Resuscitation Literature Summaries
Jansen, T.C. et al (2010) “Early lactate guided therapy in ICU patients: a multicenter, open-label, randomized controlled trial” Am J Respir Crit Care Med; 182:752-761
- goal = to see whether targeted resuscitation to decrease lactate improves outcome
- MRCT
- n = 348
- inclusion criteria: adults with lactate > 3.0mEq/L in ICU
- intervention: standard resuscitation vs standard resuscitation + lactate measurement -> goal to decrease lactate by 20% in 2 hours (resuscitated for 8 hours).
- primary end point: inhospital mortality
- secondary endpoints: ICU and 28 day mortality, resuscitation end points, APACHE II and SOFA, CRT, vasopressors, inotropes, MV, ICU and hospital stay. -> no significant difference in 28 day mortality -> significant difference in hazard ratio for in-hospital mortality (P = 0.006) -> decreased ICU mortality (P = 0.037)
- weird stuff: -> if lactate did not decrease a vasodilator was started
Abramson, D et al (1993) “Lactate clearance and survival following injury” Journal of Trauma 35(4):584-8
- n = 76
- single centre
- prospective study
- multiple trauma patients admitted from ICU/OR
- lactate and oxygen transport levels recorded at 8, 16, 24, 36 and 48 hours
- patients analysed in terms of: survival vs non-survival interms of…
(1) lactate clearance to normal (2) haemodynamic optimization (3) injury severity score (ISS) (4) ICU LOS (5) admission BP
-> no differences in CI, DO2, VO2 or ISS -> those whose lactates normalized within 24 hours survived -> if lactate normalised within 24-48 hours: survival = 75% -> if lactate did not clear until 48 hours: survival = 13% -> conclusion = time taken to normalize serum lactate levels is important prognosticator in severely injured patients
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC
