05/19/2023] [Indexed: 06/12/2023] Open
Abstract
Sepsis is a time-dependent and life-threating condition related to macro- and micro-circulatory impairment leading to anaerobic metabolism and lactate increase. We assessed the prognostic accuracy of capillary lactates (CLs) vs. serum ones (SLs) on 48-h and 7-day mortality in patients with suspected sepsis. This observational, prospective, single-centre study was conducted between October 2021 and May 2022. Inclusion criteria were: (i) suspect of infection; (ii) qSOFA ≥ 2; (iii) age ≥ 18 years; (iv) signed informed consent. CLs were assessed with LactateProTM2®. 203 patients were included: 19 (9.3%) died within 48 h from admission to the Emergency Department, while 28 (13.8%) within 7 days. Patients deceased within 48 h (vs. survived) had higher CLs (19.3 vs. 5 mmol/L, p < 0.001) and SLs (6.5 vs. 1.1 mmol/L, p = 0.001). The best CLs predictive cut-off for 48-h mortality was 16.8 mmol/L (72.22% sensitivity, 94.02% specificity). Patients within 7 days had higher CLs (11.5 vs. 5 mmol/L, p = 0.020) than SLs (2.75 vs. 1.1 mmol/L, p < 0.001). The multivariate analysis confirmed CLs and SLs as independent predictors of 48-h and 7-day mortality. CLs can be a reliable tool for their inexpensiveness, rapidity and reliability in identifying septic patients at high risk of short-term mortality.
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Affiliation(s)
- Matteo Guarino
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Benedetta Perna
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Alice Eleonora Cesaro
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Michele Domenico Spampinato
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Rita Previati
- Emergency Department, St. Anna University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Anna Costanzini
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Martina Maritati
- Department of Clinical Sciences, Infectious and Dermatology Diseases, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Carlo Contini
- Department of Clinical Sciences, Infectious and Dermatology Diseases, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
| | - Roberto De Giorgio
- Department of Translational Medicine, St. Anna University Hospital of Ferrara, University of Ferrara, 44124 Ferrara, Italy
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Musaba MW, Nambozo B, Mukunya D, Wandabwa J, Barageine JK, Kiondo P, Napyo A, Sserwanja Q, Weeks AD, Tumwine JK, Ndeezi G. Maternal and umbilical cord blood lactate for predicting perinatal death: a secondary analysis of data from a randomized controlled trial. BMC Pediatr 2023; 23:179. [PMID: 37072754 PMCID: PMC10111771 DOI: 10.1186/s12887-023-04008-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/12/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND In high resource settings, lactate and pH levels measured from fetal scalp and umbilical cord blood are widely used as predictors of perinatal mortality. However, the same is not true in low resource settings, where much of perinatal mortality occurs. The scalability of this practice has been hindered by difficulty in collecting fetal scalp and umbilical blood sample. Little is known about the use of alternatives such as maternal blood, which is easier and safer to obtain. Therefore, we aimed to compare maternal and umbilical cord blood lactate levels for predicting perinatal deaths. METHODS This was secondary analysis of data from a randomized controlled trial assessing the effect of sodium bicarbonate on maternal and perinatal outcomes among women with obstructed labour at Mbale regional referral hospital in Eastern Uganda. Lactate concentration in maternal capillary, myometrial, umbilical venous and arterial blood was measured at the bedside using a lactate Pro 2 device (Akray, Japan Shiga) upon diagnosis of obstructed labour. We constructed Receiver Operating Characteristic curves to compare the predictive ability of maternal and umbilical cord lactate and the optimal cutoffs calculated basing on the maximal Youden and Liu indices. RESULTS Perinatal mortality risk was: 102.2 deaths per 1,000 live births: 95% CI (78.1-130.6). The areas under the ROC curves were 0.86 for umbilical arterial lactate, 0.71 for umbilical venous lactate, and 0.65 for myometrial lactate, 0.59 for maternal lactate baseline, and 0.65 at1hr after administration of bicarbonate. The optimal cutoffs for predicting perinatal death were 15 0.85 mmol/L for umbilical arterial lactate, 10.15mmol/L for umbilical venous lactate, 8.75mmol/L for myometrial lactate, and 3.95mmol/L for maternal lactate at recruitment and 7.35mmol/L after 1 h. CONCLUSION Maternal lactate was a poor predictor of perinatal death, but umbilical artery lactate has a high predictive value. There is need for future studies on the utility of amniotic fluid in predicting intrapartum perinatal deaths.
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Affiliation(s)
- Milton W Musaba
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda.
| | | | - David Mukunya
- Sanyu Africa Research Institute, Mbale, Uganda
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Julius Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
| | - Justus K Barageine
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Paul Kiondo
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Agnes Napyo
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | | | - Andrew D Weeks
- Department of Obstetrics and Gynaecology, Busitema University/ Mbale Regional Referral and Teaching Hospital, Mbale, Uganda
- Sanyu Africa Research Institute, Mbale, Uganda
- Sanyu Research Unit, University of Liverpool, University of Liverpool/Liverpool Women's Hospital, Liverpool, UK
| | - James K Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Chin LK, Yang JY, Chousterman B, Jung S, Kim DG, Kim DH, Lee S, Castro CM, Weissleder R, Park SG, Im H. Dual-Enhanced Plasmonic Biosensing for Point-of-Care Sepsis Detection. ACS NANO 2023; 17:3610-3619. [PMID: 36745820 PMCID: PMC10150330 DOI: 10.1021/acsnano.2c10371] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Rapid, sensitive, simultaneous quantification of multiple biomarkers in point-of-care (POC) settings could improve the diagnosis and management of sepsis, a common, potentially life-threatening condition. Compared to high-end commercial analytical systems, POC systems are often limited by low sensitivity, limited multiplexing capability, or low throughput. Here, we report an ultrasensitive, multiplexed plasmonic sensing technology integrating chemifluorescence signal enhancement with plasmon-enhanced fluorescence detection. Using a portable imaging system, the dual chemical and plasmonic amplification enabled rapid analysis of multiple cytokine biomarkers in 1 h with sub-pg/mL sensitivities. Furthermore, we also developed a plasmonic sensing chip based on nanoparticle-spiked gold nanodimple structures fabricated by wafer-scale batch processes. We used the system to detect six cytokines directly from clinical plasma samples (n = 20) and showed 100% accuracy for sepsis detection. The described technology could be employed in rapid, ultrasensitive, multiplexed plasmonic sensing in POC settings for myriad clinical conditions.
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Affiliation(s)
- Lip Ket Chin
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Electrical Engineering, City University of Hong Kong, Kowloon, Hong Kong SAR
| | - Jun-Yeong Yang
- Department of Nano-Bio Convergence, Korea Institute of Materials Science, 797 Changwondae-ro, Changwon 51508, Republic of Korea
| | - Benjamin Chousterman
- Département d’Anesthésie-Réanimation, Hôpital Lariboisière, AP-HP, 75010, Paris, France
| | - Sunghoon Jung
- Department of Nano-Bio Convergence, Korea Institute of Materials Science, 797 Changwondae-ro, Changwon 51508, Republic of Korea
| | - Do-Geun Kim
- Department of Nano-Bio Convergence, Korea Institute of Materials Science, 797 Changwondae-ro, Changwon 51508, Republic of Korea
| | - Dong-Ho Kim
- Department of Nano-Bio Convergence, Korea Institute of Materials Science, 797 Changwondae-ro, Changwon 51508, Republic of Korea
| | - Seunghun Lee
- Department of Nano-Bio Convergence, Korea Institute of Materials Science, 797 Changwondae-ro, Changwon 51508, Republic of Korea
| | - Cesar M. Castro
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Cancer Center, Massachusetts General Hospital, Boston, MA 02114, USA
| | - Ralph Weissleder
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Cancer Center, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Systems Biology, Harvard Medical School, 200 Longwood Ave, Boston, MA 02115, USA
| | - Sung-Gyu Park
- Department of Nano-Bio Convergence, Korea Institute of Materials Science, 797 Changwondae-ro, Changwon 51508, Republic of Korea
- Corresponding authors: Hyungsoon Im (), Sung-Gyu Park ()
| | - Hyungsoon Im
- Center for Systems Biology, Massachusetts General Hospital, Boston, MA 02114, USA
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA
- Corresponding authors: Hyungsoon Im (), Sung-Gyu Park ()
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Tembo D, Mwanza S, Mwaba C, Dallah I, wa Somwe S, Seydel KB, Birbeck GL. Risk factors for acute kidney injury at presentation among children with CNS malaria: a case control study. Malar J 2022; 21:310. [PMID: 36316704 PMCID: PMC9624036 DOI: 10.1186/s12936-022-04327-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 10/18/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recent research has established that acute kidney injury (AKI) is a common problem in severe paediatric malaria. Limited access to kidney diagnostic studies in the low resources settings where malaria is common has constrained research on this important problem. METHODS Enrolment data from an ongoing clinical trial of antipyretics in children with central nervous system (CNS) malaria, CNS malaria being malaria with seizures or coma, was used to identify risk factors for AKI at presentation. Children 2-11 years old with CNS malaria underwent screening and enrollment assessments which included demographic and anthropomorphic data, clinical details regarding the acute illness, and laboratory studies including creatinine (Cr), quantitative parasite count (qPC), quantitative histidine rich protein 2 (HRP2), lactate, and bilirubin levels. Children with a screening Cr > 106 µmol/l were excluded from the study due to the potential nephrotoxic effects of the study drug. To identify risk factors for AKI at the time of admission, children who were enrolled in the study were categorized as having AKI using estimates of their baseline (i.e. before this acute illness) kidney function and creatinine at enrollment applying the Kidney Disease: Improving Global Outcome (KDIGO) 2012 guidelines. Logistic regressions and a multivariate model were used to identify clinical and demographic risk factors for AKI at presentation among those children enrolled in the study. RESULTS 465 children were screened, 377 were age-appropriate with CNS malaria, 22 (5.8%) were excluded due to Cr > 106 µmol/l, and 209 were enrolled. Among the 209, AKI using KDIGO criteria was observed in 134 (64.1%). One child required dialysis during recovery. Risk factors for AKI in both the logistic regression and multivariate models included: hyperpyrexia (OR 3.36; 95% CI 1.39-8.12) and age with older children being less likely to have AKI (OR 0.72; 95% CI 0.62-0.84). CONCLUSION AKI is extremely common among children presenting with CNS malaria. Hyperpyrexia with associated dehydration may contribute to the AKI or may simply be a marker for a more inflammatory systemic response that is also affecting the kidney. Appropriate fluid management in children with CNS malaria and AKI may be challenging since generous hydration to support kidney recovery could worsen malaria-induced cerebral oedema in this critically ill population. Trial registration https://clinicaltrials.gov/ct2/show/NCT03399318.
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Affiliation(s)
- Derby Tembo
- Department of Paediatrics and Child Health, Chipata Central Hospital, Chipata, Zambia
| | - Suzanna Mwanza
- Department of Paediatrics and Child Health, Chipata Central Hospital, Chipata, Zambia
| | - Chisambo Mwaba
- grid.12984.360000 0000 8914 5257Dept. of Paediatric & Child Health, University of Zambia School of Medicine, Lusaka, Zambia
| | - Ifunanya Dallah
- grid.16416.340000 0004 1936 9174Department of Neurology, University of Rochester, Rochester, NY 14642 USA
| | - Somwe wa Somwe
- University Teaching Hospitals, Neurology Research Office, Lusaka, Zambia
| | - Karl B. Seydel
- Blantyre Malaria Project, Kamuzu University of Health Sciences, Blantyre, Malawi ,grid.17088.360000 0001 2150 1785Dept. of Osteopathic Medical Specialties, College of Osteopathic Medicine, Michigan State University, East Lansing, MI USA
| | - Gretchen L. Birbeck
- grid.12984.360000 0000 8914 5257Dept. of Paediatric & Child Health, University of Zambia School of Medicine, Lusaka, Zambia ,grid.16416.340000 0004 1936 9174Department of Neurology, University of Rochester, Rochester, NY 14642 USA ,University Teaching Hospitals Children’s Hospital, Lusaka, Zambia
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Shaw I, Magee P. Acid-base quantification: a review of developing technology. BJA Educ 2022; 22:440-447. [PMID: 36313591 PMCID: PMC9596322 DOI: 10.1016/j.bjae.2022.07.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2022] [Indexed: 10/31/2022] Open
Affiliation(s)
- I. Shaw
- Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
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8
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Advanced Triage Protocol: The Role of an Automated Lactate Order in Expediting Rapid Identification of Patients at Risk of Sepsis in the Emergency Department. Crit Care Explor 2022; 4:e0736. [PMID: 36003829 PMCID: PMC9394690 DOI: 10.1097/cce.0000000000000736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
We undertook a process improvement initiative to expedite rapid identification of potential sepsis patients based on triage chief complaint, vital signs, and initial lactate level.
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Musaba MW, Wandabwa JN, Ndeezi G, Weeks AD, Mukunya D, Waako P, Nankabirwa V, Mugabe KTM, Semakula D, Tumwine JK, Barageine JK. Effect of pre-operative bicarbonate infusion on maternal and perinatal outcomes among women with obstructed labour in Mbale hospital: A double blind randomized controlled trial. PLoS One 2021; 16:e0245989. [PMID: 33561141 PMCID: PMC7872290 DOI: 10.1371/journal.pone.0245989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 01/11/2021] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Oral bicarbonate solution is known to improve both maternal and perinatal outcomes among women with abnormal labour (dystocia). Its effectiveness and safety among women with obstructed labour is not known. OBJECTIVE To determine the effect and safety of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal blood lactate and clinical outcomes among women with obstructed labour (OL) in Mbale hospital. METHODS We conducted a double blind, randomised controlled trial from July 2018 to September 2019. The participants were women with OL at term (≥37 weeks gestation), carrying a singleton pregnancy with no other obstetric emergency, medical comorbidity or laboratory derangements. INTERVENTION A total of 477 women with OL were randomized to receive 50ml of 8.4% sodium bicarbonate (238 women) or 50 mL of 0.9% sodium chloride (239 women). In both the intervention and controls arms, each participant was preoperatively given a single dose intravenous bolus. Every participant received 1.5 L of normal saline in one hour as part of standard preoperative care. OUTCOME MEASURES Our primary outcome was the mean difference in maternal venous blood lactate at one hour between the two arms. The secondary outcomes were umbilical cord blood lactate levels at birth, neonatal sepsis and early neonatal death upto 7 days postnatal, as well as the side effects of sodium bicarbonate, primary postpartum hemorrhage, maternal sepsis and mortality at 14 days postpartum. RESULTS The median maternal venous lactate was 6.4 (IQR 3.3-12.3) in the intervention and 7.5 (IQR 4.0-15.8) in the control group, with a statistically non-significant median difference of 1.2 mmol/L; p-value = 0.087. Vargha and Delaney effect size was 0.46 (95% CI 0.40-0.51) implying very little if any effect at all. CONCLUSION The 4.2g of preoperative intravenous sodium bicarbonate was safe but made little or no difference on blood lactate levels. TRIAL REGISTRATION PACTR201805003364421.
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Affiliation(s)
- Milton W. Musaba
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital, Mbale, Uganda
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
- * E-mail:
| | - Julius N. Wandabwa
- Department of Obstetrics and Gynaecology, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Andrew D. Weeks
- Sanyu Research Unit, University of Liverpool/Liverpool Women’s Hospital, Liverpool, United Kingdom
| | - David Mukunya
- Sanyu Research Unit, University of Liverpool/Liverpool Women’s Hospital, Liverpool, United Kingdom
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Intervention Science and Maternal Child health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
- Department of Public and Community Health, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Paul Waako
- Department of Pharmacology and Therapeutics, Busitema University Faculty of Health Sciences, Mbale, Uganda
| | - Victoria Nankabirwa
- Department of Epidemiology and Biostatistics, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
- Centre for Intervention Science and Maternal Child health (CISMAC), Centre for International Health, University of Bergen, Bergen, Norway
| | | | - Daniel Semakula
- Africa Centre for Systematic Reviews and Knowledge Translation, Makerere University College of Health Sciences, Kampala, Uganda
| | - James K. Tumwine
- Department of Paediatrics and Child Health, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K. Barageine
- Department of Obstetrics & Gynaecology, School of Medicine, Makerere University College of Health Sciences, Kampala, Uganda
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Matoori S, Mooney DJ. Near-Infrared Fluorescence Hydrogen Peroxide Assay for Versatile Metabolite Biosensing in Whole Blood. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2020; 16:e2000369. [PMID: 32329223 DOI: 10.1002/smll.202000369] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 05/17/2023]
Abstract
In emergency medicine, blood lactate levels are commonly measured to assess the severity and response to treatment of hypoperfusion-related diseases (e.g., sepsis, trauma, cardiac arrest). Clinical blood lactate testing is conducted with laboratory analyzers, leading to a delay of 3 h between triage and lactate result. Here, a fluorescence-based blood lactate assay, which can be utilized for bedside testing, based on measuring the hydrogen peroxide generated by the enzymatic oxidation of lactate is described. To establish a hydrogen peroxide assay, near-infrared cyanine derivatives are screened and sulfo-cyanine 7 is identified as a new horseradish peroxidase (HRP) substrate, which loses its fluorescence in presence of HRP and hydrogen peroxide. As hydrogen peroxide is rapidly cleared by erythrocytic catalase and glutathione peroxidase, sulfo-cyanine 7, HRP, and lactate oxidase are encapsulated in a liposomal reaction compartment. In lactate-spiked bovine whole blood, the newly developed lactate assay exhibits a linear response in a clinically relevant range after 10 min. Substituting lactate oxidase with glucose and alcohol oxidase allows for blood glucose, ethanol, and methanol biosensing, respectively. This easy-to-use, rapid, and versatile assay may be useful for the quantification of a variety of enzymatically oxidizable metabolites, drugs, and toxic substances in blood and potentially other biological fluids.
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Affiliation(s)
- Simon Matoori
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
| | - David J Mooney
- John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, MA, 02138, USA
- Wyss Institute of Biologically Inspired Engineering, Harvard University, Boston, MA, 02115, USA
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Lo VCK, Su H, Lam YM, Willis K, Pullar V, Kowgier M, Hubner RP, Tsang JLY. Management of Patients With Sepsis in Canadian Community Emergency Departments: A Retrospective Multicenter Observational Study. Health Serv Res Manag Epidemiol 2020; 7:2333392820920082. [PMID: 32341942 PMCID: PMC7175053 DOI: 10.1177/2333392820920082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/01/2020] [Accepted: 03/02/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Sepsis is a life-threatening syndrome and a leading cause of morbidity and mortality representing significant financial burden on the health-care system. Early identification and intervention is crucial to maximizing positive outcomes. We studied a quality improvement initiative with the aim of reviewing the initial management of patients with sepsis in Canadian community emergency departments, to identify areas for improving the delivery of sepsis care. We present a retrospective, multicenter, observational study during 2011 to 2015 in the community setting. METHODS We collected data on baseline characteristics, clinical management metrics (triage-to-physician-assessment time, triage-to-lactate-drawn time, triage-to-antibiotic time, and volume of fluids administered within the first 6 hours of triage), and outcomes (intensive care unit [ICU] admission, in-hospital mortality) from a regional database. RESULTS A total of 2056 patients were analyzed. The median triage-to-physician-assessment time was 50 minutes (interquartile range [IQR]: 25-104), triage-to-lactate-drawn time was 50 minutes (IQR: 63-94), and triage-to-antibiotics time was 129 minutes (IQR: 70-221). The median total amount of fluid administered within 6 hours of triage was 2.0 L (IQR: 1.5-3.0). The ICU admission rate was 36% and in-hospital mortality was 25%. We also observed a higher ICU admission rate (51% vs 24%) and in-hospital mortality (44% vs 14%) in those with higher lactate concentration (≥4 vs ≤2 mmol/L), independent of other sepsis-related parameters. CONCLUSION Time-to-physician-assessment, time-to-lactate-drawn, time-to-antibiotics, and fluid resuscitation in community emergency departments could be improved. Future quality improvement interventions are required to optimize management of patients with sepsis. Elevated lactate concentration was also independently associated with ICU admission rate and in-hospital mortality rate.
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Affiliation(s)
- Victor C. K. Lo
- Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Haitong Su
- Department of Anesthesiology, University of Toronto, Ontario, Canada
| | - Yuet Ming Lam
- Department of Family and Community Medicine, University of Toronto, Ontario, Canada
| | | | | | - Matthew Kowgier
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | | | - Jennifer L. Y. Tsang
- Niagara Regional Campus, Michael G. DeGroote School of Medicine, McMaster University, St Catharines, Ontario, Canada
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
- Niagara Health, St Catharines, Ontario, Canada
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12
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Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnostic et Prise en Charge de l’Acidose Métabolique Recommandations formalisées d’experts communes Société de réanimation de langue française (SRLF) – Société française de médecine d’urgence (SFMU). ANNALES FRANCAISES DE MEDECINE D URGENCE 2019. [DOI: 10.3166/afmu-2019-0162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
L’acidose métabolique est un trouble fréquemment rencontré en médecine d’urgence et en médecine intensive réanimation. La littérature s’étant enrichie de nouvelles données concernant la prise en charge de l’acidose métabolique, la Société de Réanimation de Langue Française (SRLF) et la Société Française de Médecine d’Urgence (SFMU) ont élaboré des recommandations formalisées d’experts selon la méthodologie GRADE. Les champs de la stratégie diagnostique, de l’orientation et de la prise en charge thérapeutique ont été traités et vingt-neuf recommandations ont été formulées : quatre recommandations fortes (Grade 1), dix recommandations faibles (Grade 2) et quinze avis d’experts. Toutes ont obtenu un accord fort. L’application des méthodes d’Henderson-Hasselbalch et de Stewart pour le diagnostic du mécanisme de l’acidose métabolique est discutée et un algorithme diagnostique est proposé. L’utilisation de la cétonémie et des lactatémies veineuse et capillaire est également traitée. L’intérêt du pH, de la lactatémie et de sa cinétique pour l’orientation des patients en pré-hospitalier et aux urgences est envisagé. Enfin, les modalités de l’insulinothérapie au cours de l’acidocétose diabétique, les indications de la perfusion de bicarbonate de sodium et de l’épuration extra-rénale ainsi que les modalités de la ventilation mécanique au cours des acidoses métaboliques sévères sont traitées dans la prise en charge thérapeutique.
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13
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Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, Levraut J, Maury E, Oberlin M, Terzi N, Viglino D, Yordanov Y, Claret PG, Bigé N. Diagnosis and management of metabolic acidosis: guidelines from a French expert panel. Ann Intensive Care 2019; 9:92. [PMID: 31418093 PMCID: PMC6695455 DOI: 10.1186/s13613-019-0563-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 07/30/2019] [Indexed: 02/07/2023] Open
Abstract
Metabolic acidosis is a disorder frequently encountered in emergency medicine and intensive care medicine. As literature has been enriched with new data concerning the management of metabolic acidosis, the French Intensive Care Society (Société de Réanimation de Langue Française [SRLF]) and the French Emergency Medicine Society (Société Française de Médecine d’Urgence [SFMU]) have developed formalized recommendations from experts using the GRADE methodology. The fields of diagnostic strategy, patient assessment, and referral and therapeutic management were addressed and 29 recommendations were made: 4 recommendations were strong (Grade 1), 10 were weak (Grade 2), and 15 were experts’ opinions. A strong agreement from voting participants was obtained for all recommendations. The application of Henderson–Hasselbalch and Stewart methods for the diagnosis of the metabolic acidosis mechanism is discussed and a diagnostic algorithm is proposed. The use of ketosis and venous and capillary lactatemia is also treated. The value of pH, lactatemia, and its kinetics for the referral of patients in pre-hospital and emergency departments is considered. Finally, the modalities of insulin therapy during diabetic ketoacidosis, the indications for sodium bicarbonate infusion and extra-renal purification as well as the modalities of mechanical ventilation during severe metabolic acidosis are addressed in therapeutic management.
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Affiliation(s)
- Boris Jung
- Département de Médecine Intensive et Réanimation, CHU Montpellier, 34000, Montpellier, France. .,INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.
| | - Mikaël Martinez
- Pôle Urgence, CH du Forez, 42605, Montbrison, France.,Réseau d'urgence Ligérien Ardèche Nord (REULIAN), Centre Hospitalier Le Corbusier, 42700, Firminy, France
| | - Yann-Erick Claessens
- Département de Médecine d'urgence, Centre Hospitalier Princesse-Grace, Avenue Pasteur, 98012, Monaco, France
| | - Michaël Darmon
- Unité de Médecine Intensive et Réanimation, Hôpital Universitaire Saint-Louis, Assistance Publique-Hôpitaux de Paris, Avenue Claude-Vellefaux, 75010, Paris, France.,Faculté de Médecine, Université Paris-Diderot, Sorbonne-Paris-Cité, Paris, France.,France Inserm, ECSTRA Team, UMR 1153, Centre d'Epidémiologie et de Biostatistique, CRESS, Biostatistics and Clinical Epidemiology, Sorbonne-Paris-Cité, Paris, France
| | - Kada Klouche
- INSERM U-1046, CNRS U-9234 (PhyMedExp), Université de Montpellier, Montpellier, France.,Département de Médecine Intensive-Réanimation, CHU Lapeyronie, 371, Avenue Doyen-Gaston-Giraud, 34295, Montpellier, France
| | - Alexandre Lautrette
- Réanimation, Centre Jean-Perrin, CHU de Clermont-Ferrand, 63000, Clermont-Ferrand, France.,LMGE, UMR CNRS 6023, Université Clermont-Auvergne, Clermont-Ferrand, France
| | - Jacques Levraut
- Département de Médecine d'urgence, CHU de Nice, Hôpital Pasteur-II, 30, Avenue de la Voie Romaine, 06000, Nice, France.,UFR de Médecine, Université de Nice Côte d'Azur, Avenue de Vallombrose, 06000, Nice, France
| | - Eric Maury
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184, Rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, Paris, France.,Sorbonne Université, Université Pierre-et-Marie Curie-Paris-VI, Paris, France.,Inserm U1136, 75012, Paris, France
| | - Mathieu Oberlin
- Structure des Urgences, Centre Hospitalier de Cahors, 335, Rue Wilson, 46000, Cahors, France
| | - Nicolas Terzi
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Universitaire de Grenoble, Université de Grenoble, Grenoble, France.,Inserm, U1042, Université Grenoble-Alpes, HP2, 38000, Grenoble, France
| | - Damien Viglino
- Service des Urgences Adultes, CS 10217, CHU Grenoble-Alpes, 38043 Grenoble Cedex 09, Grenoble, France.,Inserm U1042, Laboratoire HP2 Hypoxie-Physiopathologies, Université Grenoble-Alpes, Grenoble, France
| | - Youri Yordanov
- Faculté de Médecine, Sorbonne Universités, 75013, Paris, France.,Inserm, U1153, Université Paris-Descartes, 75006, Paris, France.,Service des Urgences, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP), 75012, Paris, France
| | - Pierre-Géraud Claret
- Pôle Anesthésie Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, 4, Rue du Professeur-Robert-Debré, 30029, Nîmes, France
| | - Naïke Bigé
- Service de Médecine Intensive-Réanimation, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, 184, Rue du Faubourg-Saint-Antoine, 75571 Paris Cedex 12, Paris, France
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Plasma lactate as a marker of metabolic health: Implications of elevated lactate for impairment of aerobic metabolism in the metabolic syndrome. Surgery 2019; 166:861-866. [PMID: 31253418 DOI: 10.1016/j.surg.2019.04.017] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 04/16/2019] [Accepted: 04/24/2019] [Indexed: 01/15/2023]
Abstract
BACKGROUND Fasting lactate is elevated in metabolic diseases and could possibly be predictive of the risk of developing the metabolic syndrome. METHODS Plasma samples were analyzed for fasting lactate to compare lean subjects, nondiabetic subjects with severe obesity, and metabolically impaired subjects. Subjects with severe obesity were studied 1 week before and 1 week to 9 months after gastric bypass surgery. Subjects with components of the metabolic syndrome were studied before and after 6 months of an exercise intervention. RESULTS Metabolically impaired subjects had higher fasting lactate concentrations (P < .0001) and respond to a glucose or insulin challenge with higher lactates than non-obese subjects (P < .004). Lactate was significantly reduced a week after gastric bypass surgery (P < .05) and further reduced 1 to 9 months after surgery (0.95 ± 0.04 mM in non-obese, 1.26 ± 0.12 mM in subjects with severe obesity, and 0.68 ± 0.03 mM 1-3 months after gastric bypass). Six months of chronic exercise resulted in a 16% reduction (P = .028) in fasting lactate. CONCLUSION Fasting plasma lactate was elevated in obese subjects with the metabolic syndrome compared with healthy lean individuals. Lactate was reduced by exercise and bariatric surgery, interventions that improve metabolic health and risk for subsequent disease. The results of this study and those previously published by our research group suggest that elevated lactate may be caused by an impairment in aerobic metabolism and may offer a metric assessing the severity of the metabolic syndrome.
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15
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Musaba MW, Barageine JK, Ndeezi G, Wandabwa JN, Weeks A. Effect of preoperative bicarbonate infusion on maternal and perinatal outcomes of obstructed labour in Mbale Regional Referral Hospital: a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e026675. [PMID: 31048444 PMCID: PMC6502014 DOI: 10.1136/bmjopen-2018-026675] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION To improve maternal and fetal outcomes among patients with obstructed labour (OL) in low-resource settings, the associated electrolyte and metabolic derangements must be adequately corrected. Oral fluid intake during labour and preoperative intravenous fluid replacement following OL corrects the associated dehydration and electrolyte changes, but it does not completely reverse the metabolic acidosis, that is, a cause of intrapartum birth asphyxia and a risk factor for primary postpartum haemorrhage due to uterine atony. Sodium bicarbonate is a safe, effective, cheap and readily available acid buffer, that is widely used by sportspeople to improve performance. It also appears to improve fetal and maternal outcomes in abnormally progressing labour. However, its effects on maternal and fetal outcomes among patients with OL is unknown. We aim at establishing the effect of a single-dose preoperative infusion of sodium bicarbonate on maternal and fetal lactate levels and clinical outcomes among patients with OL. METHODS AND ANALYSIS This will be a double blind, randomised controlled clinical phase IIb trial. We will randomise 478 patients with OL to receive either 50 mL of placebo with standard preoperative infusion of normal saline (1.5 L) or 4.2 g of sodium bicarbonate solution (50 mL of 50 mmol/L) with the preoperative infusion of normal saline (1.5 L). The primary outcome will be mean lactate levels in maternal capillary blood at 1 hour after study drug administration and in the arterial cord blood at birth. We will use the intention-to-treat analysis approach. Secondary outcomes will include safety, maternal and fetal morbidity and mortality up to 14 days postpartum. ETHICS AND DISSEMINATION Makerere University School of Medicine Research and Ethics Committee and Uganda National Council for Science and Technology have approved the protocol. Each participant will give informed consent at enrollment. TRIAL REGISTRATION NUMBER PACTR201805003364421.
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Affiliation(s)
- Milton W Musaba
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital & Busitema University, Mbale, Uganda
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Justus K Barageine
- Department of Obstetrics and Gynaecology, Makerere University College of Health Sciences, Kampala, Uganda
| | - Grace Ndeezi
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Julius N Wandabwa
- Department of Obstetrics and Gynaecology, Mbale Regional Referral Hospital & Busitema University, Mbale, Uganda
| | - Andrew Weeks
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
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16
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Graham CA, Leung LY, Lo RS, Lee KH, Yeung CY, Chan SY, Cattermole GN, Hung KK. Agreement between capillary and venous lactate in emergency department patients: prospective observational study. BMJ Open 2019; 9:e026109. [PMID: 30948594 PMCID: PMC6500234 DOI: 10.1136/bmjopen-2018-026109] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Capillary blood lactate testing with handheld analysers has great advantages to reduce the time needed for clinical decisions, and for extended use in the prehospital setting. We investigated the agreement of capillary lactate measured using handheld analysers (CL-Nova and CL-Scout+ measured by Nova and Lactate Scout+ analyzers) and the reference venous level assessed using a point-of-care testing (POCT) blood gas analyser (VL-Ref). DESIGN A prospective observational study. SETTING A university teaching hospital emergency department in Hong Kong. PARTICIPANTS Patients triaged as 'urgent' (Category 3 of a 5-point scale), aged ≥18 years during 2016 were eligible. 240 patients (mean age 69.9 years) were recruited. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was the agreement of the capillary blood lactate level measured by handheld lactate analyser when compared with the reference standard technique, namely venous blood samples obtained by venepuncture and analysed using the blood gas analyser. The secondary outcome measure was the difference in values of venous lactate using blood gas analysers and handheld lactate analysers. RESULTS The results of VL-Ref ranged from 0.70 to 5.38 mmol/L (mean of 1.96 mmol/L). Regarding capillary lactate measurements, the bias (mean difference) between VL-Ref and CL-Scout+ was -0.22 with 95% limits of agreement (LOA) of -2.17 to 1.73 mmol/L and the bias between VL-Ref and CL-Nova was 0.46, with LOA of -1.08 to 2.00 mmol/L. For venous lactate, results showed the bias between VL-Ref and VL-Scout+ was 0.22 with LOA being -0.46 to 0.90 mmol/L, and the bias between VL-Ref and VL-Nova was 0.83 mmol/L with LOA -0.01 to 1.66 mmol/L. CONCLUSION Our study shows poor agreement between capillary lactate and reference values. The study does not support the clinical utility of capillary lactate POCT. However, venous lactate measured by Scout+ handheld analyser may have potential for screening patients who may need further testing. TRIAL REGISTRATION NUMBER NCT02694887.
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Affiliation(s)
- Colin A Graham
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
- Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Ronson Sl Lo
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kwok Hung Lee
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
- Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
| | - Chun Yu Yeung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Suet Yi Chan
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Giles N Cattermole
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
| | - Kevin Kc Hung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Shatin, Hong Kong
- Emergency Department, Prince of Wales Hospital, Shatin, Hong Kong SAR
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Swan KL, Avard BJ, Keene T. The relationship between elevated prehospital point-of-care lactate measurements, intensive care unit admission, and mortality: A retrospective review of adult patients. Aust Crit Care 2019; 32:100-105. [DOI: 10.1016/j.aucc.2018.02.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 11/23/2017] [Accepted: 02/01/2018] [Indexed: 12/11/2022] Open
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Oeschger T, McCloskey D, Kopparthy V, Singh A, Erickson D. Point of care technologies for sepsis diagnosis and treatment. LAB ON A CHIP 2019; 19:728-737. [PMID: 30724931 PMCID: PMC6392004 DOI: 10.1039/c8lc01102h] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sepsis is a rapidly progressing, life threatening immune response triggered by infection that affects millions worldwide each year. Current clinical diagnosis relies on broad physiological parameters and time consuming lab-based cell culture. If proper treatment is not provided, cases of sepsis can drastically increase in severity over the course of a few hours. Development of new point of care tools for sepsis has the potential to improve diagnostic speed and accuracy, leading to prompt administration of appropriate therapeutics, thereby reducing healthcare costs and improving patient outcomes. In this review we examine developing and commercially available technologies to assess the feasibility of rapid, accurate sepsis diagnosis, with emphasis on point of care.
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Affiliation(s)
- Taylor Oeschger
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Duncan McCloskey
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Varun Kopparthy
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
| | - Ankur Singh
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
| | - David Erickson
- Sibley School of Mechanical and Aerospace Engineering, Cornell University, Ithaca, NY 14853, USA
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA
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19
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A 12-Month Clinical Audit Comparing Point-of-Care Lactate Measurements Tested by Paramedics with In-Hospital Serum Lactate Measurements. Prehosp Disaster Med 2018; 33:36-42. [DOI: 10.1017/s1049023x17007130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractObjectivePrehospital point-of-care lactate (pLA) measurement may be a useful tool to assist paramedics with diagnosing a range of conditions, but only if it can be shown to be a reliable surrogate for serum lactate (sLA) measurement. The aim of this study was to determine whether pLA is a reliable predictor of sLA.MethodsThis was a retrospective study of adult patients over a 12-month period who had pLA measured by paramedics in an urban Australian setting and were transported by ambulance to a tertiary hospital where sLA was measured. Patients were excluded if they suffered a cardiopulmonary arrest at any time, had missing data, or if sLA was not measured within 24 hours of arrival. Levels of agreement were determined using methods proposed by Bland and Altman.ResultsA total of 290 patients were transported with a pLA recorded. After exclusions, there were 155 patients (55.0% male; age 71 [SD=18] years) remaining who had sLA recorded within 24 hours. Elevated pLA (>2.0mMol/L) was associated with sLA measurement (76.1% vs 23.9%; OR 3.18; 95% CI, 1.88-5.37; P<.0001). Median time between measurements was 89 minutes (IQR=75). Overall, median pLA was higher than sLA (3.0 [IQR=2.0] mMol/L vs 1.7 [IQR=1.3]; P<.001). Bland-Altman analysis on all participants showed a mean difference of 1.48 mMol/L (95% CI, -3.34 to 6.31). Normal pLA was found to be a true negative in 82.9% of cases, and elevated pLA was a true positive in 48.3% of cases. When the time between measurements was less than 60 minutes (n=25), normal pLA predicted normal sLA with 100% accuracy, with a false-positive rate of 18.2%. As time between measurements increased, accuracy diminished and the false-positive rate increased.ConclusionsOverall, the level of agreement between pLA and sLA was poor. Accuracy of pLA diminished markedly as the time between the two measurements increased. It may be possible to use pLA as a screening tool; when considered this way, pLA performed much better, though larger prospective trials would be needed to confirm this.SwanKL, KeeneT, AvardBJ. A 12-month clinical audit comparing point-of-care lactate measurements tested by paramedics with in-hospital serum lactate measurements. Prehosp Disaster Med. 2018;33(1):36–42.
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Nolan K, O'Leary R, Bos LDJ, Martin-Loeches I. Integrative research agenda for diagnosis in sepsis. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:454. [PMID: 29266127 DOI: 10.21037/atm.2017.06.57] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- Katie Nolan
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital Dublin, Trinity Centre for Health Sciences, Trinity College (TCD), Irish Centre for Vascular Biology (ICVB), Dublin, Eire
| | - Ruth O'Leary
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital Dublin, Trinity Centre for Health Sciences, Trinity College (TCD), Irish Centre for Vascular Biology (ICVB), Dublin, Eire
| | - Lieuwe D J Bos
- Department of Intensive Care, Academic Medical Center, Amsterdam, the Netherlands
| | - Ignacio Martin-Loeches
- Multidisciplinary Intensive Care Research Organization (MICRO), St. James's Hospital Dublin, Trinity Centre for Health Sciences, Trinity College (TCD), Irish Centre for Vascular Biology (ICVB), Dublin, Eire
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21
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Li Y, Uddayasankar U, He B, Wang P, Qin L. Fast, Sensitive, and Quantitative Point-of-Care Platform for the Assessment of Drugs of Abuse in Urine, Serum, and Whole Blood. Anal Chem 2017; 89:8273-8281. [PMID: 28700829 DOI: 10.1021/acs.analchem.7b01288] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Drug abuse is a major public health problem in many countries in Europe and North America. Currently available platforms for drug abuse assessment are facing technical challenges of nonquantitation, inaccuracy, low throughput, incompatibility with diverse complex specimens, long assay times, and requirement of instrument and/or expertise for readout. Here, we report an integrated competitive volumetric-bar-chart chip (CV-Chip) to assay multiple drug targets at the point-of-care (POC). To the best of our knowledge, it is the first time that a POC platform has been demonstrated to fully address the above-mentioned limitations. We applied this integrated CV-chip platform to assay multiple drugs in 38 patient urine and serum samples and validated the on-chip results with an LC-MS/MS method, indicating a clinical sensitivity and specificity of 0.94 and 1.00, respectively. We further demonstrated that the combination of an on-chip blood separator with the CV-Chip enabled the platform to directly assay finger-prick whole blood samples, which have always been recognized as an ideal biospecimen for POC detections. In summary, this integrated CV-Chip is able to serve as a sensitive, accurate, fast, portable, readout visible, and minimally invasive platform for drug abuse assessment.
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Affiliation(s)
- Ying Li
- Department of Nanomedicine, Houston Methodist Research Institute , 6670 Bertner Avenue, Houston, Texas 77030, United States.,Department of Cell and Developmental Biology, Weill Medical College of Cornell University , New York, New York 10065, United States
| | - Uvaraj Uddayasankar
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital , 6670 Bertner Avenue, Houston, Texas 77030, United States
| | - Bangshun He
- Department of Nanomedicine, Houston Methodist Research Institute , 6670 Bertner Avenue, Houston, Texas 77030, United States.,Department of Cell and Developmental Biology, Weill Medical College of Cornell University , New York, New York 10065, United States.,Central Laboratory, Nanjing First Hospital, Nanjing Medical University , Nanjing 210006, China
| | - Ping Wang
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital , 6670 Bertner Avenue, Houston, Texas 77030, United States.,Department of Pathology and Laboratory Medicine, University of Pennsylvania , 3400 Spruce Street, Philadelphia, Pennsylvania 19104, United States
| | - Lidong Qin
- Department of Nanomedicine, Houston Methodist Research Institute , 6670 Bertner Avenue, Houston, Texas 77030, United States.,Department of Cell and Developmental Biology, Weill Medical College of Cornell University , New York, New York 10065, United States
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Mason A, Korostynska O, Louis J, Cordova-Lopez LE, Abdullah B, Greene J, Connell R, Hopkins J. Noninvasive In-Situ Measurement of Blood Lactate Using Microwave Sensors. IEEE Trans Biomed Eng 2017. [PMID: 28622665 DOI: 10.1109/tbme.2017.2715071] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
GOAL This paper reports a novel electromagnetic sensor technique for real-time noninvasive monitoring of blood lactate in human subjects. METHODS The technique was demonstrated on 34 participants who undertook a cycling regime, with rest period before and after, to produce a rising and falling lactate response curve. Sensors attached to the arm and legs of participants gathered spectral data, blood samples were measured using a Lactate Pro V2; temperature and heart rate data was also collected. RESULTS Pointwise mutual information and neural networks are used to produce a predictive model. The model shows a good correlation between the standard invasive and novel noninvasive electromagnetic wave based blood lactate measurements, with an error of 13.4% in the range of 0-12 mmol/L. CONCLUSION The work demonstrates that electromagnetic wave sensors are capable of determining blood lactate level without the need for invasive blood sampling. SIGNIFICANCE Measurement of blood metabolites, such as blood lactate, in real-time and noninvasively in hospital environments will reduce the risk of infection, increase the frequency of measurement and ensure timely intervention only when necessary. In sports, such tools will enhance training of athletes, and enable more effecting training regimes to be prescribed.
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Glasmacher SA, Bonongwe P, Stones W. Point-of-care lactate and creatinine analysis for sick obstetric patients at Queen Elizabeth Central Hospital in Blantyre, Malawi: A feasibility study. Malawi Med J 2017; 28:15-8. [PMID: 27217912 DOI: 10.4314/mmj.v28i1.4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND To achieve good outcomes in critically ill obstetric patients, it is necessary to identify organ dysfunction rapidly so that life-saving interventions can be appropriately commenced. However, timely access to clinical chemistry results is problematic, even in referral institutions, in the sub-Saharan African region. Reliable point-of-care tests licensed for clinical use are now available for lactate and creatinine. AIM We aimed to assess whether implementation of point-of-care testing for lactate and creatinine is feasible in the obstetric unit at the Queen Elizabeth Central Hospital (QECH) in Blantyre, Malawi, by obtaining the opinions of clinical staff on the use of these tests in practice. METHODS During a two-month evaluation period nurse-midwives, medical interns, clinical officers, registrars, and consultants were given the opportunity to use StatStrip® and StatSensor® (Nova Biomedical, Waltham, USA) devices, for lactate and creatinine estimation, as part of their routine clinical practice in the obstetric unit. They were subsequently asked to complete a short questionnaire. RESULTS Thirty-seven questionnaires were returned by participants: 22 from nurse-midwives and the remainder from clinicians. The mean satisfaction score for the devices was 7.6/10 amongst clinicians and 8.0/10 amongst nurse-midwives. The majority of participants stated that the obstetric high dependency unit (HDU) was the most suitable location for the devices. For lactate, 31 participants strongly agreed that testing should be continued and 24 strongly agreed that it would influence patient management. For creatinine, 29 strongly agreed that testing should be continued and 28 strongly agreed that it would influence their patient management. Twenty participants strongly agreed that they trust point-of-care devices. CONCLUSIONS Point-of-care clinical chemistry testing was feasible, practical, and well received by staff, and was considered to have a useful role to play in the clinical care of sick obstetric patients at this referral centre.
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Affiliation(s)
- S A Glasmacher
- School of Medicine University of St Andrews United Kingdom
| | - P Bonongwe
- Department of Obstetrics and Gynaecology, Queen Elizabeth Central Hospital, Blantyre, Malawi
| | - W Stones
- School of Medicine University of St Andrews United Kingdom; Department of Obstetrics and Gynaecology, College of Medicine, University of Malawi, Blantyre, Malawi; School of Public Health and Family Medicine, College of Medicine, University of Malawi, Blantyre, Malawi
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Abstract
Prehospital care providers are tasked with the delivery of time-sensitive care, and emergency medical services (EMS) systems must match patients to appropriate clinical resources. Modern systems are uniquely positioned to recognize and treat patients with sepsis. Interventions such as administration of intravenous fluid and transporting patients to the appropriate level of definitive care are linked to improved patient outcomes. As EMS systems refine their protocols for the recognition and stabilization of patients with suspected or presumed sepsis, EMS providers need to be educated about the spectrum of sepsis-related presentations and treatment strategies need to be standardized.
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Affiliation(s)
- Jerrilyn Jones
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca Street, 6th floor, Suite 200, Baltimore, MD 21201, USA.
| | - Benjamin J Lawner
- Department of Emergency Medicine, University of Maryland School of Medicine, 110 S. Paca Street, 6th floor, Suite 200, Baltimore, MD 21201, USA; Baltimore City Fire Department, Emergency Medical Services, 3500 West Northern Parkway, Baltimore, MD 21215, USA
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Handheld Capillary Blood Lactate Analyzer as an Accessible and Cost-Effective Prognostic Tool for the Assessment of Death and Heart Failure Occurrence during Long-Term Follow-Up. DISEASE MARKERS 2017; 2016:5965782. [PMID: 28115788 PMCID: PMC5225332 DOI: 10.1155/2016/5965782] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Revised: 11/26/2016] [Accepted: 12/06/2016] [Indexed: 01/05/2023]
Abstract
Impact of tissue lactate accumulation on prognosis after acute myocardial infarction (AMI) is biased. The study aimed to assess the prognostic role of lactate concentration (LC) in patients with AMI during one year of follow-up. 145 consecutive patients admitted due to AMI were enrolled. The data on the frequency of endpoint occurrence (defined as I, death; II, heart failure (HF); and III, recurrent myocardial infarction (re-MI)) were collected. The patients were divided into group A (LC below the cut-off value) and group B (LC above the cut-off value) for the endpoints according to receiver operating characteristic (ROC) analysis. The cumulative survival rate was 99% in group I-A and 85% in group I-B (p = 0.0004, log-rank test). The HF-free survival rate was 95% in group II-A and 82% in group II-B (p = 0.0095, log-rank test). The re-MI-free survival rate did not differ between groups. A multivariate Cox analysis showed a statistically significant influence of LC on death [Hazard Ratio (HR): 1.41, 95% Confidence Interval (CI) (1.13–1.76), and p = 0.002] and HF [HR: 1.21, 95% CI (1.05–1.4), and p = 0.007] with no impact on re-MI occurrence. LC in capillary blood may be considered a useful prognostic marker of late-onset heart failure and death after AMI.
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Baig MA, Shahzad H, Hussain E, Mian A. Validating a point of care lactate meter in adult patients with sepsis presenting to the emergency department of a tertiary care hospital of a low- to middle-income country. World J Emerg Med 2017; 8:184-189. [PMID: 28680514 DOI: 10.5847/wjem.j.1920-8642.2017.03.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Timely identification of high blood lactate levels in septic patients may allow faster detection of those patients requiring immediate resuscitation. Point-of-care (POC) testing is being increasingly utilized in the emergency department (ED). We examined the accuracy and time-saving effect of a handheld POC lactate device for the measurement of fingertip and whole blood lactate as compared with reference laboratory blood testing in septic ED patients. METHODS A convenience sample of adult ED patients receiving serum lactate testing were enrolled prospectively in the ED of a multidisciplinary tertiary care hospital serving the population of one of the major cities of Pakistan. Participants underwent fingertip POC lactate measurement with a portable device simultaneous whole blood sampling for analysis by both the POC lactate device and standard laboratory method. Lactate measurements were compared by intraclass correlation (ICC) and Bland and Altman plots. RESULTS Forty-three septic patients were included in the study. The fingertip POC & whole blood POC lactate measurements each correlated tightly with the reference method (ICC=0.93 & ICC=0.92, respectively). Similarly at 6 hours, the fingertip POC & whole blood POC lactate measurements demonstrated satisfactory correlation with the reference method (ICC=0.95 & ICC=0.97, respectively). CONCLUSION Fingertip POC lactate measurement is an accurate method to determine lactate levels in septic ED patients.
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Affiliation(s)
- Muhammad Akbar Baig
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Hira Shahzad
- Department of Medicine, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Erfan Hussain
- Adult Critical Care Services, Aga Khan University Hospital, Karachi 74800, Pakistan
| | - Asad Mian
- Department of Emergency Medicine, Pediatrics and Child Health, Aga Khan University Hospital, Karachi 74800, Pakistan
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Collange O, Garcia V, Kindo M, Meyer N, Lavaux T, Mertes PM, Joshi GP, Diemunsch P. Comparison of capillary and arterial lactate levels in patients with shock. Anaesth Crit Care Pain Med 2016; 36:157-162. [PMID: 27867135 DOI: 10.1016/j.accpm.2016.08.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 08/26/2016] [Accepted: 08/31/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Several guidelines recommend point-of-care lactate measurements for therapeutic decision-making in patients with shock. The aim of the study was to validate capillary lactate measurements with a bedside micromethod in patients with shock. STUDY DESIGN Prospective observational study. PATIENTS AND MEASUREMENTS Capillary lactate levels measured by a micromethod (CAPI) and arterial lactate levels measured by a standard laboratory method (ARTs) were simultaneously and repeatedly assayed in consecutive ICU patients with shock. The validity and clinical acceptability of the CAPI method was assessed from its reproducibility, the arterio-capillary lactate difference (ACLD) and conventional diagnostic indicators. MAIN RESULTS Lactate measurements were available for 139 time-points in 37 patients. CAPI values correlated well with ARTs values (intraclass coefficient correlation: r2=0.92, P<0.001). CAPI had a sensitivity of 98%, a specificity of 36%, an accuracy of 88% and a positive predictive value of 89% to detect lactate values≥2mmol/L (P<0.0001). The mean bias between the two methods (ACLD: 0.56±2.21mmol/L) was mainly due to higher lactate concentration in capillary blood. CONCLUSION CAPI was correctly correlated to ARTs. The bias between the two methods is probably acceptable for triage purpose. Patients with elevated capillary lactate or in shock should be monitored with atrial-based lactate.
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Affiliation(s)
- Olivier Collange
- Pôle d'anesthésie, réanimation chirurgicale, Samu-Smur, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, institut de physiologie, fédération de médecine translationnelle de Strasbourg (FMTS), faculté de médecine de Strasbourg, 67000 Strasbourg, France.
| | - Vincent Garcia
- Pôle d'anesthésie, réanimation chirurgicale, Samu-Smur, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
| | - Michel Kindo
- Département de chirurgie cardiovasculaire, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Nicolas Meyer
- Département de Santé publique, groupe méthode en recherche clinique, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Thomas Lavaux
- Laboratoire de biochimie et biologie moléculaire, hôpitaux universitaires de Strasbourg, 67000 Strasbourg, France
| | - Paul Michel Mertes
- Pôle d'anesthésie, réanimation chirurgicale, Samu-Smur, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France; EA 3072, institut de physiologie, fédération de médecine translationnelle de Strasbourg (FMTS), faculté de médecine de Strasbourg, 67000 Strasbourg, France
| | - Girish P Joshi
- Department of anesthesiology and pain management, university of Texas Southwestern medical center at Dallas, Texas, USA
| | - Pierre Diemunsch
- Pôle d'anesthésie, réanimation chirurgicale, Samu-Smur, hôpitaux universitaires de Strasbourg, 1, place de l'Hôpital, 67000 Strasbourg, France
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Lightowler B, Hoswell A. Can handheld POC capillary lactate measurement be used with arterial and venous laboratory testing methods in the identification of sepsis? ACTA ACUST UNITED AC 2016. [DOI: 10.12968/jpar.2016.8.8.396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bryan Lightowler
- Trainee advanced clinical practitoner, Airedale General Hospital NHS Foundation Trust
| | - Anthony Hoswell
- Paramedic programme lead, Faculty of Health Studies, University of Bradford
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Sabat J, Gould S, Gillego E, Hariprashad A, Wiest C, Almonte S, Lucido DJ, Gave A, Leitman IM, Eiref SD. The use of finger-stick blood to assess lactate in critically ill surgical patients. Ann Med Surg (Lond) 2016; 10:41-8. [PMID: 27547397 PMCID: PMC4978218 DOI: 10.1016/j.amsu.2016.07.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 07/23/2016] [Accepted: 07/24/2016] [Indexed: 12/15/2022] Open
Abstract
Background Using finger-stick capillary blood to assess lactate from the microcirculation may have utility in treating critically ill patients. Our goals were to determine how finger-stick capillary lactate correlates with arterial lactate levels in patients from the surgical intensive care unit, and to compare how capillary and arterial lactate trend over time in patients undergoing resuscitation for shock. Methods Capillary whole blood specimens were obtained from finger-sticks using a lancet, and assessed for lactate via a handheld point-of-care device as part of an “investigational use only” study. Comparison was made to arterial blood specimens that were assessed for lactate by standard laboratory reference methods. Results 40 patients (mean age 68, mean APACHEII 18, vasopressor use 62%) were included. The correlation between capillary and arterial lactate levels was 0.94 (p < 0.001). Capillary lactate measured slightly higher on average than paired arterial values, with a mean difference 0.99 mmol/L. In patients being resuscitated for septic and hemorrhagic shock, capillary and arterial lactate trended closely over time: rising, peaking, and falling in tandem. Clearance of capillary and arterial lactate mirrored clinical improvement, normalizing in all patients except two that expired. Conclusion Finger-stick capillary lactate both correlates and trends closely with arterial lactate in critically ill surgical patients, undergoing resuscitation for shock. Finger-stick capillary lactate correlates with blood gas and core lab values. Capillary lactate trends closely over time with arterial lactate. Rising or falling capillary lactate reflects the adequacy of global perfusion. Capillary lactate measurements require a fraction of the time and blood to process. Preliminary results imply capillary lactate may be used in lieu of invasive methods.
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Affiliation(s)
- Joseph Sabat
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Scott Gould
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Ezra Gillego
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Anita Hariprashad
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Christine Wiest
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Shailyn Almonte
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - David J Lucido
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Asaf Gave
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - I Michael Leitman
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
| | - Simon D Eiref
- Division of Surgical-Critical Care, Department of Surgery, Icahn School of Medicine at Mount Sinai Beth Israel, First Avenue and 16th Street, New York, NY 10003, USA
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Boland LL, Hokanson JS, Fernstrom KM, Kinzy TG, Lick CJ, Satterlee PA, LaCroix BK. Prehospital Lactate Measurement by Emergency Medical Services in Patients Meeting Sepsis Criteria. West J Emerg Med 2016; 17:648-55. [PMID: 27625735 PMCID: PMC5017855 DOI: 10.5811/westjem.2016.6.30233] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/24/2016] [Accepted: 06/06/2016] [Indexed: 12/29/2022] Open
Abstract
Introduction We aimed to pilot test the delivery of sepsis education to emergency medical services (EMS) providers and the feasibility of equipping them with temporal artery thermometers (TATs) and handheld lactate meters to aid in the prehospital recognition of sepsis. Methods This study used a convenience sample of prehospital patients meeting established criteria for sepsis. Paramedics received education on systemic inflammatory response syndrome (SIRS) criteria, were trained in the use of TATs and hand-held lactate meters, and enrolled patients who had a recent history of infection, met ≥ 2 SIRS criteria, and were being transported to a participating hospital. Blood lactate was measured by paramedics in the prehospital setting and again in the emergency department (ED) via usual care. Paramedics entered data using an online database accessible at the point of care. Results Prehospital lactate values obtained by paramedics ranged from 0.8 to 9.8 mmol/L, and an elevated lactate (i.e. ≥ 4.0) was documented in 13 of 112 enrolled patients (12%). The unadjusted correlation of prehospital and ED lactate values was 0.57 (p< 0.001). The median interval between paramedic assessment of blood lactate and the electronic posting of the ED-measured lactate value in the hospital record was 111 minutes. Overall, 91 patients (81%) were hospitalized after ED evaluation, 27 (24%) were ultimately diagnosed with sepsis, and 3 (3%) died during hospitalization. Subjects with elevated prehospital lactate were somewhat more likely to have been admitted to the intensive care unit (23% vs 15%) and to have been diagnosed with sepsis (38% vs 22%) than those with normal lactate levels, but these differences were not statistically significant. Conclusion In this pilot, EMS use of a combination of objective SIRS criteria, subjective assessment of infection, and blood lactate measurements did not achieve a level of diagnostic accuracy for sepsis that would warrant hospital prenotification and committed resources at a receiving hospital based on EMS assessment alone. Nevertheless, this work provides an early model for increasing EMS awareness and the implementation of novel devices that may enhance the prehospital assessment for sepsis. Additional translational research studies with larger numbers of patients and more robust methods are needed.
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Affiliation(s)
- Lori L Boland
- Allina Health, Division of Applied Research, Minneapolis, Minnesota; Allina Health, Emergency Medical Services, St. Paul, Minnesota
| | - Jonathan S Hokanson
- Abbott Northwestern Hospital, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Karl M Fernstrom
- Allina Health, Division of Applied Research, Minneapolis, Minnesota
| | - Tyler G Kinzy
- Allina Health, Division of Applied Research, Minneapolis, Minnesota
| | - Charles J Lick
- Allina Health, Emergency Medical Services, St. Paul, Minnesota
| | - Paul A Satterlee
- Allina Health, Emergency Medical Services, St. Paul, Minnesota; Abbott Northwestern Hospital, Department of Emergency Medicine, Minneapolis, Minnesota
| | - Brian K LaCroix
- Allina Health, Emergency Medical Services, St. Paul, Minnesota
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Bouzat P, Schilte C, Vinclair M, Manhes P, Brun J, Bosson JL, Payen JF. Capillary lactate concentration on admission of normotensive trauma patients: a prospective study. Scand J Trauma Resusc Emerg Med 2016; 24:82. [PMID: 27267942 PMCID: PMC4896037 DOI: 10.1186/s13049-016-0272-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 05/24/2016] [Indexed: 11/18/2022] Open
Abstract
Background Elevated serum blood lactate is an indicator of on-going bleeding in severe trauma patients. Point-of-care (POC) capillary lactate measurement devices may be useful to rapidly assess lactate concentration at the bedside. The aim of this study was to test the diagnostic performance of capillary lactate to predict significant transfusion in normotensive trauma patients. Methods We conducted a prospective observational study in one level-I trauma centre. From August 2011 to February 2013, 120 consecutive adult patients with systolic blood pressure (SBP) higher than 90 mmHg were included. Capillary lactate was measured on admission in the trauma bay. The primary outcome was defined as a significant transfusion within the first 48 h. Diagnostic performance was determined using receiver operating characteristic (ROC) curve analysis. We also tested the agreement between capillary lactate and blood lactate concentrations using Bland and Altman analysis. Results Of the 120 normotensive trauma patients, 30 (25 %) required at least one unit of packed red blood cells (RBC) and 12 (10 %) patients received at least four RBC within the first 48 h. All patients with significant RBC transfusion had capillary lactate higher than 3.5 mmol/l. The area under the ROC curve of capillary lactate on admission to predict transfusion of at least 4 RBC units was 0.68 [95 % CI 0.58 – 0.78]. The average bias between capillary and blood lactate measurements was 2.4 mmol/l with a standard deviation of 3.0 mmol/l (n = 60 patients). Conclusions Although a significant association was found between POC lactate concentration and transfusion requirements, the diagnostic performance of capillary lactate measurements was poor. Due to large disagreement between capillary lactate and blood lactate, capillary lactate cannot be considered in the clinical setting. Trial registration ClinicalTrials.gov, No. NCT01793428. Electronic supplementary material The online version of this article (doi:10.1186/s13049-016-0272-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pierre Bouzat
- Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France. .,University Grenoble Alpes, F-38000, Grenoble, France. .,INSERM U1216, F-38000, Grenoble, France.
| | - Clotilde Schilte
- Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France
| | - Marc Vinclair
- Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France
| | - Pauline Manhes
- Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France
| | - Julien Brun
- Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France
| | - Jean-Luc Bosson
- Centre d'investigation clinique, CHU Grenoble Alpes, F-38000, Grenoble, France
| | - Jean-François Payen
- Pôle Anesthesie Reanimation, CHU Grenoble Alpes, F-38000, Grenoble, France.,University Grenoble Alpes, F-38000, Grenoble, France.,INSERM U1216, F-38000, Grenoble, France
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Khan M, Brown N, Mian AI. Point-of-care lactate measurement in resource-poor settings. Arch Dis Child 2016; 101:297-8. [PMID: 26582825 DOI: 10.1136/archdischild-2015-309484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Accepted: 10/23/2015] [Indexed: 11/03/2022]
Affiliation(s)
- Muhammad Khan
- Department of Emergency Medicine, Aga Khan University (AKU), Karachi, Pakistan
| | - Nick Brown
- Department of Paediatric Medicine, Salisbury District Hospital, Wiltshire, UK Department of Child Health and Epidemiology, AKU, Karachi, Pakistan
| | - Asad I Mian
- Department of Emergency Medicine, Paediatrics and Child Health, AKU, Karachi, Pakistan
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Lactate Assay Application Using a New Comprehensive Bioelectronic System for Point-of-Care Applications. POINT OF CARE 2016. [DOI: 10.1097/poc.0000000000000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Predicting blood transfusion using automated analysis of pulse oximetry signals and laboratory values. J Trauma Acute Care Surg 2016; 79:S175-80. [PMID: 26406427 DOI: 10.1097/ta.0000000000000738] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Identification of hemorrhaging trauma patients and prediction of blood transfusion needs in near real time will expedite care of the critically injured. We hypothesized that automated analysis of pulse oximetry signals in combination with laboratory values and vital signs obtained at the time of triage would predict the need for blood transfusion with accuracy greater than that of triage vital signs or pulse oximetry analysis alone. METHODS Continuous pulse oximetry signals were recorded for directly admitted trauma patients with abnormal prehospital shock index (heart rate [HR] / systolic blood pressure) of 0.62 or greater. Predictions of blood transfusion within 24 hours were compared using Delong's method for area under the receiver operating characteristic (AUROC) curves to determine the optimal combination of triage vital signs (prehospital HR + systolic blood pressure), pulse oximetry features (40 waveform features, O2 saturation, HR), and laboratory values (hematocrit, electrolytes, bicarbonate, prothrombin time, international normalization ratio, lactate) in multivariate logistic regression models. RESULTS We enrolled 1,191 patients; 339 were excluded because of incomplete data; 40 received blood within 3 hours; and 14 received massive transfusion. Triage vital signs predicted need for transfusion within 3 hours (AUROC, 0.59) and massive transfusion (AUROC, 0.70). Pulse oximetry for 15 minutes predicted transfusion more accurately than triage vital signs for both time frames (3-hour AUROC, 0.74; p = 0.004) (massive transfusion AUROC, 0.88; p < 0.001). An algorithm including triage vital signs, pulse oximetry features, and laboratory values improved accuracy of transfusion prediction (3-hour AUROC, 0.84; p < 0.001) (massive transfusion AUROC, 0.91; p < 0.001). CONCLUSION Automated analysis of triage vital signs, 15 minutes of pulse oximetry signals, and laboratory values predicted use of blood transfusion during trauma resuscitation more accurately than triage vital signs or pulse oximetry analysis alone. Results suggest automated calculations from a noninvasive vital sign monitor interfaced with a point-of-care laboratory device may support clinical decisions by recognizing patients with hemorrhage sufficient to need transfusion. LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.
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Purcarea A, Bourgarit A, Sovaila A, Ghiura C, Diemunsch P, Andres E. Brief report: Serial capillary lactate measurement predict the evolution of early sepsis. J Med Life 2016; 9:74-78. [PMID: 27974919 PMCID: PMC5152613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE In intensive care settings, blood lactate level measurement proved to be an excellent predictor of outcomes. In patients requiring less urgent treatment, the arterial blood lactate is less sensitive and its usefulness remains to be proven. Capillary blood lactate dosing, an emergent point-of-care technique readily available should be more sensitive to changes in these settings. METHOD prospective, observational, monocentric study conducted in a polyvalent internal medicine ward in a French University Hospital. The inclusion criteria were the existence of new symptoms of abrupt onset in an otherwise stable patient. All the patients had a point of care measurement of baseline capillary and venous lactate levels (EDGE, ApexBio) and standardized control before any therapeutic means were initiated. A follow-up test was performed once again within 12 to 36 hours. All the patients received standard medical care adapted to their condition. The primary outcomes were considered dying within 30 days or requiring intensive care or invasive therapeutic procedures. RESULTS 13 patients were analyzed. Seven patients reached the composite outcome with 3 deaths. The superimposed complication proved to be infectious in every case. The median lactate levels were at baseline (mmol/ l): capillary Mc0=5.2(2.16), venous Mv0=2.3(2.0) and arterial Ma0=1.8(1.7) and at follow-up (mmol/ l) capillary: Mc1=3.3(1.1), venous Mv1=1.8(1.8) and arterial Ma1=1.3(0.7). In nonparametric analysis, the absence of normalization of capillary lactate at follow-up was correlated well with poor outcomes (p=.05). This was not the case of arterial or venous lactate measurements. The positive lactate clearance was present in the majority of patients (83.3%) but it did not predict the outcomes (p=.435) and there was no correlation between the baseline lactate and the clinical outcome (p>.05). CONCLUSION In non intensive care settings, capillary lactate level could be a more sensitive method than the classical lactate measurement for predicting the outcomes of acute conditions, especially infectious. A persistently high lactate level rather than its initial value or clearance seems to correlate better with poorer outcomes. ABBREVIATIONS SSC = Surviving sepsis campaign, ED = Emergency department, ICU = intensive care unit, , POC = Point of care, ICC = inter class coefficient.
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Affiliation(s)
- A Purcarea
- Internal Medicine, “Hopital Civil” Hospital, Strasbourg, France,Internal Medicine Department, Internist.ro, Brasov, Romania
| | - A Bourgarit
- Internal Medicine Department, Internist.ro, Brasov, Romania,Internal Medicine, “Hautepierre” Hospital, Strasbourg, France
| | - A Sovaila
- Internal Medicine Department, Internist.ro, Brasov, Romania,Internal Medicine, “Hautepierre” Hospital, Strasbourg, France
| | - C Ghiura
- Internal Medicine, “Hopital Civil” Hospital, Strasbourg, France
| | - P Diemunsch
- Anesthesiology, Critical Care and Prehospital Emergency Medicine, Strasbourg, France
| | - E Andres
- Internal Medicine, “Hopital Civil” Hospital, Strasbourg, France
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Lactate point-of-care testing for acidosis: Cross-comparison of two devices with routine laboratory results. Pract Lab Med 2015; 4:41-49. [PMID: 28856192 PMCID: PMC5574518 DOI: 10.1016/j.plabm.2015.12.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 12/18/2015] [Accepted: 12/22/2015] [Indexed: 11/20/2022] Open
Abstract
Objectives Lactate is a major parameter in medical decision making. During labor, it is an indicator for fetal acidosis and immediate intervention. In the Emergency Department (ED), rapid analysis of lactate/blood gas is crucial for optimal patient care. Our objectives were to cross-compare-for the first time-two point-of-care testing (POCT) lactate devices with routine laboratory results using novel tight precision targets and evaluate different lactate cut-off concentrations to predict metabolic acidosis. Design and methods Blood samples from the delivery room (n=66) and from the ED (n=85) were analyzed on two POCT devices, the StatStrip-Lactate (Nova Biomedical) and the iSTAT-1 (CG4+ cassettes, Abbott), and compared to the routine laboratory analyzer (ABL-735, Radiometer). Lactate concentrations were cross-compared between these analyzers. Results The StatStrip correlated well with the ABL-735 (R=0.9737) and with the iSTAT-1 (R=0.9774) for lactate in umbilical cord blood. Lactate concentrations in ED samples measured on the iSTAT-1 and ABL-735 showed a correlation coefficient of R=0.9953. Analytical imprecision was excellent for lactate and pH, while for pO2 and pCO2 the coefficient of variation was relatively high using the iSTAT-1. Conclusion Both POCT devices showed adequate analytical performance to measure lactate. The StatStrip can indicate metabolic acidosis in 1 μl blood and will be implemented at the delivery room.
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Ismail F, Mackay WG, Kerry A, Staines H, Rooney KD. The accuracy and timeliness of a Point Of Care lactate measurement in patients with Sepsis. Scand J Trauma Resusc Emerg Med 2015; 23:68. [PMID: 26383239 PMCID: PMC4573294 DOI: 10.1186/s13049-015-0151-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2015] [Accepted: 09/04/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The aims of this study were to a) compare the lactate measurement of a Point of Care (POC) handheld device to near patient blood gas analysers, and b) determine the differential reporting times between the analysers. METHODS A two-staged study; method comparison and prospective observational stages, was conducted. For the first stage, blood samples were analysed on the i-STAT handheld device and the near patient blood gas analysers (GEM 4000 and OMNI S). Results were compared using Pearson correlation coefficient and Bland-Altman tests. For the second stage, we examined the differential reporting times of the POC device compared to the near patient blood gas analysers in two Scottish hospitals. Differential reporting times were assessed using Mann-Whitney test and descriptive statistics were reported with quartiles. RESULTS Highly significant Pearson correlation coefficients (0.999 and 0.993 respectively) were found between i-STAT and GEM 4000 and OMNI S. The Bland-Altman agreement method showed bias values of -0.03 and -0.24, between i-STAT and GEM 4000 and OMNI S respectively. Median time from blood draw to i-STAT lactate results was 5 min (Q1-Q3 5-7). Median time from blood draw to GEM 4000 lactate results was 10 min (Q1-Q3 7.75-13). Median time from blood draw to OMNIS lactate results was 11 min (Q1-Q3 8-22). The i-STAT was significantly quicker than both the GEM 4000 and the OMNIS (each p-value < 0.001). In addition, 18 of our study samples were sent to the central laboratory for analysis due to a defect in the lactate module of OMNI S. The median time for these samples from blood draw to availability of the central laboratory results at the clinical area was 133 min. CONCLUSIONS The POC handheld device produced accurate, efficient and timely lactate measurements with the potential to influence clinical decision making sooner.
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Affiliation(s)
- Fatene Ismail
- Institute of Healthcare Policy and Practice, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK
| | - William G Mackay
- Institute of Healthcare Associated Infection, University of the West of Scotland and University Hospital Crosshouse, Kilmarnock, UK
| | - Andrew Kerry
- Biochemistry Laboratory, Royal Alexandra Hospital, Paisley, UK
| | | | - Kevin D Rooney
- Institute of Healthcare Policy and Practice, School of Health, Nursing and Midwifery, University of the West of Scotland, Paisley, UK.
- Intensive Care Unit, Royal Alexandra Hospital and Institute of Healthcare Policy and Practice, University of the West of Scotland, Paisley, UK.
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Otu A, Elston J, Nsutebu E. Sepsis in Africa: practical steps to stem the tide. Pan Afr Med J 2015; 21:323. [PMID: 26587170 PMCID: PMC4633776 DOI: 10.11604/pamj.2015.21.323.6462] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Accepted: 03/03/2015] [Indexed: 11/11/2022] Open
Affiliation(s)
- Akaninyene Otu
- Department of Internal Medicine, University of Calabar,Nigeria
| | - James Elston
- Public Health, Yorkshire Deanery, Leeds, United Kingdom
| | - Emmanuel Nsutebu
- Tropical and Infectious Diseases Unit, Royal Liverpool University Hospital Trust, Liverpool, United Kingdom
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Contenti J, Corraze H, Lemoël F, Levraut J. Effectiveness of arterial, venous, and capillary blood lactate as a sepsis triage tool in ED patients. Am J Emerg Med 2015; 33:167-72. [DOI: 10.1016/j.ajem.2014.11.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Accepted: 11/01/2014] [Indexed: 11/16/2022] Open
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Abstract
A variety of point-of-care monitors for the measurement of hematocrit, hemoglobin, blood gas with electrolytes, and lactate can be used also in the prehospital setting for optimizing and individualizing trauma resuscitation. Point-of-care coagulation testing with activated prothrombin test, prothrombin test, and activated coagulation/clotting time tests is available for prehospital use. Although robust, battery driven, and easy to handle, many devices lack documentation for use in prehospital care. Some of the devices correspond poorly to corresponding laboratory analyses in acute trauma coagulopathy and at lower hematocrits. In trauma, viscoelastic tests such as rotational thromboelastometry and thromboelastography can rapidly detect acute trauma coagulopathy and give an overall dynamic picture of the hemostatic system and the interaction between its different components: coagulation activation, fibrin polymerization, fibrin platelet interactions within the clot, and fibrinolysis. Rotational thromboelastometry is shock resistant and has the potential to be used outside the hospital setting to guide individualized coagulation factor and blood component therapies. Sonoclot and Rheorox are two small viscoelastic instruments with one-channel options, but with less documentation. The point-of-care market for coagulation tests is quickly expanding, and new devices are introduced all the time. Still they should be better adopted to prehospital conditions, small, robust, battery charged, and rapid and use small sample volumes and whole blood.
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Singer AJ, Taylor M, LeBlanc D, Williams J, Thode HC. ED bedside point-of-care lactate in patients with suspected sepsis is associated with reduced time to iv fluids and mortality. Am J Emerg Med 2014; 32:1120-4. [PMID: 25082597 DOI: 10.1016/j.ajem.2014.06.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 06/23/2014] [Accepted: 06/25/2014] [Indexed: 10/25/2022] Open
Abstract
OBJECTIVE Early recognition and treatment of sepsis improves outcomes. We determined the effects of bedside point-of-care (POC) lactate measurement on test turnaround time, time to administration of IV fluids and antibiotics, mortality, and ICU admissions in adult ED patients with suspected sepsis. We hypothesized that bedside lactate POC testing would reduce time to IV fluids and antibiotics. METHODS We compared 80 ED patients with suspected sepsis and a lactate level of 2 mmol/L or greater before and 80 similar patients after introduction of POC lactate measurements. Groups were compared with Χ(2) and Mann Whitney U tests. A sample size of 80 patients in each group had 85% power to detect a 30-minute difference in time to IV fluids or antibiotics. RESULTS Study groups were similar in age, gender, baseline lactate levels, sepsis severity, and Sequential Organ Failure Assessment (SOFA) scores. Introduction of POC lactate was associated with significant reductions in test turnaround time (34 [26-55] vs. 122 [82-149] minutes; P < 0.001), time to IV fluids (55 [34-83] vs. 71 [42-110] minutes; P = 0.03), mortality (6% vs. 19%; P = 0.02), and ICU admissions (33% vs. 51%, P = 0.02), but not time to IV antibiotics (89 [54-156] vs. 88 [60-177] minutes; P = 0.35). CONCLUSIONS Implementation of bedside POC lactate measurement in adult ED patients with suspected sepsis reduces time to test results and time to administration of IV fluids but not antibiotics. A significant reduction in mortality and ICU admissions was also demonstrated, which is likely due, at least in part, to POC testing.
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Affiliation(s)
- Adam J Singer
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY.
| | - Maria Taylor
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
| | - Debra LeBlanc
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
| | - Justin Williams
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
| | - Henry C Thode
- Department of Emergency Medicine, Stony Brook University, Stony Brook, NY
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Abstract
INTRODUCTION Lactate measurement has been used to identify critical medical illness and initiate early treatment strategies. The prehospital environment offers an opportunity for very early identification of critical illness and commencement of care. HYPOTHESIS The investigators hypothesized that point-of-care lactate measurement in the prehospital aeromedical environment would: (1) identify medical patients with high mortality; (2) influence fluid, transfusion, and intubation; and (3) increase early central venous catheter (CVC) placement. METHODS Critically ill, medical, nontrauma patients who were transported from September 2007 through February 2009 by University of Massachusetts (UMass) Memorial LifeFlight, a university-based emergency medical helicopter service, were eligible for enrollment. Patients were prospectively randomized to receive a fingerstick whole-blood lactate measurement on an alternate-day schedule. Flight crews were not blinded to results. Flight crews were asked to inform the receiving attending physician of the results. The primary endpoint was the ability of a high, prehospital lactate value [> 4 millimoles per liter (mmol/L)] to identify mortality. Secondary endpoints included differences in post-transport fluid, transfusion, and intubation, and decrease in time to central venous catheter (CVC) placement. Categorical variables were compared between groups by Fisher's Exact Test, and continuous variables were compared by t-test. RESULTS Patients (N = 59) were well matched for age, gender, and acuity. In the lactate cohort (n = 20), mean lactate was 7 mmol/L [Standard error of the mean, SEM = 1]. Initial analysis revealed that prehospital lactate levels of ≥ 4 mmol/L did show a trend toward higher mortality with an odds ratio of 2.1 (95% CI, 0.3-13.8). Secondary endpoints did not show a statistically significant change in management between the lactate and non lactate groups. There was a trend toward decreased time to post-transport CVC in the non lactate faction. CONCLUSION Prehospital aeromedical point-of-care lactate measurement levels ≥ 4 mmol/L may help stratify mortality. Further investigation is needed, as this is a small, limited study. The initial analysis did not find a significant change in post-transport management.
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Hawkes M, Conroy AL, Opoka RO, Namasopo S, Liles WC, John CC, Kain KC. Performance of point-of-care diagnostics for glucose, lactate, and hemoglobin in the management of severe malaria in a resource-constrained hospital in Uganda. Am J Trop Med Hyg 2014; 90:605-8. [PMID: 24591431 DOI: 10.4269/ajtmh.13-0689] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Severe malaria is frequently managed without access to laboratory testing. We report on the performance of point-of-care tests used to guide the management of a cohort of 179 children with severe malaria in a resource-limited Ugandan hospital. Correlation coefficients between paired measurements for glucose (i-STAT and One Touch Ultra), lactate (i-STAT and Lactate Scout), and hemoglobin (Hb; laboratory and i-STAT) were 0.86, 0.85, and 0.73, respectively. The OneTouch Ultra glucometer readings deviated systematically from the i-STAT values by +1.7 mmol/L. Lactate Scout values were systematically higher than i-STAT by +0.86 mmol/L. Lactate measurements from either device predicted subsequent mortality. Hb estimation by the i-STAT instrument was unbiased, with upper and lower limits of agreement of -34 and +34 g/L, and it was 91% sensitive and 89% specific for the diagnosis of severe anemia (Hb < 50 g/L). New commercially available bedside diagnostic tools, although imperfect, may expedite clinical decision-making in the management of critically ill children in resource-constrained settings.
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Affiliation(s)
- Michael Hawkes
- Division of Infectious Diseases, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine and Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda; Department of Paediatrics, Jinja Regional Referral Hospital, Jinja, Uganda; Department of Medicine, University of Washington, Seattle, Washington; Division of Global Pediatrics, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; Sandra A. Rotman Laboratories, Sandra Rotman Centre for Global Health, Toronto, Ontario, Canada; Tropical Disease Unit, University Health Network-Toronto General Hospital, Toronto, Ontario, Canada
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Kirby K. Pre-hospital lactate testing in the identification of patients with sepsis: a review of the literature. ACTA ACUST UNITED AC 2013. [DOI: 10.12968/jpar.2013.5.12.698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kim Kirby
- paramedic for South Western Ambulance Service NHS Foundation Trust
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Gultepe E, Green JP, Nguyen H, Adams J, Albertson T, Tagkopoulos I. From vital signs to clinical outcomes for patients with sepsis: a machine learning basis for a clinical decision support system. J Am Med Inform Assoc 2013; 21:315-25. [PMID: 23959843 DOI: 10.1136/amiajnl-2013-001815] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To develop a decision support system to identify patients at high risk for hyperlactatemia based upon routinely measured vital signs and laboratory studies. MATERIALS AND METHODS Electronic health records of 741 adult patients at the University of California Davis Health System who met at least two systemic inflammatory response syndrome criteria were used to associate patients' vital signs, white blood cell count (WBC), with sepsis occurrence and mortality. Generative and discriminative classification (naïve Bayes, support vector machines, Gaussian mixture models, hidden Markov models) were used to integrate heterogeneous patient data and form a predictive tool for the inference of lactate level and mortality risk. RESULTS An accuracy of 0.99 and discriminability of 1.00 area under the receiver operating characteristic curve (AUC) for lactate level prediction was obtained when the vital signs and WBC measurements were analysed in a 24 h time bin. An accuracy of 0.73 and discriminability of 0.73 AUC for mortality prediction in patients with sepsis was achieved with only three features: median of lactate levels, mean arterial pressure, and median absolute deviation of the respiratory rate. DISCUSSION This study introduces a new scheme for the prediction of lactate levels and mortality risk from patient vital signs and WBC. Accurate prediction of both these variables can drive the appropriate response by clinical staff and thus may have important implications for patient health and treatment outcome. CONCLUSIONS Effective predictions of lactate levels and mortality risk can be provided with a few clinical variables when the temporal aspect and variability of patient data are considered.
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Affiliation(s)
- Eren Gultepe
- Department of Biomedical Engineering, University of California, Davis, California, USA
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