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
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)
-> 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
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
After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.
He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE. He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.
His one great achievement is being the father of two amazing children.
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