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Lactate and lactate clearance in critically burned patients: usefulness and limitations as a resuscitation guide and as a prognostic factor.

Authors
  • Herrero De Lucas, Eva1
  • Sanchez-Sanchez, Manuel2
  • Cachafeiro Fuciños, Lucia1
  • Agrifoglio Rotaeche, Alexander1
  • Martínez Mendez, Jose Ramón3
  • Flores Cabeza, Eva1
  • Millan Estañ, Pablo1
  • García-de-Lorenzo, Abelardo1
  • 1 Servicio de Medicina Intensiva. Hospital Universitario La Paz-Cantoblanco-CarlosIII/IdiPAZ. Paseo de la Castellana 261. Madrid 28046. Spain. , (Spain)
  • 2 Servicio de Medicina Intensiva. Hospital Universitario La Paz-Cantoblanco-CarlosIII/IdiPAZ. Paseo de la Castellana 261. Madrid 28046. Spain. Electronic address: [email protected] , (Spain)
  • 3 Servicio de Cirugía Plástica y Reparadora. Hospital Universitario La Paz-Cantoblanco-CarlosIII/IdiPAZ. Paseo de la Castellana 261. Madrid 28046. Spain. , (Spain)
Type
Published Article
Journal
Burns : journal of the International Society for Burn Injuries
Publication Date
Dec 01, 2020
Volume
46
Issue
8
Pages
1839–1847
Identifiers
DOI: 10.1016/j.burns.2020.06.003
PMID: 32653255
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Lactate levels to guide resuscitation in critically burned patients are controversial. The purpose of our study was to determine whether absolute lactate values or lower lactate clearance predict mortality, and whether these are useful tools in the resuscitation phase. We conducted a prospective, unicentric, observational study of a cohort of 214 burn patients admitted in the Burn Intensive Care Unit. We collected demographic and laboratory data, complications, absolute lactate levels and lactate clearance every 8 h since admission to 72 h. In critical patients we monitored hemodynamic parameters with transpulmonary thermodilution. We used Student's t-test or nonparametric tests, mixed models and Pearson and Spearman methods, Fisher's exact and chi-squared test. Of the 214 patients, 76.6% were male, mean age were 46 ± 15 years and 23.0 ± 19.5% of Total Basal Surface Area (TBSA) burned. Initial mean absolute levels of lactate were 2.02 ± 1.62 mmol/L in survivors vs. 4.05 ± 3.90 mmol/L in nonsurvivors. Initial elevated lactate levels increased mortality (p < .001), length of ICU stay, mechanical ventilation and shock. In the subgroup of burned TBSA < 20%, lowering the lactate cut-off point from 2.0 to 1.8 mmol/L improved the mortality prediction (OR:9.3). We found no relationship between lactate clearance in the first 24 h and mortality. In more severe patients (> 20% TBSA burned and initial lactate levels > 2), a good correlation was found between lactate and cardiac index; but not with intrathoracic blood volume index (ITBVI). Patients with low ITBVI preload (< 600 mL/m2) did not show significant differences in lactate clearance compared with those with ITBVI > 600. Initial elevated lactate levels are a factor of poor prognosis and the cut-off point that best predicts mortality should be adjusted in the patients with TBSA burned < 20%. The global clearance of lactate in the first 24 h, unlike what occurs in other injuries, does not correlate with mortality. Monitoring lactate can ensure adequate peripheral perfusion during resuscitation with lower than normal fluid preload values. Copyright © 2020 Elsevier Ltd and ISBI. All rights reserved.

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