TY - JOUR
T1 - Sepsis-associated pulmonary complications in emergency department patients monitored with serial lactate
T2 - An observational cohort study
AU - Dettmer, Matthew R.
AU - Mohr, Nicholas M.
AU - Fuller, Brian M.
N1 - Funding Information:
MRD was supported by the Emergency Medicine Foundation/Emergency Medicine Residents' Association Resident Critical Care Research Grant. NMM was supported by the Emergency Medicine Foundation Research Fellowship. BMF was supported by the Washington University Emergency Care Research Core, which receives funding from the Barnes-Jewish Hospital Foundation, as well as the Washington University Institute of Clinical and Translational Sciences grants UL1 TR000448 and KL2 TR000450 from the National Center for Advancing Translational Sciences . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or any of the other supporting bodies.
Publisher Copyright:
© 2015 Elsevier Inc.
PY - 2015/12
Y1 - 2015/12
N2 - Purpose: Patients with severe sepsis and septic shock are at high risk for development of pulmonary complications, including acute respiratory distress syndrome (ARDS). Serial lactate monitoring is a useful tool to gauge global tissue hypoxia in emergency department (ED) patients with sepsis. We hypothesized that patients undergoing serial lactate monitoring (SL) would demonstrate a decreased incidence of pulmonary complications. Methods: This is a retrospective observational cohort study of adult severe sepsis and septic shock patients with elevated lactate presenting to a large academic ED. A total of 243 patients were assigned to SL (n = 132) or no serial lactate monitoring (NL; n = 111). The primary outcome was a composite of pulmonary complications: (1) ARDS development and (2) respiratory failure. Results: Twenty-eight patients (21%) in the SL group and 37 patients (33%) in the NL group developed the primary outcome (P = .03). Multivariate analysis demonstrated an association between the NL group and development of pulmonary complications (adjusted odds ratio [aOR], 2.1; confidence interval [CI], 1.15-3.78). Emergency department mechanical ventilation was independently associated with development of ARDS (aOR, 3.5; 1.8-7.0). In the a priori subgroup of patients mechanically ventilated in the ED (n = 97), those who developed ARDS received higher tidal volumes compared to patients who did not develop ARDS (8.7 mL/kg predicted body weight [interquartile range, 7.6-9.5] vs 7.6 [interquartile range, 6.8-9.0]; P < .01). Conclusions: Serial lactate monitoring is associated with a decrease in major pulmonary complications in severe sepsis and septic shock. Acute respiratory distress syndrome incidence is also influenced by ED-based mechanical ventilation. These results provide 2 potentially modifiable variables to be targeted in future studies to prevent pulmonary complications in this patient subset.
AB - Purpose: Patients with severe sepsis and septic shock are at high risk for development of pulmonary complications, including acute respiratory distress syndrome (ARDS). Serial lactate monitoring is a useful tool to gauge global tissue hypoxia in emergency department (ED) patients with sepsis. We hypothesized that patients undergoing serial lactate monitoring (SL) would demonstrate a decreased incidence of pulmonary complications. Methods: This is a retrospective observational cohort study of adult severe sepsis and septic shock patients with elevated lactate presenting to a large academic ED. A total of 243 patients were assigned to SL (n = 132) or no serial lactate monitoring (NL; n = 111). The primary outcome was a composite of pulmonary complications: (1) ARDS development and (2) respiratory failure. Results: Twenty-eight patients (21%) in the SL group and 37 patients (33%) in the NL group developed the primary outcome (P = .03). Multivariate analysis demonstrated an association between the NL group and development of pulmonary complications (adjusted odds ratio [aOR], 2.1; confidence interval [CI], 1.15-3.78). Emergency department mechanical ventilation was independently associated with development of ARDS (aOR, 3.5; 1.8-7.0). In the a priori subgroup of patients mechanically ventilated in the ED (n = 97), those who developed ARDS received higher tidal volumes compared to patients who did not develop ARDS (8.7 mL/kg predicted body weight [interquartile range, 7.6-9.5] vs 7.6 [interquartile range, 6.8-9.0]; P < .01). Conclusions: Serial lactate monitoring is associated with a decrease in major pulmonary complications in severe sepsis and septic shock. Acute respiratory distress syndrome incidence is also influenced by ED-based mechanical ventilation. These results provide 2 potentially modifiable variables to be targeted in future studies to prevent pulmonary complications in this patient subset.
KW - ARDS
KW - Emergency department
KW - Lactate
KW - Sepsis
UR - http://www.scopus.com/inward/record.url?scp=84947043307&partnerID=8YFLogxK
U2 - 10.1016/j.jcrc.2015.07.031
DO - 10.1016/j.jcrc.2015.07.031
M3 - Article
C2 - 26362864
AN - SCOPUS:84947043307
SN - 0883-9441
VL - 30
SP - 1163
EP - 1168
JO - Journal of Critical Care
JF - Journal of Critical Care
IS - 6
M1 - 51909
ER -