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Introduction: Severe community acquired pneumonia (SCAP) occurs in approximately 18–36% of all CAP and the mortality rate could be as high as 67% in patients with SCAP. Several studies have described a correlation between baseline lactate concentration and mortality of ICU patients. Aim of the work: To follow lactate clearance after admission for 24 h which could be an indicator of outcome in severe community acquired pneumonia. Patients and methods: Forty-six consecutively admitted adult patients were diagnosed as severe community acquired pneumonia. Lactate was measured at the time of admission (H0), reassessment of lactate level was done after 8 h and also another lactate measurement done after 24 h. In a trial to follow the guideline for management and to optimize oxygen delivery (DO2) and reach a ScvO2 ⩾ 70%, ScvO2 was measured through a central venous blood sample done at the same time with lactate. During the study resuscitation by inotropic medications and patient’s physiological parameters were measured routinely. All data needed to calculate the Acute Physiology and Chronic Health Evaluation (APACHE II) score were recorded. Results: Most of patients in the current study were above the age of 60 years. Twenty-five patients had lactate clearance of more than 40%, those patients were included in group 1, whereas 21 had lactate clearance of 40% or less and they were included in group II. There was no significant difference in the age and sex distribution between both groups. Out of 21 patients included in group II, inotropic drugs were used in 8 patients (38%), whereas there was one patient only in group 1. The rate of intubation in addition to the mean APACHE II score and ICU length of stay was significantly higher in group II compared to group I. Over the first 24 h three readings for mixed venous oxygen were recorded and included in the analysis. The reading of mixed venous oxygen recorded after 24 h of ICU admission was significantly high in group 1. All indices of blood lactate clearance over the first 24 h were higher in group 1 compared to group II, however it was only significantly high after 24 h (p-value 0.01). Conclusion: Our study suggests that lactate clearance could be used as a useful biomarker which is inexpensive and a reliable predictor of patient outcome in critically ill patients admitted to ICU with severe community-acquired pneumonia.

To determine a correlation between lactate clearance within 48 h and survival in trauma patients at a Level I trauma centre in a developing country and compare to previous international lactate clearance studies. Methods: We conducted a retrospective study of a prospectively collected database at a Level I trauma centre from March 2007 to November 2010. Patients of all ages were included. Metabolic parameters from initial arterial blood gas were measured in all patients, an abnormal lactate being defined as >2.5 mmol/L. A subgroup analysis of blunt versus penetrating injury was performed. Results: Of the 657 patients in the database, 493 had complete lactate data. The survival rate of patients with lactate values

Background Serum lactate (sLac) concentration during liver resection with intermittent hepatic hilum clamping (i.e. Pringle maneuver, PM) was retrospectively investigated. Methods A total of 133 patients who underwent liver resection were enrolled. We analyzed the sLac peri-operatively. Correlations were searched between the PM and lactatemia and its variations (i.e. lactate clearance, cLac) and other factors which it might be related to. Lactatemia in triplicate intraoperatively was recorded, just after the awakening, and 1 and 2 h later. The cLac between two consecutive measurements [(sLac1 − sLac2)/sLac1] was computed. Results A reliable dependence of sLac was found from the cumulative PM. More than 76 min of cumulative Pringle Time ( cPT) exposed patients to a worse cLac at the end of the resection phase ( P < 0.0001). We found cPT >76 min, global operation time >365 min and bleeding >225 ml to be predictors of hyperlactatemia ( sLac >4 mmol/L). Normal liver resulted as a risk factor for hyperlactatemia and steatosis was not ( P = 0.030 vs. P = 0.325). Finally, cLac showed a 'square-root- shape, just like the mathematical operation sign. Conclusions Lactatemia during liver resection depends on the duration of PM, bleeding and the duration of the operation. Normal liver may expose the patient to the risk of hyperlactatemia. [ABSTRACT FROM AUTHOR]

Objectives: To determine whether early lactate reduction is associated with improved survival and good neurologic outcome in patients with out-of-hospital cardiac arrest.Design: Ad hoc data analysis of a prospective, multicenter observational study.Setting: Out-of-hospital cardiac arrest patients at 67 emergency hospitals in Kanto, Japan between January 2012 and March 2013.Patients: Adult patients with out-of-hospital cardiac arrest admitted to the hospital after successful resuscitation were identified.Interventions: Blood lactate concentrations were measured at hospital admission and 6 h after hospital admission. Early lactate clearance was defined as the percent change in lactate level 6 h after a baseline measurement.Measurements and Main Results: The 543 patients (mean age, 65 ± 16 yr; 72.6% male) had a mean lactate clearance of 42.4% ± 53.7%. Overall 30-day survival and good neurologic outcome were 47.1% and 27.4%, respectively. The survival proportion increased with increasing lactate clearance (quartile 1, 29.4%; quartile 2, 42.6%; quartile 3, 51.5%; quartile 4, 65.2%; p < 0.001). Multivariate logistic regression analysis showed that lactate clearance quartile was an independent predictor of the 30-day survival and good neurologic outcome. In the Cox proportional hazards model, the frequency of mortality during 30 days was significantly higher for patients with lactate clearance in quartile 1 (hazard ratio, 3.12; 95% CI, 2.14-4.53), quartile 2 (hazard ratio, 2.13; 95% CI, 1.46-3.11), and quartile 3 (hazard ratio, 1.49; 95% CI, 1.01-2.19) than those with lactate clearance in quartile 4. Furthermore, multivariate logistic regression analysis revealed that lactate clearance was a significant predictor of good neurologic outcome at 30 days after hospital admission.Conclusions: Effective lactate reduction over the first 6 hours of postcardiac arrest care was associated with survival and good neurologic outcome independently of the initial lactate level. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this study was to investigate the difference between arterialized and venous blood lactate concentrations [La] during constant-load exercises at different intensities. Methods: Fifteen physically active men cycled for 30 minutes (or until exhaustion) at the first lactate threshold (LT1), at 50% of the difference between the first and second lactate threshold (TT50%), at the second lactate threshold (LT2), and at 25% of the difference between LT2 and maximal aerobic power output (TW25%). Samples of both arterialized and venous blood were collected simultaneously at rest and every 5 minutes during the exercise. Results: The arterialized blood [La] was higher at minute 5 than venous blood [La] for all exercise intensities (p < 0.05). After this period, the arterialized and venous [La] samples became similar until the end of the exercise (p > 0.05). The arterialized-venous difference during the first 10 minutes was greater for the two highest exercise intensities (LT2 and TW25%) compared with the two lowest (LT1 and TT50%, p < 0.05). Thereafter, arterialized-venous difference decreased progressively, reaching values close to zero for all exercise intensities (p > 0.05). Conclusion: These results suggest a delayed lactate appearance in the venous blood, which is accentuated at higher exercise intensities. The lactate measured in arterialized and venous blood is interchangeable only when blood samples are collected at least 10 minutes after the exercise starts. [ABSTRACT FROM AUTHOR]

Context: Septic shock can rapidly evolve into multiple system organ failure and death. In the recent years, hyperlactatemia has been found to be a risk factor for mortality in critically ill adults. Aims: To evaluate the predictive value of lactate clearance and to determine the optimal cut-off value for predicting outcome in children with septic shock. Settings and Design: A prospective observational study was performed on children with septic shock admitted to pediatric Intensive Care Unit (PICU). Subjects and Methods: Serial lactate levels were measured at PICU admission, 24 and 48 h later. Lactate clearance, percent decrease in lactate level in 24 h, was calculated. The primary outcome measure was survival or nonsurvival at the end of hospital stay. We performed receiver operating characteristic analyses to calculate optimal cut-off values. Results: The mean lactate levels at admission were significantly higher in the nonsurvivors than survivors, 5.12 ± 3.51 versus 3.13 ± 1.71 mmol/L (P = 0.0001). The cut-off for lactate level at admission for the best prediction of mortality was determined as ≥4 mmol/L (odds ratio 5.4; 95% confidence interval [CI] =2.45–12.09). Mean lactate clearance was significantly higher in survivors than nonsurvivors (17.9 ± 39.9 vs. −23.2 ± 62.7; P < 0.0001). A lactate clearance rate of <10% at 24 h had a sensitivity and specificity of 78.7% and 72.2%, respectively and a positive predictive value of 83.1% for death. Failure to achieve a lactate clearance of more than 10% was associated with greater risk of mortality (likelihood ratio + 2.83; 95% CI = 1.82–4.41). Conclusions: Serial lactate levels can be used to predict outcome in pediatric septic shock. A 24 h lactate clearance cut-off of <10% is a predictor of in-hospital mortality in such patients. [ABSTRACT FROM AUTHOR]

The purpose of this study was to investigate physiological responses to climbing with different hold types. Eight elite climbers (red-point achievements 8a - 9a, French grades) performed two climbing tests to failure which were steady in pace and uniform in wall inclination, distances between holds and hold deepness. Only the hold contact surface inclination was different. Duration of test 1 (111±54 s) was significantly (P=0.005) less than test 2 (255±127 s), but peak and average oxygen uptake ( VO2), heart rate (HR) and post-climbing lactate concentrations were not different (P>0.05). Nevertheless, hold type had a greater impact on peak compared to average VO2 and HR. Peak VO2 and HR in test 1 and 2 were 34.1±4.8 versus 37±2.1 ml/min/kg and 166±16 versus 171±13 bpm, respectively. Average VO2 and HR were 28.2±2.7 versus 29.2±2.1 ml/min/kg and 154±15 versus 156±14 bpm. Duration of test 1 and percent lactate clearance were significantly correlated with red-point achievement (r=0.94, P=0.001 and r=0.75, P=0.033, respectively). Peak VO2 was significantly correlated with duration of test 1 (r=0.80, P=0.017) and average VO2 was significantly correlated with duration of test 2 (r=0.85, P=0.008). Different climbing hold types had no influence on either average or maximal VO2 and HR or on post-climbing lactate. Therefore, these variables could be used for performance evaluation but not as intensity indicators during training for sport climbing. [ABSTRACT FROM AUTHOR]

Background: The aim of the present study was to compare the effects of active (AR) vs. passive recovery (PR) between two Wingate Anaerobic Tests (WAnT) on power output, blood lactate (BLa) and oxygen consumption (VO 2 ) in a second WAnT., Methods: Twelve well-trained cyclists underwent three experimental sessions. In the first session, they completed an incremental test for maximum oxygen consumption (V O 2 max) and lactate threshold determination. In the second and third sessions, cyclists completed, in random order, two WAnT tests separated by 30-min recovery intervals, during which they performed an AR at 70% of the V O 2 at lactate threshold (V O 2 LT) or a PR. The cardiorespiratory, metabolic, and mechanical responses in the two recovery conditions were compared., Results: No differences were found in the VO 2 -on kinetics between WAnT tests (p > 0.05). As expected, blood lactate kinetics showed a greater clearance (from the 7th to the 31st min, p < 0.001) during AR; however, no differences were found in peak BLa between conditions (p > 0.05). Mean and peak power, and total work were significantly higher in the second WAnT after AR (p < 0.001), while the power decline was also lower in this condition (p < 0.05)., Conclusion: The submaximal active recovery strategy used in the present study can induce an improvement in mechanical power and total work during a second WAnT. This suggests that AR of submaximal intensity can induce a post-activation performance enhancement when used during the recovery phase between maximal anaerobic efforts., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Arginine vasopressin as a supplementary vasopressor in septic shock restores vascular tone and mean arterial pressure, meanwhile decreases dose and exposure time to catecholamines. The objective of this study was to evaluate the effect of vasopressin on lactate and lactate clearance as markers of tissue perfusion during septic shock. In this prospective, randomized, controlled trial, 30 patients with septic shock were enrolled in two groups. One group received norepinephrine infusion (titrated to reach the target MAP of ≥65 mm Hg) and the other group in addition to norepinephrine, received vasopressin at a constant rate of 0.03 u/min. Serum lactate levels were assessed at baseline, 24 and 48 hours after randomization. Lactate clearance was estimated for each patient at 24 and 48 hours. Venous lactate was measured in both groups. Despite a tendency toward higher venous lactate at 24 and 48 hours in the norepinephrine group (3.1 vs. 2.5, P=0.67 and 1.7 vs. 1.1, P=0.47), the conflict was not statistically significant among them. While lactate clearance after 24 hours was significantly higher in vasopressin treatment group (46% vs. 20%, respectively; P=0.048), the 48-hour lactate clearance did not differ from statistic viewpoints despite their clinical values (66% vs. 40%, P=0.17). Although lactate levels did not significantly differ between treatment groups, lactate clearance at 24 hours was significantly higher in vasopressin group. This may be the effect of vasopressin effect on microcirculation and tissue hypoperfusion or its catecholamine sparing effect.

Microdialysis (MD) can provide continuous information about tissue composition. To assess in critically ill patients adipose tissue metabolic patterns, the relationships between metabolic patterns and blood cytokine concentration associations of adipose tissue energy metabolism and clinical outcome we studied 203 mechanically ventilated general intensive care unit (ICU) patients. Upon ICU admission an MD catheter was inserted into the subcutaneous adipose tissue of the upper thigh to measure lactate (L), glucose, pyruvate (P), and glycerol. Serum concentrations of IL-10, IL-6, IL-8, and TNF-α were determined within 48 h from ICU admission. Mitochondrial dysfunction was defined as L/P ratio >30 and pyruvate ≥70 μmol/L, ischemia as L/P ratio >30 and pyruvate

No study has directly measured tissue lactate clearance in patients with sepsis during the post-resuscitation period. In this study we aimed to assess in ICU patients with sepsis (n = 32) or septic shock (n = 79)—during the post-resuscitation phase—the relative kinetics of blood/tissue lactate clearances and to examine whether these are associated with outcome. We measured serially—over a 48-h period—blood and adipose tissue interstitial fluid lactate levels (with microdialysis) and we calculated lactate clearance. Statistics included mixed model analysis, Friedman’s analysis of variance, Wilcoxon’s test, Mann-Whitney’s test, receiver operating characteristics curves and logistic regression. Forty patients died (28-day mortality rate = 28%). Tissue lactate clearance was higher compared to blood lactate clearance at 0–8, 0–12, 0–16, 0–20 and 0–24 h (all p < 0.05). Tissue lactate clearance was higher in survivors compared to non-survivors at 0–12, 0–20 and 0–24 h (all p = 0.02). APACHE II along with tissue lactate clearance

Purpose: Previous studies have revealed that elevated mean central venous pressure (CVP) was associated with poor prognosis in specific patient groups. But no study explored the impact of mean CVP on prognosis of patients who underwent coronary artery bypass grafting surgery (CABG). The purpose of this study was to investigate the impacts of elevated CVP and its time-course on clinical outcomes of patients who underwent CABG and potential mechanisms., Methods: A retrospective cohort study was performed based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. We first identified the CVP during specific period with the most predictive value. Patients were categorized into the low-CVP and high-CVP group on the basis of the cut-off value. A propensity score matching was used to adjust covariates. The primary outcome was a 28-day mortality. The secondary outcomes were 1-year mortality and in-hospital mortality, the length of intensive care unit (ICU) stay and hospitalization, acute kidney injury incidence, use of vasopressors, duration of ventilation and oxygen index, and lactate levels and clearance. Patients in the high-CVP group were categorized into the "second day CVP ≤ 13.46 mmHg" group and the "second day CVP > 13.46 mmHg" group, respectively, and the clinical outcomes were the same as before., Results: A total of 6,255 patients who underwent CABG were picked from the MIMIC-IV database, of which 5,641 CABG patients were monitored by CVP measurement during the first 2 days after ICU admission and 206,016 CVP records were extracted from the database. The mean CVP during the first 24 h was the most correlative and statistically significant for the 28-day mortality. The risk of the 28-day mortality was increased in the high-CVP group [OR 3.45 (95% CI: 1.77-6.70; p  < 0.001)]. Patients with elevated CVP levels had worse secondary outcomes. The maximum of lactate levels and lactate clearance were also poor in the high-CVP group. For patients in the high-CVP group during the first 24 h, whose mean CVP during the second day lowered to less than the cut-off value, had better clinical outcomes., Conclusions: An elevated mean CVP during the first 24 h was correlated with poor outcomes in patients who underwent CABG. The potential mechanisms may be influencing the lactate levels and lactate clearance through the impact on afterload of tissue perfusion. Patients whose mean CVP during the second day dropped to less than the cut-off value had favorable prognosis., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2023 Zhao, Zhang, Wang and Liu.)

Background:  Fluid resuscitation with normal saline (NS) can aggravate lactate production. The objective of this study was to evaluate the efficacy of small-volume resuscitation using 3% hypertonic sodium chloride (HS) and its comparison with NS in trauma patients. The primary endpoint was an increase in lactate clearance after 1 hr of fluid resuscitation. The secondary endpoint was the incidence of hemodynamic stability, the volume of transfusion, correction of metabolic acidosis, and complications such as fluid overload and abnormal serum sodium levels., Materials and Methods: It was a prospective, randomized, single-blind study. The study was conducted on 60 patients who arrived at the trauma center for emergency operative intervention. Inclusion criteria for patient selection were trauma victims of age more than 18 years and the requirement of emergency operative intervention for trauma except for traumatic brain injury. Patients were divided into two groups: Group HS (hypertonic saline) and Group NS (normal saline). Patients were resuscitated with either 3% HS (4ml/kg) or 0.9% NS (20ml/kg)., Results: The HS group had higher lactate clearance at 1 hour compared to the NS group, and this difference was statistically significant with a p-value of <0.001. When hemodynamic parameters were compared at 30 and 60 minutes after resuscitation, the HS group had a significantly lower heart rate (p<0.05 at 30 minutes and <0.001 at 60 minutes, respectively), a higher mean arterial pressure at 60 minutes (p<0.001), a higher pH at 60 minutes (p< 0.05), and a higher bicarbonate concentration at 60 minutes (p<0.05). The HS and NS groups had significant differences in serum sodium levels at 60 minutes (p<0.001)., Conclusions: Resuscitation with 3% hypertonic saline improved lactate clearance. Lower volumes of fluid infusion for resuscitation achieved better hemodynamic stability and correction of metabolic acidosis in the hypertonic saline group. Our study shows that hypertonic saline can be a promising fluid for small-volume resuscitation in trauma patients with compensated mild to moderate shock., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Meena et al.)

Background and Aims: To validate the lactate clearance (LC) at 6 h for mortality prediction in Pediatric Intensive Care Unit (PICU)-admitted patients and its comparison with a pediatric index of mortality 2 (PIM 2) score. Design: A prospective, observational study in a tertiary care center. Materials and Methods: Children <13 years of age, admitted to PICU were included in the study. Lactate levels were measured at 0 and 6 h of admission for clearance. LC and delayed or nonclearance group compared for in-hospital mortality and compared with PIM 2 score for mortality prediction. Results: Of the 140 children (mean age 33.42 months) who were admitted to PICU, 23 (16.42%) patients died. For LC cut-off (16.435%) at 6 h, 92 patients qualified for clearance and 48 for delayed or non-LC group. High mortality was observed (39.6%) in delayed or non-LC group as compared to clearance group (4.3%) (P = 0.000). LC cut-off of 16.435% at 6 h (sensitivity 82.6%, specificity 75.2%, positive predictive value 39.6%, and negative predictive value 95.7%) correlates with mortality. Area under receiver operating characteristic (ROC) for LC at 6 h for mortality prediction was 0.823 (P = 0.000).The area under ROC curve for expected mortality prediction by PIM 2 score at admission was 0.906 and at 12.3% cut-off of PIM 2 Score was related with mortality. The mean PIM 2 score was high in delayed or non-LC group (25.25%) compared to LC group (10.95%) (P = 0.004). Conclusion: LC cut-off < 16.435% at 6 h was associated with high mortality. [ABSTRACT FROM AUTHOR]

Introduction The assessment and treatment of children with major injury is fraught with difficulty – differences in anatomy and physiology mean that children that have suffered trauma can be over or under assessed. In recent years, there has been an increase in the use of biochemical markers, such as haematocrit, to assist the clinician in determining severity of injury. This paper examines the evidence surrounding lactate as a marker in paediatric trauma. Method A literature search was completed on Medline, CINAHL, Ovid and Science. 63 papers were initially identified – 41 papers were rejected after reading the abstracts. Of the 22 remaining papers – 6 had a paediatric focus, 16 were adult – of these 12 were rejected as not primary studies. Ten papers were fully critically reviewed – of these only one article related to paediatric patients and trauma. Results The literature shows that an elevated lactate in a trauma patient is strongly correlated to severity of injury, length of stay and morbidity and mortality. However, one elevated lactate may be misleading and lactate clearance – that is the time when lactate levels return to normal, is just as important in the assessment of the severely injured. However, from this literature review it is clear that there is very little evidence for the relationship between lactate levels and trauma in children and that more studies are required. [ABSTRACT FROM AUTHOR]

Background: Persistent hyperlactatemia during septic shock is multifactorial. Hypoperfusion-related anaerobic production and adrenergic-driven aerobic generation together with impaired lactate clearance have been implicated. An excessive adrenergic response could contribute to persistent hyperlactatemia and adrenergic modulation might be beneficial. We assessed the effects of dexmedetomidine and esmolol on hemodynamics, lactate generation, and exogenous lactate clearance during endotoxin-induced septic shock.Methods: Eighteen anesthetized and mechanically ventilated sheep were subjected to a multimodal hemodynamic/perfusion assessment including hepatic and portal vein catheterizations, total hepatic blood flow, and muscle microdialysis. After monitoring, all received a bolus and continuous infusion of endotoxin. After 1 h they were volume resuscitated, and then randomized to endotoxin-control, endotoxin-dexmedetomidine (sequential doses of 0.5 and 1.0 μg/k/h) or endotoxin-esmolol (titrated to decrease basal heart rate by 20 %) groups. Samples were taken at four time points, and exogenous lactate clearance using an intravenous administration of sodium L-lactate (1 mmol/kg) was performed at the end of the experiments.Results: Dexmedetomidine and esmolol were hemodynamically well tolerated. The dexmedetomidine group exhibited lower epinephrine levels, but no difference in muscle lactate. Despite progressive hypotension in all groups, both dexmedetomidine and esmolol were associated with lower arterial and portal vein lactate levels. Exogenous lactate clearance was significantly higher in the dexmedetomidine and esmolol groups.Conclusions: Dexmedetomidine and esmolol were associated with lower arterial and portal lactate levels, and less impairment of exogenous lactate clearance in a model of septic shock. The use of dexmedetomidine and esmolol appears to be associated with beneficial effects on gut lactate generation and lactate clearance and exhibits no negative impact on systemic hemodynamics. [ABSTRACT FROM AUTHOR]

Not all patients with upper gastrointestinal bleeding (UGIB) require emergency endoscopy. Lactate clearance has been suggested as a parameter for predicting patient outcomes in various critical care settings. This study investigates whether lactate clearance can predict active bleeding in critically ill patients with UGIB. This single-center, retrospective, observational study included critically ill patients with UGIB who met all of the following criteria: admission to the emergency department (ED) from April 2011 to August 2014; had blood samples for lactate evaluation at least twice during the ED stay; and had emergency endoscopy within 6 h of ED presentation. The main outcome was active bleeding detected with emergency endoscopy. Classification and regression tree (CART) analyses were performed using variables associated with active bleeding to derive a prediction rule for active bleeding in critically ill UGIB patients. A total of 154 patients with UGIB were analyzed, and 31.2 % (48/154) had active bleeding. In the univariate analysis, lactate clearance was significantly lower in patients with active bleeding than in those without active bleeding (13 vs. 29 %, P < 0.001). Using the CART analysis, a prediction rule for active bleeding is derived, and includes three variables: lactate clearance; platelet count; and systolic blood pressure at ED presentation. The rule has 97.9 % (95 % CI 90.2-99.6 %) sensitivity with 32.1 % (28.6-32.9 %) specificity. Lactate clearance may be associated with active bleeding in critically ill patients with UGIB, and may be clinically useful as a component of a prediction rule for active bleeding. [ABSTRACT FROM AUTHOR]

Purpose: We assessed the role of monocarboxylate transporter 1 (MCT1) on lactate clearance during an active recovery after high-intensity exercise, by comparing genetic groups based on the T1470A (rs1049434) MCT1 polymorphism, whose influence on lactate transport has been proven.Methods: Sixteen young male elite field hockey players participated in this study. All of them completed two 400 m maximal run tests performed on different days, followed by 40 min of active or passive recovery. Lactate samples were measured immediately after the tests, and at min 10, 20, 30 and 40 of the recoveries. Blood lactate decreases were calculated for each 10-min period. Participants were distributed into three groups according to the T1470A polymorphism (TT, TA and AA).Results: TT group had a lower blood lactate decrease than AA group during the 10-20 min period of the active recovery (p = 0.018). This period had the highest blood lactate for the whole sample, significantly differing from the other periods (p ≤ 0.003). During the passive recovery, lactate declines were constant except for the 0-10-min period (p ≤ 0.003), suggesting that liver uptake is similar in all the genetic groups, and that the difference seen during the active recovery is mainly due to muscle lactate uptake.Conclusions: These differences according to the polymorphic variant T1470A suggest that MCT1 affects the plasma lactate decrease during a crucial period of active recovery, where the maximal lactate amount is cleared (i.e. 10-20 min period). [ABSTRACT FROM AUTHOR]

Background: The identification of biomarkers for predicting morbidity and mortality, particularly in pediatric population undergoing cardiac surgery will contribute toward improving the patient outcome. There is an increasing body of literature establishing the clinical utility of hyperlactatemia and lactate clearance as prognostic indicator in adult cardiac surgical patients. However, the relationship between lactate clearance and mortality risk in the pediatric population remains to be established.Objective: To assess the role of lactate clearance in determining the outcome in children undergoing corrective surgery for tetralogy of Fallot (TOF).Methods and Study Design: A prospective, observational study.Setting: A tertiary care center.Study Population: Two hundred children undergoing elective surgery for TOF.Study Method: Blood lactate levels were obtained as baseline before operation (T0), postoperatively at admission to the cardiac intensive care unit after surgery (T1), and then at every 6 h for the first 24 h of Intensive Care Unit (ICU) stay (T6, T12, T18, and T24, respectively). The lactate clearance in the study is defined by the equation ([lactate initial - lactate delayed]/lactate initial) ×100%. Lactate clearance was determined at T1-T6, T1-T12, T1-T18, and T1-T24 time interval, respectively. The primary outcome measured was mortality. Secondary outcomes measured were the duration of mechanical ventilation, duration of inotropic requirement, and duration of ICU stay.Results: Eleven out of the two hundred patients enrolled in the study died. Nonsurvivors had higher postoperative lactate concentration (P < 0.05) and low-blood lactate clearance rate during 24 h (P < 0.05) in comparison to the survivors. Lactate clearance was significantly higher in survivors than in nonsurvivors for the T1-T6 period (19.55 ± 14.28 vs. 5.24 ± 27.79%, P = 0.009) and remained significantly higher for each studied interval in first 24 h. Multivariate logistic regression analysis of statistically significant univariate variables showed early lactate clearance to have a significant relationship with mortality. Patients with a lactate clearance >10%, relative to patients with a lactate clearance <10%, in the early postoperative period, had improved outcome and lower mortality.Conclusion: Lactate clearance in the early postoperative period (6 h) is associated with decreased mortality rate. Patients with higher lactate clearance (>10%) after 6 h have improved outcome compared with those with lower lactate clearance. [ABSTRACT FROM AUTHOR]

Aim of Study: In Surviving Sepsis Campaign Guidelines 2012, noradrenalin (NA) is recommended as a first choice vasopressor. Although vasopressin (VP) is recommended for the treatment of NA‑resistant septic shock, the optimal parameters for its administration remain unclear. Materials and Methods: We conducted a retrospective study to evaluate the clinical outcomes of the administration of VP to adult septic shock patients who were undergoing high‑dose NA (≥0.25 μg/kg/min) therapy in our Intensive Care Unit between January 2010 and December 2013. We defined high‑dose NA as a dose of >0.25 µg/kg/min, based on the definition of low‑dose NA as a dose of 5-14 µg/min because the average body weight of the patients in this study was 53.0 kg. Results: Among 29 patients who required the administration of high‑dose NA, 18 patients received VP. Although the patient background physiological conditions and NA dose did not differ between the two groups, the survival rate of the VP‑treated patients was significantly lower (33%) than that of the patients who were managed with a high‑dose of NA‑alone (82%) (P = 0.014). The lactate clearance did not change after the administration of VP, whereas it improved when in NA treatment alone. Conclusion: The results suggest that the administration of VP did not improve the mortality among septic shock patients when administered in addition to high‑dose NA. [ABSTRACT FROM AUTHOR]

Arginine vasopressin as a supplementary vasopressor in septic shock restores vascular tone and mean arterial pressure, meanwhile decreases dose and exposure time to catecholamines. The objective of this study was to evaluate the effect of vasopressin on lactate and lactate clearance as markers of tissue perfusion during septic shock. In this prospective, randomized, controlled trial, 30 patients with septic shock were enrolled in two groups. One group received norepinephrine infusion (titrated to reach the target MAP of ≥65 mm Hg) and the other group in addition to norepinephrine, received vasopressin at a constant rate of 0.03 u/min. Serum lactate levels were assessed at baseline, 24 and 48 hours after randomization. Lactate clearance was estimated for each patient at 24 and 48 hours. Venous lactate was measured in both groups. Despite a tendency toward higher venous lactate at 24 and 48 hours in the norepinephrine group (3.1 vs. 2.5, P = 0.67 and 1.7 vs. 1.1, P = 0.47), the conflict was not statistically significant among them. While lactate clearance after 24 hours was significantly higher in vasopressin treatment group (46% vs. 20%, respectively; P = 0.048), the 48-hour lactate clearance did not differ from statistic viewpoints despite their clinical values (66% vs. 40%, P = 0.17). Although lactate levels did not significantly differ between treatment groups, lactate clearance at 24 hours was significantly higher in vasopressin group. This may be the effect of vasopressin effect on microcirculation and tissue hypoperfusion or its catecholamine sparing effect. [ABSTRACT FROM AUTHOR]