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Posts:
4
Registered:
9/23/08
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how usefull is serum lactate in ICU
Posted:
Aug 20, 2009 3:10 AM
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I would like to take some opinion how useful is serum lactate measurement in approaching cardiac function in adult cardiac surgery patient in first postop hours in the ICU. Do You have some personal experience. What is in your opinion its impact on catecholamine dosage, I.A.B.P. use an weaning. Do you have some idea of research papers regarding this matter in adult CS, I have found some for congenital put there are comletely different conditions in children. Could this marker be reliable in clinical descission making?
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7
Registered:
9/23/08
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Re: how usefull is serum lactate in ICU
Posted:
Sep 20, 2009 12:23 PM
in response to: Dimitar Simov
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Lactate levels may be a good guide. You must remmeber that there are different causes of Lactate increase and when combined with mixeed venous Sats is very yseful. In bleeding patients hyperlactatemia is a usual accompaniment to surgical bleeding and I tend to be very cautious in patients who bleed and have an increasing lactate.
Lactates may also increase in vasoplegic states, occasionaly with nitroprusside or adrenaline administration .
It is the trend that is important.
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4
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9/23/08
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Re: how usefull is serum lactate in ICU
Posted:
Oct 8, 2009 3:45 AM
in response to: Mohan Rao Prasa...
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Dr. Prasana thank you for your kind reply,
I would like to ask You to suggest some reading regarding non cardiac causes for serum lactate increase in adult cardiac surgery patients. I have found some correlations with use of vasoactive medications. Often patients with poor heart function are treated with combination of vasoactive drugs and what I thought relying on its values in ICU for assessing cardiac function is often misleading, inspite some ICU staff rely ot it. It's change in bleeding patient is also interesting point for revaluation of lactate impact on clinical descission making.
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7
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9/23/08
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Re: how usefull is serum lactate in ICU
Posted:
Oct 19, 2009 10:32 PM
in response to: Dimitar Simov
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Dimitar, I am sorry I did not reply earlier 9I usually do not log on often to ctsnet). The drugs that typically can cause Type 2 hyperlactatemia (ie not related to low output/hypoperfusion) are adrenaline , beta stimulants like Isoprenaline and sodium nitroprusside. Hyperlactatemia combined with low mixed venous saturation is invariably due to low output . If clinical signs do not correlate combining the two helps.
There is a good article in Medscape wrt hyperlactatemia causes etc.
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Posts:
4
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9/23/08
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Re: how usefull is serum lactate in ICU
Posted:
Oct 30, 2009 7:20 AM
in response to: Mohan Rao Prasa...
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thank you for your kind reply!
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