Journal article
Sepsis-associated pulmonary complications in emergency department patients monitored with serial lactate: An observational cohort study
Journal of critical care, Vol.30(6), pp.1163-1168
12/2015
DOI: 10.1016/j.jcrc.2015.07.031
PMCID: PMC4648355
PMID: 26362864
Abstract
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.
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.
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).
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.
Details
- Title: Subtitle
- Sepsis-associated pulmonary complications in emergency department patients monitored with serial lactate: An observational cohort study
- Creators
- Matthew R Dettmer - Division of Critical Care Medicine, Department of Medicine, Cooper Medical School of Rowan University, Cooper University Hospital, Camden, NJ 08103Nicholas M Mohr - Department of Emergency Medicine, Roy J. Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA 52242Brian M Fuller - Division of Emergency Medicine, Washington University School of Medicine in St Louis, St Louis, MO 63110
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.30(6), pp.1163-1168
- DOI
- 10.1016/j.jcrc.2015.07.031
- PMID
- 26362864
- PMCID
- PMC4648355
- NLM abbreviation
- J Crit Care
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Publisher
- Elsevier BV
- Grant note
- DOI: 10.13039/100006108, name: National Center for Advancing Translational Sciences, award: UL1 TR000448, KL2 TR000450
- Language
- English
- Date published
- 12/2015
- Academic Unit
- Epidemiology; Emergency Medicine; Anesthesia; Injury Prevention Research Center
- Record Identifier
- 9984025284602771
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