Serial Lactate Measurements as a Prognostic Tool in Venovenous Extracorporeal Membrane Oxygenation Support
| Autor: | Morena Cozzolino, Marco Chiostri, Manuela Bonizzoli, Giovanni Cianchi, Maria Boddi, Adriano Peris, Stefano Batacchi, Simona Di Valvasone, Chiara Lazzeri, Paolo Terenzi |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty ARDS medicine.medical_treatment 030204 cardiovascular system & hematology law.invention Sepsis 03 medical and health sciences Extracorporeal Membrane Oxygenation 0302 clinical medicine Refractory law Internal medicine Extracorporeal membrane oxygenation medicine Humans Lactic Acid Aged Receiver operating characteristic business.industry 030208 emergency & critical care medicine Odds ratio Middle Aged Prognosis medicine.disease Intensive care unit Confidence interval Surgery Logistic Models Editorial surgical procedures operative Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Annals of Thoracic Surgery. 103:812-818 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/j.athoracsur.2016.06.087 |
| Popis: | Background Serial lactate measurements over time or lactate clearance has been reported to be clinically reliable for risk stratification in different pathologic conditions ranging from sepsis to trauma, but no data are so far available on the behavior of lactate during venovenous extracorporeal membrane oxygenation (VV-ECMO) support in refractory adult acute respiratory distress syndrome (ARDS). Methods We assessed lactate values during VV-ECMO support and the prognostic role of lactate clearance at 6, 24, and 72 hours after ECMO start in 126 consecutive patients with refractory ARDS treated with VV-ECMO. Results Survivors showed a progressive, significant decrease in lactate values throughout the study period, whereas nonsurvivors exhibited a progressive increase. Lactate values (measured before ECMO initiation, as well as 6 and 24 hours after) were independently associated with intensive care unit (ICU) death. A significantly higher lactate clearance was observed for survivors at 72 hours after ECMO start than for nonsurvivors. At logistic regression analysis, lactate clearance at 72 hours after ECMO start was an independent predictor of ICU death (odds ratio 0.988, 95% confidence interval [CI]: 0.995 to 0.982, p = 0.001) (together with age, body mass index, and Sequential Organ Failure Assessment). At receiver operating characteristic curve analysis, lactate clearance at 72 hours after ECMO start cutoff value of −16% had a sensitivity of 68% and a specificity of 63% (area under the curve = 0.67, 95% CI: 0.57 to 0.77, p = 0.002). Conclusions Lactate (measured before ECMO initiation, as well as 6 and 24 hours after) is a prognostic factor in patients with refractory ARDS treated with VV-ECMO, and lactate clearance at 72 hours after ECMO initiation helps in the risk stratification of these patients, being independently associated with death. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|