A large part of the confusion appears to be regarding what is abnormal vs what necessitates a more intensive treatment, i.e. aggressive sepsis resuscitation. I assume that 2.5 correlates to the upper limit of normal on most labs (our lab uses 2.3, and my guess is that the policy quoted by Mr. Coon is based on that lab having 2.2 as its ULN). From a strict standpoint it's correct to refer to anyone with a lactate higher that the lab's upper limit of normal as having a lactatemia. A separate but related question is what is the clinical significance of a lactatemia in a given person? Rivers' paper used a lactate of 4 as one of the inclusion criteria for his study, and all guidelines based on that paper have echoed that cutoff. If you pull the original Rivers paper, you'll see no footnote attached to choosing that value in the materials and methods section, and I'm not aware of anyone showing a physiologic rationale for 4.0 vs any other number higher than the ULN. Is the best cutoff the ULN itself, 3.2, 3.5, 3.8, etc.? I doubt that we'll ever have a definitive answer to this question, and I suspect that there's not a sharp breakpoint making the question impossible to answer. Bottom line is that it's fair to say that a lactate > 4 indicates aggressive treatment for septic shock in the correct clinical situation. It becomes a matter of clinical judgement how to interpret a lactate in the ULN - 4.0 range. William Hutchens, MD, FCCP Assistant Professor of Medicine Eastern Virginia Medical School
-----Original Message----- From: [email protected] [mailto:[email protected]]On Behalf Of Giussepe Sent: Thursday, May 03, 2012 1:55 PM To: Hess, Dr. Donald Cc: Coon, Joshua; [email protected] Subject: Re: [Sepsis Groups] Lactic acid result reporting. Unfortunately we do not have aun established concensus at my center. Personally i use 3.0 as a critical level, but i Pay special attention to those who reach 2.5 El 03/05/2012, a las 08:22, "Hess, Dr. Donald" < [email protected]> escribió: I’ve found various cutoffs in the literature. We use >= 4.0 at my institution. Sincerely, Donald W Hess MD MPH CME/IRB Liaison - Susquehanna Health 700 High St. - Williamsport, PA 17701 T: 570.321.2175 - F: 570.321.2133 - [email protected] "A minute of thought is worth more than an hour of talk" Confidentiality Notice: This message and any attachments originate by electronic mail from Susquehanna Health and their subsidiaries/affiliates ("SH"). Both this document and any attachments are intended for the sole use of the addressee indicated above and may contain proprietary, privileged and/or confidential information. If you are not the intended recipient of this message, you are hereby notified that any use or disclosure of this information is strictly prohibited. If you received this message in error, or have reason to believe you are not authorized to receive it, please notify the sender by reply email, with a copy to [email protected] , and then promptly delete the original and reply messages. Thank you for your cooperation. _____ From: [email protected] [mailto:[email protected]] On Behalf Of Coon, Joshua Sent: Wednesday, May 02, 2012 10:45 AM To: [email protected] Subject: [Sepsis Groups] Lactic acid result reporting. Can anyone help me during my sepsis collaborative this year we are looking to implement Lactic acid as one of the values if critical it is reported. Has anyone established a critical result for lactic acid. We have in our policy that the values greater than 2.2 are high. No critical has been established. And does anyone have literature on this topic? Thanks . "Always the Best" Joshua Joshua Coon RN CEN Emergency Department Administrative Charge Nurse Florida Hospital Waterman (352) 253-3264 _______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
_______________________________________________ Sepsisgroups mailing list [email protected] http://lists.sepsisgroups.org/listinfo.cgi/sepsisgroups-sepsisgroups.org
