tailieunhanh - Báo cáo khoa học: "Lactate concentration gradient from right atrium to pulmonary artery: a commentary"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: Lactate concentration gradient from right atrium to pulmonary artery: a commentary. | Available online http content 9 4 337 Commentary Lactate concentration gradient from right atrium to pulmonary artery a commentary Jacques Creteur Assistant Professor Department of Intensive Care Erasme University Hospital Free University of Brussels Brussels Belgium Corresponding author Jacques Creteur jcreteur@ Published online 1 July 2005 This article is online at http content 9 4 337 2005 BioMed Central Ltd Critical Care 2005 9 337-338 DOI cc3769 See related research by Gutierrez et al. in this issue http content 9 4 R425 Abstract Inadequate myocardial performance is a common complication of severe sepsis. Studies in humans strongly argue against a decrease in coronary blood flow in the pathogenesis of this sepsis-induced cardiac injury. Moreover regional myocardial ischemia may well be present in sepsis patients with coexistent coronary artery disease. Nevertheless the diagnosis of myocardial ischemia remains difficult in patients with sepsis since elevation of troponin in these patients can be the result of a variety of conditions other than acute myocardial ischemia. The use of the right atrium to pulmonary artery lactate gradient could perhaps help the clinician in detecting myocardial ischemia in patients with sepsis. In this issue Gutierrez et al. 1 compared simultaneous measurements of blood lactate concentrations in the right atrium and pulmonary artery in critically ill patients. They found decreases in both blood lactate concentrations and venous blood oxygen saturation in gradients from the right atrium to the pulmonary artery. These gradients are presumably produced by mixing right atrial blood with coronary venous blood which has lower lactate concentrations and blood oxygen saturation. More interestingly in this study the lactate gradient was inverted in three patients suggesting myocardial ischemia a condition associated with lactate release by the heart. Blood lactate levels are typically .