Long-Term β-Blocker Therapy Decreases Blood Lactate Concentration in Severely Septic Patients.


OBJECTIVES:Measurement of blood lactate concentration in the early management of sepsis is an important step in severity assessment. High blood lactate levels in the early phase of sepsis have classically been thought to be related to tissue hypoxia, but other factors could intervene. We hypothesized that the activation of glycolysis through β-adrenergic stimulation by endogenous catecholamines plays an important role in lactate production and that long-term β-blocker therapy could affect the lactate concentration in patients with severe sepsis and septic shock. DESIGN:Retrospective cohort study. SETTING:Emergency department. PATIENTS:Two hundred sixty patients with severe sepsis or septic shock were included. Twenty-five percent were previously treated with β-blockers. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:We recorded initial vital signs, the source of infection, mortality at 28 days, blood lactate concentration, and Predisposition Insult Response of Organ failure and Sequential Organ Failure Assessment scores using an electronic database. Blood lactate concentration was significantly lower in patients previously treated with β-blockers (3.9 ± 2.3 mmol/L vs 5.6 ± 3.6 mmol/L; p < 0.001). This difference was still significant after controlling for mortality (p < 0.005), for the level of the Predisposition Insult Response of Organ failure (p < 0.05) and Sequential Organ Failure Assessment (p < 0.05) scores, and for the source of infection (p < 0.05). Nearly four times more patients treated with β-blockers had normal blood lactate levels (p< 0.001). Only two factors were significantly and independently associated with normal blood lactate concentration during severe sepsis and septic shock: survival (p = 0.03) and β-blocker therapy (p = 0.01). CONCLUSIONS:Long-term β-blocker therapy decreases blood lactate concentration of severely ill septic patients at presentation. We conclude that the use of blood lactate measurement as a triage tool in the initial assessment of septic patients with β-blocker therapy may underestimate the severity of the sepsis.


Crit Care Med


Critical care medicine


Contenti J,Occelli C,Corraze H,Lemoël F,Levraut J




Has Abstract


2015-12-01 00:00:00












  • Airway pressure measurement during high frequency oscillatory ventilation.

    abstract::We developed a method to measure accurately pressures at the airway opening (Pao) and in the trachea (Ptr) in neonates during high frequency oscillatory ventilation (HFOV) from 15-30 Hz. All component parts of the pressure-measuring system were tested as a unit against a reference transducer in a closed chamber in whi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Boynton BR,Mannino FL,Meathe EA,Kopotic RJ,Friederichsen G

    更新日期:1984-01-01 00:00:00

  • Neurobiologic Correlates of Attention and Memory Deficits Following Critical Illness in Early Life.

    abstract:OBJECTIVES:Survivors of critical illness in early life are at risk of long-term-memory and attention impairments. However, their neurobiologic substrates remain largely unknown. DESIGN:A prospective follow-up study. SETTING:Erasmus MC-Sophia Children's Hospital, Rotterdam, the Netherlands. PATIENTS:Thirty-eight scho...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schiller RM,IJsselstijn H,Madderom MJ,Rietman AB,Smits M,van Heijst AFJ,Tibboel D,White T,Muetzel RL

    更新日期:2017-10-01 00:00:00

  • Core temperature measurement in the intensive care unit.

    abstract:OBJECTIVE:To compare three devices that measure core body temperature at the bedside in ICU patients. DESIGN:Prospective, consecutive sample. SETTING:Voluntary community teaching hospital. PATIENTS:Fifteen patients, 78 +/- 6 (SD) yrs of age, admitted to the medical ICU over a 5-month period who had pulmonary artery ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Nierman DM

    更新日期:1991-06-01 00:00:00

  • Treatment of multifocal atrial tachycardia with metoprolol.

    abstract::We used metoprolol orally or iv in 25 patients with multifocal atrial tachycardia that was complicating severe cardiopulmonary illness, and we observed its effect on heart rate and rhythm, BP, and arterial blood gases. All patients showed a dramatic slowing of heart rate, averaging 54.0 +/- 4.0 beat/min (p less than ....

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hazard PB,Burnett CR

    更新日期:1987-01-01 00:00:00

  • Regionalization of medical critical care: what can we learn from the trauma experience?

    abstract:OBJECTIVE:To review the rationale for the regionalization of adult critical care and discuss how lessons from the trauma experience may be relevant to this debate. DESIGN:Narrative review and opinion. RESULTS:Variation in the quality of critical care among hospitals has prompted calls for regionalization of care for ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Kahn JM,Branas CC,Schwab CW,Asch DA

    更新日期:2008-11-01 00:00:00

  • An unseen danger: frequency of posterior vessel wall penetration by needles during attempts to place internal jugular vein central catheters using ultrasound guidance.

    abstract:OBJECTIVES:To evaluate the frequency of unsuspected posterior vessel wall penetration of the internal jugular vein during ultrasound-guided needle cannulation. DESIGN:Prospective, single-blinded observational study. SETTING:Urban level I emergency department with an annual census of 80,000. PATIENTS:Residents who ha...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Blaivas M,Adhikari S

    更新日期:2009-08-01 00:00:00

  • N-acetylcysteine is effective for prevention but not for treatment of folic acid-induced acute kidney injury in mice.

    abstract:OBJECTIVES:There is controversy regarding the benefits of N-acetylcysteine in acute kidney injury. This study was to compare three commonly used regimens and explore which regimen is best for the protection of acute kidney injury. DESIGN:Prospective experimental study. SETTING:University research laboratory. INTERVE...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wang HZ,Peng ZY,Wen XY,Rimmelé T,Bishop JV,Kellum JA

    更新日期:2011-11-01 00:00:00

  • Influence of political power, medical provincialism, and economic incentives on the rationing of surgical intensive care unit beds.

    abstract:OBJECTIVE:To determine factors influencing rationing decisions in a surgical ICU during a temporary nursing shortage when two to six of the unit's 16 beds were closed. DESIGN:Blinded, concurrent data collection, retrospective chart review. SETTING:Surgical ICU. PATIENTS:All patients (n = 308) for whom a surgical ICU...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Marshall MF,Schwenzer KJ,Orsina M,Fletcher JC,Durbin CG Jr

    更新日期:1992-03-01 00:00:00

  • Carbamezapine for pain management in Guillain-Barré syndrome patients in the intensive care unit.

    abstract:OBJECTIVE:To evaluate carbamezapine (CBZ) for neuritic pain relief in Guillain-Barré syndrome (GBS) patients in the intensive care unit (ICU). DESIGN:Prospective, double-blind, randomly allocated cross-over study days. SETTING:ICU in a tertiary care university hospital. PARTICIPANTS:Twelve consecutive, conscious adu...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Tripathi M,Kaushik S

    更新日期:2000-03-01 00:00:00

  • Liquid lung ventilation reduces neutrophil sequestration in a neonatal swine model of cardiopulmonary bypass.

    abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Williams EA,Welty SE,Geske RS,Hubble CL,Craig DM,Quick G,Meliones JN,Cheifetz IM

    更新日期:2001-04-01 00:00:00

  • Effects of propofol on hemodynamic and inflammatory responses to endotoxemia in rats.

    abstract:OBJECTIVE:To document the effects of propofol on the hemodynamic and inflammatory responses to endotoxemia in an animal model. DESIGN:Randomized, prospective laboratory study. SETTING:University experimental laboratory. SUBJECTS:Thirty-two male rats. INTERVENTIONS:The animals were randomly assigned to one of four g...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Taniguchi T,Yamamoto K,Ohmoto N,Ohta K,Kobayashi T

    更新日期:2000-04-01 00:00:00

  • Impact of Sepsis Classification and Multidrug-Resistance Status on Outcome Among Patients Treated With Appropriate Therapy.

    abstract:OBJECTIVE:To assess the impact of sepsis classification and multidrug-resistance status on outcome in patients receiving appropriate initial antibiotic therapy. DESIGN:A retrospective cohort study. SETTING:Barnes-Jewish Hospital, a 1,250-bed teaching hospital. PATIENTS:Individuals with Enterobacteriaceae sepsis, sev...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Burnham JP,Lane MA,Kollef MH

    更新日期:2015-08-01 00:00:00

  • Platelet factor 4 modulation of the thrombomodulin-protein C system.

    abstract:OBJECTIVE:To review published studies of the influence of platelet factor 4 (PF4) and other cationic proteins on the generation of activated protein C (APC) by the thrombomodulin-protein C system. DATA SOURCE:Using the PubMed citation index, literature published from 1973 to 2003 regarding cationic proteins, PF4, and ...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Slungaard A

    更新日期:2004-05-01 00:00:00

  • Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial.

    abstract:OBJECTIVES:The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. DESIGN:A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. SETTING:Heart Institute of São Paulo University. PATIENTS:High-ri...

    journal_title:Critical care medicine

    pub_type: 杂志文章,随机对照试验


    authors: Rocha Ferreira GS,de Almeida JP,Landoni G,Vincent JL,Fominskiy E,Gomes Galas FRB,Gaiotto FA,Dallan LO,Franco RA,Lisboa LA,Palma Dallan LR,Fukushima JT,Rizk SI,Park CL,Strabelli TM,Gelas Lage SH,Camara L,Zeferino S,Jar

    更新日期:2018-08-01 00:00:00

  • Circulating Secretoneurin Concentrations After Cardiac Surgery: Data From the FINNish Acute Kidney Injury Heart Study.

    abstract:OBJECTIVES:Secretoneurin is associated with cardiomyocyte Ca handling and improves risk prediction in patients with acute myocardial dysfunction. Whether secretoneurin improves risk assessment on top of established cardiac biomarkers and European System for Cardiac Operative Risk Evaluation II in patients undergoing ca...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Brynildsen J,Petäjä L,Myhre PL,Lyngbakken MN,Nygård S,Stridsberg M,Christensen G,Ottesen AH,Pettilä V,Omland T,Røsjø H

    更新日期:2019-05-01 00:00:00

  • Continuous noninvasive estimation of cardiac output by electrical bioimpedance: an experimental study in dogs.

    abstract::A new device has been developed to estimate continuously and noninvasively cardiac output from the thoracic electrical bioimpedance (CObi). CObi was compared to cardiac output by thermodilution (COtd) in five anesthetized dogs. Blood pressure, blood volume, and blood flow were manipulated by hemorrhage and infusions o...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Tremper KK,Hufstedler SM,Barker SJ,Zaccari J,Harris D,Anderson S,Roohk V

    更新日期:1986-03-01 00:00:00

  • Revised National Estimates of Emergency Department Visits for Sepsis in the United States.

    abstract:OBJECTIVES:The emergency department is an important venue for initial sepsis recognition and care. We sought to determine contemporary estimates of the epidemiology of U.S. emergency department visits for sepsis. DESIGN:Analysis of data from the National Hospital Ambulatory Medical Care Survey. SETTING:U.S. emergency...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wang HE,Jones AR,Donnelly JP

    更新日期:2017-09-01 00:00:00

  • Distribution of normal saline and 5% albumin infusions in cardiac surgical patients.

    abstract:OBJECTIVE:To determine the relative distribution of fluid within the extracellular fluid volume (ECFV) and the effect on oxygen delivery after infusing either normal saline or 5% albumin in cardiac surgical patients. DESIGN:Prospective, randomized, unblinded, interventional study. SETTING:Cardiac surgical intensive c...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Ernest D,Belzberg AS,Dodek PM

    更新日期:2001-12-01 00:00:00

  • Salutary effects of ATP-MgCl2 on the depressed endothelium-dependent relaxation during hyperdynamic sepsis.

    abstract:OBJECTIVES:Studies have shown that endothelium-dependent relaxation (mediated by endothelium-derived nitric oxide) is depressed during the early, hyperdynamic stage of sepsis. Although it is known that ATP-MgCl2 produces beneficial effects following various adverse circulatory conditions, it remains unknown whether thi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wang P,Ba ZF,Cioffi WG,Bland KI,Chaudry IH

    更新日期:1999-05-01 00:00:00

  • Skeletal morbidity among survivors of critical illness.

    abstract:OBJECTIVES:To describe the incident fracture rate in survivors of critical illness and to compare fracture risk with population-matched control subjects. DESIGN:Retrospective longitudinal case-cohort study. SETTING:A tertiary adult intensive care unit in Australia. PATIENTS:All patients ventilated admitted to intens...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Orford NR,Saunders K,Merriman E,Henry M,Pasco J,Stow P,Kotowicz M

    更新日期:2011-06-01 00:00:00

  • High-frequency oscillatory ventilation: lessons learned from mechanical test lung models.

    abstract:OBJECTIVE:Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. DESIGN:Review of selected studies from PubMed, published abstracts, an...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Van de Kieft M,Dorsey D,Morison D,Bravo L,Venticinque S,Derdak S

    更新日期:2005-03-01 00:00:00

  • Overestimation of pulmonary artery occlusion pressure in pulmonary hypertension due to partial occlusion.

    abstract:OBJECTIVE:To evaluate partial occlusion in patients with pulmonary hypertension with regard to a) the degree to which it leads to overestimation of pulmonary artery occlusion pressure (Ppao) and b) identification of factors that could enhance its recognition. DESIGN:Observational descriptive study. SETTING:Medical in...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Leatherman JW,Shapiro RS

    更新日期:2003-01-01 00:00:00

  • Treatment with exogenous surfactant stimulates endogenous surfactant synthesis in premature infants with respiratory distress syndrome.

    abstract:OBJECTIVE:Treatment of preterm infants with respiratory distress syndrome (RDS) with exogenous surfactant has greatly improved clinical outcome. Some infants require multiple doses, and it has not been studied whether these large amounts of exogenous surfactant disturb endogenous surfactant metabolism in humans. We stu...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Bunt JE,Carnielli VP,Janssen DJ,Wattimena JL,Hop WC,Sauer PJ,Zimmermann LJ

    更新日期:2000-10-01 00:00:00

  • Improved cardiovascular stability during continuous modes of renal replacement therapy in critically ill patients with acute hepatic and renal failure.

    abstract:OBJECTIVE:To determine whether continuous modes of renal replacement therapy result in improved cardiovascular stability compared with standard daily intermittent treatment in critically ill patients. DESIGN:Prospective, randomized controlled trial. SETTING:Intensive care unit in a quaternary referral center for live...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,随机对照试验


    authors: Davenport A,Will EJ,Davidson AM

    更新日期:1993-03-01 00:00:00

  • Rehabilitation interventions for postintensive care syndrome: a systematic review.

    abstract:OBJECTIVE:An increasing number of ICU patients survive and develop mental, cognitive, or physical impairments. Various interventions support recovery from this postintensive care syndrome. Physicians in charge of post-ICU patients need to know which interventions are effective. DATA SOURCES:Systematic literature searc...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Mehlhorn J,Freytag A,Schmidt K,Brunkhorst FM,Graf J,Troitzsch U,Schlattmann P,Wensing M,Gensichen J

    更新日期:2014-05-01 00:00:00

  • Pericardial disease and pericardial tamponade.

    abstract::The pericardium serves many important functions, but it is not essential for life. Pericardial heart disease comprises only pericarditis and its complications, tamponade and constriction, and congenital lesions. However, the pericardium is affected by virtually every category of disease. The critical care physician is...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Hoit BD

    更新日期:2007-08-01 00:00:00

  • How to use articles about diagnostic technology: gastric tonometry.

    abstract:PURPOSE:Periodic diagnostic tests and continuous and intermittent monitoring are integral to critical care medicine. The focus of this article is understanding the impact of existing diagnostic technology, as well as that of new diagnostic technology. DATA SYNTHESIS:We use literature about gastric tonometry to illustr...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Keenan SP,Guyatt GH,Sibbald WJ,Cook DJ,Heyland DK,Jaeschke RZ

    更新日期:1999-09-01 00:00:00

  • Human rabies: clinical features, diagnosis, complications, and management.

    abstract::A case of rabies was treated with intensive medical support. This led to a prolongation of life to 25 days. The neurologic progression of the disease was monitored clinically and with serial EEG. This prolonged course enabled us to witness and manage a wide variety of unusual complications including the adult respirat...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Udwadia ZF,Udwadia FE,Katrak SM,Dastur DK,Sekhar M,Lall A,Kumta A,Sane B

    更新日期:1989-08-01 00:00:00

  • β1-Adrenergic Inhibition Improves Cardiac and Vascular Function in Experimental Septic Shock.

    abstract:OBJECTIVE:Preliminary experimental data suggest that selective β1-blockers may improve ex vivo cardiac function in animal sepsis. Currently, the effects of esmolol on in vivo cardiac function and on vascular function are unknown. The present study was designed to examine the effects of the β1-selective blocker esmolol ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Kimmoun A,Louis H,Al Kattani N,Delemazure J,Dessales N,Wei C,Marie PY,Issa K,Levy B

    更新日期:2015-09-01 00:00:00

  • Instrumentation for the continuous measurement of gas exchange and ventilation of infants during assisted ventilation.

    abstract::A system of instrumentation for continuous measurement of oxygen consumption (VO2), carbon dioxide production (VCO2) and minute ventilation (V1) in human newborns on assisted ventilation is described. VO2 and VCO2 are measured by open-circuit indirect calorimetry utilizing a Servomex OA 184 differential paramagnetic o...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Schulze K,Stefanski M,Masterson J,James LS

    更新日期:1983-11-01 00:00:00