I agree. We should use the guidelines but it comes down to clinical judgement
for the variety of cases-young and old. We took care of a very young (22yr old)
individual who had a lactate in the mid 2’s and was clearly very sick based
upon other clinical values. Barb
Barbara A Taylor RN BS
Performance improvement Coordinator
Lancaster General Hospital
Lancaster, PA
(717) 544-5924
From: [email protected]
[mailto:[email protected]] On Behalf Of Hutchens,
William T.
Sent: Friday, May 04, 2012 12:03 PM
To: [email protected]
Subject: Re: [Sepsis Groups] Lactic acid result reporting.
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]>
[mailto:[email protected]]On Behalf Of Giussepe
Sent: Thursday, May 03, 2012 1:55 PM
To: Hess, Dr. Donald
Cc: Coon, Joshua;
[email protected]<mailto:[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]<mailto:[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]<mailto:[email protected]>
"A minute of thought is worth more than an hour of talk"
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________________________________
From:
[email protected]<mailto:[email protected]>
[mailto:[email protected]] On Behalf Of Coon, Joshua
Sent: Wednesday, May 02, 2012 10:45 AM
To:
[email protected]<mailto:[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
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