Measurement of acid-base resuscitation endpoints: Lactate, base deficit, bicarbonate or what?

Current Opinion in Critical Care

Volumn 12, Issue 6, 2006, Pages 569-574

  Englehart, Michael S ^a   Schreiber, Martin A ^a,b  

^a OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

^b OREGON HEALTH AND SCIENCE UNIVERSITY   (United States)

Author keywords

Base excess; Bicarbonate; Lactate; Resuscitation endpoints; Supranormal oxygen delivery

Indexed keywords

BASE; BICARBONATE; BIOLOGICAL MARKER; LACTIC ACID;

ACID BASE BALANCE; BLEEDING; CAPNOGRAPHY; CELL DAMAGE; HEART PERFORMANCE; HEMODYNAMICS; HOSPITALIZATION; HUMAN; INTENSIVE CARE UNIT; METABOLIC ACIDOSIS; MORBIDITY; MORTALITY; NEAR INFRARED SPECTROSCOPY; PERFUSION; PULMONARY ARTERY CATHETER; RESUSCITATION; REVIEW; SHOCK; TISSUE INJURY; TISSUE OXYGENATION;

ACIDOSIS; BICARBONATES; CATHETERIZATION, SWAN-GANZ; CELL HYPOXIA; HEMOGLOBINS; HUMANS; HYDROGEN-ION CONCENTRATION; LACTIC ACID; OXIMETRY; OXYHEMOGLOBINS; RESUSCITATION; SHOCK; SPECTROSCOPY, NEAR-INFRARED;

EID: 33750557867     PISSN: 10705295     EISSN: 15317072     Source Type: Journal    
DOI: 10.1097/MCC.0b013e328010ba4f     Document Type: Review

References (50)

1. Shoemaker WC, Appel PL, Kram HB. Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med 1988; 16:1117-1120.
2. Abou-Khalil B, Scalea TM, Trooskin SZ, et al. Hemodynamic responses to shock in young trauma patients: need for invasive monitoring. Crit Care Med 1994; 22:633-639.
3. De Backer D, Creteur J, Dubois MJ, et al. The effect of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med 2006; 34:403-408. A clinical study in patients with severe sepsis that demonstrates that despite normalization of hemodynamic parameters, microcirculatory alterations were still present and that dobutamine was able to reverse these effects.
4. Rixen D, Siegel JH. Bench-to-bedside review: oxygen debt and its metabolic correlates as quantifiers of the severity of hemorrhagic and post-traumatic shock. Crit Care 2005; 9:441-453.
5. Vincent J-L, Dufaye P, Berre J, et al. Serial lactate determinations during circulatory shock. Crit Care Med 1983; 11:449-451.
6. Abramson D, Scalea TM, Hitchcock R, et al. Lactate clearance and survival following injury. J Trauma 1993; 35:584-589.
7. Manikis P, Jankowski S, Zhang H, et al. Correlation of serial blood lactate levels to organ failure and mortality after trauma. Am J Emerg Med 1995; 13:619-622.
8. Singhal R, Coghill JE, Guy AW, et al. Serum lactate and base deficit as predictors of mortality after ruptured abdominal aortic aneurysm repair. Eur J Vasc Endovasc Surg 2005; 30:263-266. Retrospective review demonstrating that serum lactate and base deficit are independent predictors of mortality in patients with ruptured abdominal aortic aneurysms. Lactate of 4.0 mmol/l or above and base deficit of -7 mmol/l or less was associated with a 94.5% probability of death.
9. Martin MJ. Venous bicarbonate correlates linearly with arterial base deficit only if pH is constant - reply. Arch Surg 2006; 141:105.
10. Davis JW, Kaups KL, Parks SN. Base deficit is superior to pH in evaluating clearance of acidosis after traumatic shock. J Trauma 1998; 44:114-118.
11. Davis JW, Shackford SR, MacKersie RC, Hoyt DB. Base deficit as a guide to volume resuscitation. J Trauma 1988; 28:1464-1467.
12. Davis JW, Kaups KL. Base deficit in the elderly: a marker of severe injury and death. J Trauma 1998; 45:873-877.
13. Cancio LC, Eleuterio G, Turner CE, et al. Base deficit and alveolar-arterial gradient during resuscitation contribute independently but modestly to the prediction of mortality after burn injury. J Burn Care Res 2006; 27:289-296. Prospective analysis of 162 burn patients where factors associated with mortality were percentage area burned, age, alveolar-arterial gradient, full-thickness burn size, inhalational injury and worse base deficit.
14. Balasubramanyan N, Havens PL, Hoffman GM. Unmeasured anions identified by the Fenci-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit. Crit Care Med 1999; 27:1577-1581.
15. Brill SA, Stewart TR, Brundage SI, Schreiber MA. Base deficit does not predict mortality when secondary to hyperchloremic acidosis. Shock 2002; 17:459-462.
16. Forni LG, McKinnon W, Lord GA, et al. Circulating anions usually associated with the Krebs cycle in patients with metabolic acidosis. Crit Care 2005; 9:R591-R595. Low-molecular-weight anions associated with the Krebs cycle were significantly elevated in patients with an anion gap metabolic acidosis, but not in those with a normal anion gap acidosis.
17. FitzSullivan E, Salim A, Demetriades D, et al. Serum bicarbonate may replace the arterial base deficit in the trauma intensive care unit. Am J Surg 2005; 190:961-967. Retrospective review of over 3000 trauma patients at a level I trauma facility. Bicarbonate was superior to pH, lactate and anion gap, and equivalent to base deficit in predicting significant metabolic acidosis.
18. Martin MJ, FitzSullivan E, Salim A, et al. Use of serum bicarbonate measurement in place of arterial base deficit in the surgical intensive care unit. Arch Surg 2005; 140:745-751. Retrospective review of over 2200 trauma patients at an academic surgical ICU. Bicarbonate was superior to pH, lactate and anion gap, and equivalent to base deficit in predicting significant metabolic acidosis.
19. Cheatham ML, Nelson LD, Chang MC, Safcsak K. Right ventricular end-diastolic volume index as a predictor of preload status in patients on positive end-expiratory pressure. Crit Care Med 1998; 26:1801-1806.
20. Connors AF, Speroff T, Dawson NV, et al. The effectiveness of right heart catheterization in the initial care of critically ill patients. SUPPORT Investigators. JAMA 1996; 276:889-897.
21. Shah MR, Hasselblad V, Stevenson LW, et al. Impact of the pulmonary artery catheter in critically ill patients: meta-analysis of randomized clinical trials. JAMA 2005; 294:1664-1670. Meta-analysis of 13 randomized controlled trials evaluating PAC use. The use of PACs did not improve survival or decrease length of stay. The authors concluded that PACs should not be used routinely in surgical ICU patients.
22. The National Heart, Lung, and Blood Institute Acute Respiratory Distress Syndrome (ARDS) Clinical Trials Network. Pulmonary-artery versus central venous catheter to guide treatment of acute lung injury. N Engl J Med 2006; 354:2213-2224. A randomized controlled trial of PAC vs. central venous catheter use to guide treatment of acute lung injury. There was no difference in survival or organ function and the PAC group had twice the rate of catheter-related complications.
23. Friese R, Shafi S, Gentilello LM. Pulmonary artery catheter use is associated with reduced mortality in severely injured patients: a National Trauma Data Bank analysis of 53,312 patients. Crit Care Med 2006; 34:1597-1601. A retrospective review of trauma patients receiving PACs using the National Trauma Data Bank.This paper is the first to demonstrate a survival benefit with the use of PACs.
24. Frank O. Die Grundform Des Arteriellen Pulses. Z Biol 1899; 37:483-526.
25. Wesseling KH, deWit B, Weber JAP, et al. A simple device for the continuous measurement of cardiac output. Adv Cardiovasc Physiol 1983; 5:16-62.
26. Goedje O, Hoeke K, Lichtwarck-Aschoff M, et al. Continuous cardiac output by femoral arterial thermodilution calibrated pulse contour analysis: comparison with pulmonary arterial thermodilution. Crit Care Med 1999; 27:2578-2579.
27. Lopez-Herce J, Ruperez M, Sanchez C, et al. Correlation between cardiac output measured by the femoral arterial thermodilution technique pulmonary arterial and that measured by contour pulse analysis in a paediatric animal model. J Clin Monit Comput 2006; 20:19-23.
28. Schuerholz T, Meyer MC, Friedrich L, et al. Reliability of continuous cardiac output determination by pulse-contour analysis in porcine septic shock. Acta Anaesthesiol Scand 2006; 50:407-413.
29. Poeze M, Solberg BC, Greve JW, Ramsay G. Monitoring global volume-related hemodynamic or regional variables after initial resuscitation: what is a better predictor of outcome in critically ill septic patients? Crit Care Med 2005; 33:2494-2500. A clinical comparison of regional vs. global endpoints of resuscitation in critically ill patients with sepsis. Regional endpoints were found unnecessary during initial resuscitation, but predicted outcome better than global variables following resuscitation.
30. Cammarata GA, Weil MH, Fries M, et al. Buccal capnometry to guide management of massive blood loss. J Appl Physiol 2006; 100:304-306.
31. Pellis T, Weil MH, Tang W, et al. Increases in both buccal and sublingual partial pressure of carbon dioxide reflect decreases of tissue blood flows in a porcine model during hemorrhagic shock. J Trauma 2005; 58:817-824. Animal study of hemorrhagic shock in which both buccal and sublingual capnography directly correlated with hemodynamic parameters during both hemorrhage and resuscitation.
32. Creteur J, De Backer D, Sakr Y, et al. Sublingual capnometry tracks microcirculatory changes in septic patients. Intensive Care Med 2006; 32:516-523. Prospective clinical study in septic patients where sublingual capnometry correlated with regional microcirculatory blood flow and gastric mucosal carbon dioxide pressures.
33. Miami Trauma Clinical Trials Group. Splanchnic hypoperfusion-directed therapies in trauma: a prospective randomized trial. Am Surg 2005; 71:252-260. Prospective, randomized clinical trial in trauma patients in which gastric tonometry compared with conventional management demonstrated equivalent outcomes.
34. Calvet X, Baigorri F, Duarte M, et al. Effect of ranitidine on gastric intramucosal pH in critically ill patients. Intensive Care Med 1998; 24:12-17.
35. Marik PE, Lorenzaza A. Effect of tube feedings on the measurement of gastric intramucosal pH. Crit Care Med 1996; 24:1498-1500.
36. Horecker BL. The absorption spectra of hemoglobin and its derivatives in the visible and near infra-red regions. J Biol Chem 1943; 148:173-183.
37. 2 and calculated global oxygen delivery during hemorrhagic shock.
38. 2 saturation during resuscitation on traumatic shock monitored using near infrared spectrometry. J Trauma 2000; 48:637-642.
39. Cairns CB, Moore FA, Haenel JB, et al. Evidence for early supply independent mitochondrial dysfunction in patients developing multiple organ failure after trauma. J Trauma 1997; 42:532-536.
40. Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94:1176-1186.
41. Boyd O, Grounds R, Bennett ED. A randomized clinical trial of the effect of deliberate perioperative increase of oxygen delivery on mortality in high-risk surgical patients. JAMA 1993; 270:2699-2707.
42. Bishop MH, Shoemaker WC, Appel PL, et al. Prospective, randomized trial of survivor values in cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 1995; 38:780-787.
43. Pearse R, Dawson D, Fawcell J, et al. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial. Crit Care 2005; 9:R687-R693. Randomized controlled clinical trial of goal-directed therapy vs. conventional management in high-risk surgical patients. Goal-directed therapy proved superior in reducing complications and hospital stay.
44. Poeze M, Greve JW, Graham R. Meta-analysis of hemodynamic optimization: relationship to methodological quality. Crit Care 2005; 9:R771-R779. Meta-analysis of 30 randomized controlled trials of goal-directed therapy in adults. Pooled data demonstrated decreased mortality with goal directed therapy.
45. Velmahos GC, Demetriades D, Shoemaker WC, et al. Endpoints of resuscitation of critically injured patients: normal or supranormal? A prospective randomized trial. Ann Surg 2000; 232:409-418.
46. Gattinoni L, Brazzi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critical ill patients. N Engl J Med 1995; 333:1025-1032.
47. McKinley B, Kozar RA, Cocanour CS, et al. Normal versus supranormal oxygen delivery goals in shock resuscitation: the response is the same. J Trauma 2002; 53:825-832.
48. Heyland DK, Cook DJ, King D, et al. Maximizing oxygen delivery in critically ill patients: a methodological appraisal of the evidence. Crit Care Med 1996; 24:517-524.
49. Hayes MA, Timmins AC, Yau EH, et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994; 330:1717-1722.
50. Balogh Z, McKinley BA, Cocanour CS, et al. Supranormal trauma resuscitation causes more cases of abdominal compartment syndrome. Arch Surg 2003; 138:637-643.