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Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock

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Abstract

Objective

To identify early prognostic markers of septic shock among catheterization-derived hemodynamic and metabolic data.

Design

Prospective cohort study.

Setting

A medical intensive care unit in a university hospital.

Patients

Thirty-two consecutive patients with septic shock, separated into two groups according to shortterm (10-day) evolution: 18 acute survivors and 14 fatalities.

Measurements

Usual hemodynamic and metabolic variables were measured at the onset of shock, i.e. when the catheter was inserted (T0), and 24 h later (T24). The values collected for each group at T0 and T24 and their 24-h changes were compared.

Results

On admission, no difference was found between acute survivors and eventual fatalities. After 24 h, fatalities presented with significantly lower mean arterial pressure (p<0.01), left ventricular stroke work index (P<0.05) and higher lactate levels (p<0.01) than acute survivors. Moreover, the 24-h changes of lactate and blood pressure were also of prognostic value (p<0.05). Oxygen delivery and oxygen consumption did not differ statistically between the two groups. At T24, a mean arterial pressure of less than 85 mmHg and a lactate level equal to or greater than 3.5 mmol/l were independently associated with poor survival (37.5% and 30.7%, respectively). Day 10 survival was only 12.5% when both criteria were present at T24.

Conclusions

Changes in mean arterial pressure and arterial blood lactate within the first 24 h of treatment are strong prognostic indicators of short-term survival in patients with septic shock. After 24 h of treatment, maintenance of a mean blood pressure equal to or greater than 85 mmHg correlates with survival at day 10. Data suggest that early reductions in both cardiac function and vascular tone play a determining role in the hypotension observed in fatalities. Persistence of hyperlactatemia in hypotensive patients bodes particularly ill. Blood pressure and lactate level are simple bedside parameters that can enable the clinician to identify patients with a high risk of mortality.

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References

  1. Parker MM (1990), Cardiac dysfunction in human septic shock. In: Parillo JE, Septic shock in humans: advances in the understanding of pathogenesis, cardiovascular dysfunction and therapy. Ann Intern Med 115:227–242

    Google Scholar 

  2. Thijs LG, Groeneveld ABJ (1987), The circulatory defect of septic shock. In: Vincent JL, Thijs LG (eds) Update in intensive care and emergency medicine. Septic shock. Springer, Berlin Heidelberg New York, pp 161–178

    Google Scholar 

  3. Pinsky MR (1990) Assessment of adequacy of oxygen transport in the critically ill. Appl Cardiopulm Pathophysiol 3:271–278

    Google Scholar 

  4. Parker MM, Shelhamer JH, Natanson C, Alling DW, Parillo JE (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–929

    Google Scholar 

  5. Groeneveld ABJ, Bronsveld W, Thijs, LG (1986) Hemodynamic determinants of mortality in human septic shock. Surgery 99:140–153

    Google Scholar 

  6. Hankeln KB, Senker R, Schwarten JU, Beez MG, Engel HJ, Laniewsky P (1987) Evaluation of prognostic indices based on hemodynamic and oxygen transport variables in shock patients with adult respiratory distress syndrome. Crit Care Med 15:1–7

    Google Scholar 

  7. Bihari D, Smithies M, Grimson A, Tinker J (1987) The effects of vasodilation with prostacycline on oxygen delivery and uptake in critically ill patients. N Engl J Med 317:307–303

    Google Scholar 

  8. LeGall JR, Loirat P, Alperovitch A (1983) Simplified acute physiologic score for intensive care patients. Lancet II:741–743

    Google Scholar 

  9. LeGall JR (1987) Prognosis of septic shock. In: Vincent JL, Thijs LG (eds) Update in intensive care and emergency medicine. Septic shock. Springer, Berlin Heidelberg New York, pp 283–288

    Google Scholar 

  10. Dhainaut JF, Huyghebaert MF, Monsallier JF, Lefevre G, Dall'Ava Santucci J, Brunet F et al (1987) Coronary hemodynamics and myocardial metabolism of lactates, free fatty acids, glucose, and ketones in patients with septic shock. Circulation 75:533–541

    Google Scholar 

  11. D'Orio V, Mendes P, Saad G, Marcelle R (1990) Accuracy in early prediction of prognosis of patients with septic shock by analysis of simples indices: prospective study. Crit Care Med 18: 1339–1345

    Google Scholar 

  12. Tuchschmidt J, Fried J, Swinney R, Sharma OMP (1989) Early hemodynamic correlates of survival in patients with septic shock. Crit Care Med 17:719–723

    Google Scholar 

  13. Vincent JL, Weil MH, Puri V, Carlson RW (1981) Circulatory shock associated with purulent peritonitis. Am J Surg 142:262–270

    Google Scholar 

  14. Groeneveld ABJ, Kester ADM, Nauta JJP, Thijs LG (1987) Relation of arterial blood lactate to oxygen delivery and hemodynamic variables in human shock states. Circ Shock 22:35–53

    Google Scholar 

  15. Vincent JL, Gris P, Coffernils M, Leon M, Pinsky M, Reuse C, Kahn RJ (1992) Myocardial depression characterizes the fatal course of septic shock. Surgery 111:660–667

    Google Scholar 

  16. Mizock BA, Falk JL (1992) Lactic acidosis in critical illness. Crit Care Med 20:80–93

    Google Scholar 

  17. Weil MH, Afifi AA (1970) Experimental and clinical studies on lactate and pyruvate as indicators of the severity of acute circulatory failure (shock). Circulation 41:989–901

    Google Scholar 

  18. Vincent JL, Dufaye P, Berré J, Leeman M, Degaute JP, Kahn RJ (1983) Serial lactate determinations during circulatory shock. Crit Care Med 11:449–451

    Google Scholar 

  19. Azimi G, Vincent JL (1986) Ultimate survival from septic shock. Resuscitation 14:245–253

    Google Scholar 

  20. Bakker J, Coffernils M, Leon M, Gris P, Vincent JL (1991) Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 99:956–962

    Google Scholar 

  21. Falk JL, Rackow EC, Leavy J et al (1985) Delayed lactate clearance in patients surviving circulatory shock. Acute Care 11:212–215

    Google Scholar 

  22. Ronco JJ, Fenwick JC, Wiggs BR, Phang PT, Russel JA, Tweeddale MG (1993) Oxygen consumption in independent of increases in oxygen delivery by dobutamine in septic patients who have normal or increased plasma lactate. Am Rev Respir Dis 147:25–31

    Google Scholar 

  23. Gutierrez G, Bismar H, Dantzker D, Silva N (1992) Comparison of gastric intramucosal pH with measures of oxygen transport and consumption in critically ill patients. Crit Care Med 20: 451–457

    Google Scholar 

  24. Friedman G, Berlot G, Kahn RJ, Vincent JL (1994) Combination of blood lactate levels and pH in severe sepsis. Crit Care Med 22: A112

    Google Scholar 

  25. Intaglietta M (1989) Objectives for the treatment of the microcirculation in ischemia, shock, and reperfusion. In: Vincent JL (ed) Update in intensive care and emergency medicine. Springer, Berlin Heidelberg New York, pp 293–298

    Google Scholar 

  26. Russel JA, Ronco JJ, Lockhat D, Belzberg A, Kiess M, Dodek PM (1990) Oxygen delivery and consumption and ventricular preload are greater in survivors than in nonsurvivors of the adult respiratory distress syndrome. Am Rev Respir Dis 141:659–665

    Google Scholar 

  27. Shoemaker WC, Appel P, Kram H, Waxman K, Lee TS (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186

    Google Scholar 

  28. Tuchschmidt J, Fried J, Astiz M, Rackow E (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102: 216–220

    Google Scholar 

  29. Edwards JD, Brown GCS, Nightingale P, Slater RM, Faragher EB (1989) Use of survivors cardiorespiratory values as therapeutic goals in septic shock. Crit Care Med 17:1098–1103

    Google Scholar 

  30. Martin C, Eon B, Saux B, Albanese J, Aknin P, Gouin F (1989) Utilisation de la noradrénaline dans le traitement du choc septique. Ann Fr Anesth Réanim 8:19–25

    Google Scholar 

  31. Shoemaker WC, Appel PL, Wakman K, Schwartz S, Chang P (1982) Clinical trial of survivors cardiorespiratory patterns as therapeutic goals in critically ill postoperative patients. Crit Care Med 10:398–303

    Google Scholar 

  32. Hayes MA, Timmins AC, Yan EHS, Palazzo M, Hinds CJ, Watson D (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722

    Google Scholar 

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Authors and Affiliations

  1. Service de Réanimation Médicale, Hôpital l'Archet, BP 79, F-06202, Nice Cedex 3, France

    G. Gernardin, F. Tiger, P. Deloffre & M. Mattei

  2. Department of Infectious Diseases, University Hospital, Nice, France

    C. Pradier

Authors
  1. G. Gernardin
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  2. C. Pradier
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  3. F. Tiger
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  4. P. Deloffre
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  5. M. Mattei
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Gernardin, G., Pradier, C., Tiger, F. et al. Blood pressure and arterial lactate level are early indicators of short-term survival in human septic shock. Intensive Care Med 22, 17–25 (1996). https://doi.org/10.1007/BF01728326

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  • DOI: https://doi.org/10.1007/BF01728326

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