Lactate and base deficit in trauma: Prognostic value
Keywords:
Lactic acid, Wounds and injuries, Shock, Anoxia, Anemia
Abstract
Objectives: Clinical case discussion and non-systematic literature review on lactate and base deficit in trauma, its pathophysiology and prognostic value.
Materials and method: The case of a polytraumatized patient that underwent major vascular and orthopedic surgery, ICU management and outcomes is discussed with the approval of the Ethics Committee of our Institution. The literature search included Pub Med, Scielo and Bireme.
Results:Lactate and base deficit are early follow-up clinical tools in trauma for identifying anaerobic metabolism, in addition to evaluating and changing the resuscitation strategy. This model is applicable to cardiovascular surgery.
Conclusions: Both in trauma and cardiovascular surgery, lactate and base deficit are biomark-ers that need to be quantified very early and in a serial manner. They are independent predictive factors for mortality in trauma patients in the first 48 h. Similarly, the base deficit allows for an early staging of patients in shock and for establishing with a high probability the need for blood by-products or mass transfusion. Further studies are required for normotensive patients.
References
1. Mizock BA, Falk JL. Lactic acidosis in critical illness. Crit Care Med. 1992;20:80-93.
2. Quintero E. Nuevos objetivos de reanimación: probables aplicaciones. Revista Colombiana de Cirugía. 2004;19:6.
3. Englehart MS, Schreiber MA. Measurement of acid-base resuscitation endpoints: Lactate, base deficit, bicarbonate or what? Curr Opin Crit Care. 2006;12:569-74.
4. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al., Spanish Lung Failure Collaborative Group. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med. 1995;332:345-50.
5. Siggaard-Andersen O, Fogh-Andersen N. Base excess or buffer base (strong ion difference) as measure of a non-respiratory acid-base disturbance. Acta Anaesthesiol Scand Suppl. 1995;107:123-8.
6. Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles M, et al. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998;157 4 Pt 1:1021-6.
7. Dunne JR, Tracy JK, Scalea TM, Napolitano LM. Lactate and base deficit in trauma: Does alcohol or drug use impair their predictive accuracy? J Trauma. 2005;58:959-66.
8. Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J AmColl Surg. 2000;190:656-64.
9. Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013;74:999-1004.
10. Régnier MA, Raux M, le Manach Y, Asencio Y, Gaillard J, Devilliers C, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012;117:1276-88.
11. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182:752-61.
12. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009;66:1040-4.
13. Lindsay AJ, Xu M, Sessler DI, Blackstone EH, Bashour CA. Lactate clearance time and concentration linked to morbidity and death in cardiac surgical patients. Ann Thorac Surg. 2013;95:486-92.
14. Mustafa I, Roth H, Hanafiah A, Hakim T, Anwar M, Siregar E, et al. Effect of cardiopulmonary bypass on lactate metabolism. Intensive Care Med. 2003;29: 1279-85.
15. Inoue S, Kuro M, Furuya H. What factors are associated with hyperlactatemia after cardiac surgery characterized by well-maintained oxygen delivery and a normal postoperative course? A retrospective study. Eur J Anaesthesiol. 2001;18:576-84.
16. Davies AR, Bellomo R, Raman JS, Gutteridge GA, Buxton BF. High lactate predicts the failure of intraaortic balloon pumping after cardiac surgery. Ann Thorac Surg. 2001;71:1415-20.
17. Vandromme MJ, Griffin RL, Weinberg JA, Rue LW, Kerby JD. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: Could prehospital measures improve trauma triage? J Am Coll Surg. 2010;210:861-7. Discussion: 867-869861-7.
18. Morgan TJ, Clark C, Endre ZH. Accuracy of base excessâan in vitro evaluation of the Van Slyke equation. Crit Care Med. 2000;28:2932-6.
19. Davis JW. The relationship of base deficit to lactate in porcine hemorrhagic shock and resuscitation. J Trauma. 1994;36:168-72.
20. Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, et al. Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med. 1991;19:231-43.
21. Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma. 1988;28:1464-7.
22. Davis JW, Mackersie RC, Holbrook TL, Hoyt DB. Base deficit as an indicator of significant abdominal injury. Ann Emerg Med. 1991;20:842-4.
23. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, et al. Renaissance of base deficit for the initial assessment of trauma patients: A base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®. Crit Care. 2013;17:R42.
24. Siegel JH, Rivkind AI, Dalal S, Goodarzi S. Early physiologic predictors of injury severity and death in blunt multiple trauma. Arch Surg. 1990;125:498-508.
25. Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit. Crit Care Med. 1999;27:1577-81.
2. Quintero E. Nuevos objetivos de reanimación: probables aplicaciones. Revista Colombiana de Cirugía. 2004;19:6.
3. Englehart MS, Schreiber MA. Measurement of acid-base resuscitation endpoints: Lactate, base deficit, bicarbonate or what? Curr Opin Crit Care. 2006;12:569-74.
4. Esteban A, Frutos F, Tobin MJ, Alía I, Solsona JF, Valverdú I, et al., Spanish Lung Failure Collaborative Group. A comparison of four methods of weaning patients from mechanical ventilation. N Engl J Med. 1995;332:345-50.
5. Siggaard-Andersen O, Fogh-Andersen N. Base excess or buffer base (strong ion difference) as measure of a non-respiratory acid-base disturbance. Acta Anaesthesiol Scand Suppl. 1995;107:123-8.
6. Levraut J, Ciebiera JP, Chave S, Rabary O, Jambou P, Carles M, et al. Mild hyperlactatemia in stable septic patients is due to impaired lactate clearance rather than overproduction. Am J Respir Crit Care Med. 1998;157 4 Pt 1:1021-6.
7. Dunne JR, Tracy JK, Scalea TM, Napolitano LM. Lactate and base deficit in trauma: Does alcohol or drug use impair their predictive accuracy? J Trauma. 2005;58:959-66.
8. Lavery RF, Livingston DH, Tortella BJ, Sambol JT, Slomovitz BM, Siegel JH. The utility of venous lactate to triage injured patients in the trauma center. J AmColl Surg. 2000;190:656-64.
9. Odom SR, Howell MD, Silva GS, Nielsen VM, Gupta A, Shapiro NI, et al. Lactate clearance as a predictor of mortality in trauma patients. J Trauma Acute Care Surg. 2013;74:999-1004.
10. Régnier MA, Raux M, le Manach Y, Asencio Y, Gaillard J, Devilliers C, et al. Prognostic significance of blood lactate and lactate clearance in trauma patients. Anesthesiology. 2012;117:1276-88.
11. Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: A multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med. 2010;182:752-61.
12. Callaway DW, Shapiro NI, Donnino MW, Baker C, Rosen CL. Serum lactate and base deficit as predictors of mortality in normotensive elderly blunt trauma patients. J Trauma. 2009;66:1040-4.
13. Lindsay AJ, Xu M, Sessler DI, Blackstone EH, Bashour CA. Lactate clearance time and concentration linked to morbidity and death in cardiac surgical patients. Ann Thorac Surg. 2013;95:486-92.
14. Mustafa I, Roth H, Hanafiah A, Hakim T, Anwar M, Siregar E, et al. Effect of cardiopulmonary bypass on lactate metabolism. Intensive Care Med. 2003;29: 1279-85.
15. Inoue S, Kuro M, Furuya H. What factors are associated with hyperlactatemia after cardiac surgery characterized by well-maintained oxygen delivery and a normal postoperative course? A retrospective study. Eur J Anaesthesiol. 2001;18:576-84.
16. Davies AR, Bellomo R, Raman JS, Gutteridge GA, Buxton BF. High lactate predicts the failure of intraaortic balloon pumping after cardiac surgery. Ann Thorac Surg. 2001;71:1415-20.
17. Vandromme MJ, Griffin RL, Weinberg JA, Rue LW, Kerby JD. Lactate is a better predictor than systolic blood pressure for determining blood requirement and mortality: Could prehospital measures improve trauma triage? J Am Coll Surg. 2010;210:861-7. Discussion: 867-869861-7.
18. Morgan TJ, Clark C, Endre ZH. Accuracy of base excessâan in vitro evaluation of the Van Slyke equation. Crit Care Med. 2000;28:2932-6.
19. Davis JW. The relationship of base deficit to lactate in porcine hemorrhagic shock and resuscitation. J Trauma. 1994;36:168-72.
20. Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, et al. Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med. 1991;19:231-43.
21. Davis JW, Shackford SR, Mackersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma. 1988;28:1464-7.
22. Davis JW, Mackersie RC, Holbrook TL, Hoyt DB. Base deficit as an indicator of significant abdominal injury. Ann Emerg Med. 1991;20:842-4.
23. Mutschler M, Nienaber U, Brockamp T, Wafaisade A, Fabian T, Paffrath T, et al. Renaissance of base deficit for the initial assessment of trauma patients: A base deficit-based classification for hypovolemic shock developed on data from 16,305 patients derived from the TraumaRegister DGU®. Crit Care. 2013;17:R42.
24. Siegel JH, Rivkind AI, Dalal S, Goodarzi S. Early physiologic predictors of injury severity and death in blunt multiple trauma. Arch Surg. 1990;125:498-508.
25. Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit. Crit Care Med. 1999;27:1577-81.
How to Cite
1.
Laverde Sabogál CE, Correa Rivera AF, Joya Higuera AY. Lactate and base deficit in trauma: Prognostic value. Colomb. J. Anesthesiol. [Internet]. 2014 Jan. 1 [cited 2024 Apr. 18];42(1):60–64. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/628
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Published
2014-01-01
How to Cite
1.
Laverde Sabogál CE, Correa Rivera AF, Joya Higuera AY. Lactate and base deficit in trauma: Prognostic value. Colomb. J. Anesthesiol. [Internet]. 2014 Jan. 1 [cited 2024 Apr. 18];42(1):60–64. Available from: https://www.revcolanest.com.co/index.php/rca/article/view/628
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