lactate clearance as a predictor of mortality in trauma patients reno rudiman
TRANSCRIPT
• Important in clinical uncertainty
• Mis-inference may result in an increased risk of an adverse event
• Avoiding unnecessary cost of care
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Why do we need predictor?
Mortality of trauma
• 10% of all deaths are caused by trauma (Maegel 2010)
• In Indonesia 2011, there were 108.696 traffic accidents, of which 31.195 dead (BPS, 2011)
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Lactate
• End product of anaerobic metabolism
• Marker for cellular hypoxia in shock
• Early identification of severe injury
Lactate clearance
• Rapid clearance of lactate is associated with improved outcome in septic shock & critically ill
• Is it a better indicator for ongoing tissue hypoperfusion?
• Better guide for resuscitation?
Lactate clearance
Lactate clearance = ([Lactateinitial – Lactatedelayed]/ Lactateinitial) × 100 × Delay−1 (expressed as %/h)
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Admission Lactate
Although mean admission lactate was significantly lower in survivors than nonsurvivors, the overlap between the groups was so great that little ability to discriminate survivors from non-survivors is apparent
11Pal JD, et al. J Trauma 2006; 60: 583-589
Relationship of lactate and ISS values in 5,995 trauma patients
14Pal JD, et al. J Trauma 2006; 60: 583-589
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initial p=0,356
post p<0,01
0
0.55
1.1
1.65
2.2
successful failed
Successful vs failed Non Operative management in blunt abdominal trauma
Haryatama, Rudiman, Sulthana. In publication, 2012.
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lactate pre vs post
lactate pre vs BE pre
latate post vs BE post
BE pre vs post
lactate diff vs BE diff
-0.7 -0.35 0 0.35 0.7 1.05
Failed Successful
Haryatama, Rudiman, Sulthana. In publication, 2012.
Successful vs failed Non Operative management in blunt abdominal trauma
Mortality according to initial blood lactate level and/or lactate clearance (n = 453)
20Regnier, et al. Anesthesiology 2012; 71(6): 1276-1288