Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial
| Autor: | Tim C, Jansen, Jasper, van Bommel, F Jeanette, Schoonderbeek, Steven J, Sleeswijk Visser, Johan M, van der Klooster, Alex P, Lima, Sten P, Willemsen, Jan, Bakker, A, Brouwers |
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| Přispěvatelé: | Intensive Care, Epidemiology |
| Rok vydání: | 2010 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty Resuscitation Time Factors Critical Care Critical Illness Population Kaplan-Meier Estimate Early goal-directed therapy Critical Care and Intensive Care Medicine law.invention Randomized controlled trial law Risk Factors Intensive care medicine Humans Hospital Mortality Lactic Acid education Aged Proportional Hazards Models education.field_of_study Proportional hazards model business.industry Oxygenation Length of Stay Middle Aged Intensive care unit Surgery Intensive Care Units Treatment Outcome Anesthesia Female business Biomarkers |
| Zdroj: | American Journal of Respiratory and Critical Care Medicine, 182(6), 752-761. American Thoracic Society |
| ISSN: | 1535-4970 1073-449X |
| Popis: | Rationale: It is unknown whether lactate monitoring aimed to decrease levels during initial treatment in critically ill patients improves outcome. Objectives: To assess the effect of lactate monitoring and resuscitation directed at decreasing lactate levels in intensive care unit (ICU) patients admitted with a lactate level of greater than or equal to 3.0 mEq/L. Methods: Patients were randomly allocated to two groups. In the lactate group, treatment was guided by lactate levels with the objective to decrease lactate by 20% or more per 2 hours for the initial 8 hours of ICU stay. In the control group, the treatment team had no knowledge of lactate levels (except for the admission value) during this period. The primary outcome measure was hospital mortality. Measurements and Main Results: The lactate group received more fluids and vasodilators. However, there were no significant differences in lactate levels between the groups. In the intention-to-treat population (348 patients), hospital mortality in the control group was 43.5% (77/177) compared with 33.9% (58/171) in the lactate group (P = 0.067). When adjusted for predefined risk factors, hospital mortality was lower in the lactate group (hazard ratio, 0.61; 95% confidence interval, 0.43-0.87; P = 0.006). In the lactate group, Sequential Organ Failure Assessment scores were lower between 9 and 72 hours, inotropes could be stopped earlier, and patients could be weaned from mechanical ventilation and discharged from the ICU earlier. Conclusions: In patients with hyperlactatemia on ICU admission, lactate-guided therapy significantly reduced hospital mortality when adjusting for predefined risk factors. As this was consistent with important secondary endpoints, this study suggests that initial lactate monitoring has clinical benefit. |
| Databáze: | OpenAIRE |
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