tailieunhanh - Báo cáo y học: "Hyperlactatemia in critical illness and cardiac surgery"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học quốc tế cung cấp cho các bạn kiến thức về ngành y đề tài: Hyperlactatemia in critical illness and cardiac surgery. | O Connor and Fraser Critical Care 2010 14 421 http content 14 3 421 CRITICAL CARE LETTER L_ Hyperlactatemia in critical illness and cardiac surgery Enda D O Connor 1 and John F Fraser2-4 See related research by Nichol etal. http content 14 1 R25 We read with interest the article by Nichol and colleagues 1 in a recent issue of Critical Care. Their study of more than 7 000 medical and surgical patients supports the claim that an admission plasma lactate level in the upper normal range is associated with increased mortality. However we are concerned about the lack of data regarding patient baseline characteristics. Specifically although 3 166 and 1 614 patients had diagnoses of surgery and cardiac vascular respectively it is likely but not stated that numerous patients were admitted following cardiac surgery. This is of great importance as changes in lactate in this patient group are not homogenous in nature. In post-cardiac surgery patients early hyperlactatemia and late hyperlactatemia LHL differ in both risk profile and physiological rationale. Early hyperlactatemia on intensive care unit arrival is associated with adverse outcome. This association is not seen in the 10 to 20 of patients who develop LHL pooled odds ratio OR of death with LHL in two published trials 95 confidence interval CI to 2-4 . Moreover in our recent single-center review of prospectively collated data from 529 post-cardiac surgical patients in a tertiary Australian cardiac surgical intensive care unit 25 developed LHL mmol L . When compared with patients with a normal lactate profile patients with LHL showed no increase in hospital mortality OR 95 CI to unpublished data . Therefore we believe that inclusion of such patients in studies of lactate in critical illness should be avoided and as in the study by Nichol and colleagues may actually weaken any association demonstrated between lactate levels and hospital mortality. Authors .