Abstract:
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.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Contenti J,Occelli C,Corraze H,Lemoël F,Levraut Jdoi
10.1097/CCM.0000000000001308subject
Has Abstractpub_date
2015-12-01 00:00:00pages
2616-22issue
12eissn
0090-3493issn
1530-0293journal_volume
43pub_type
杂志文章abstract:OBJECTIVE:To determine whether plasma lipid hydroperoxides may be a useful marker for sepsis. DESIGN:Exploratory, open-label study. SETTING:Critical care unit at a university medical center. PATIENTS:Twelve patients with sepsis syndrome requiring hemodynamic monitoring with pulmonary artery catheters. Seven patients...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199109000-00004
更新日期:1991-09-01 00:00:00
abstract::Seven dogs with electromagnetic flow probes implanted on their main (QT) and left (QL) pulmonary arteries, had catheters placed in their left atria and pulmonary artery, and were ventilated via Carlen's double-lumen endotracheal tubes. The effect of high-frequency oscillation (HFO) on the redistribution of pulmonary b...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198405000-00008
更新日期:1984-05-01 00:00:00
abstract:OBJECTIVE:Heatstroke is characterized by hyperthermia, vasoplegic shock, and cerebral ischemia and hypoxia. Hyperbaric oxygen (HBO) has been shown to reduce brain ischemia and behavioral dysfunction during cerebral artery occlusion. The efficacy of HBO therapy for resuscitation from heatstroke remains to be determined ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000159193.42628.e8
更新日期:2005-04-01 00:00:00
abstract::We evaluated 95 extubated neonates to determine if certain risk factors could predict the development of laryngeal injury. Risk factors were recorded prospectively during the intubation period and correlated with laryngeal injury determined by laryngoscopy after extubation. Duration of intubation greater than or equal...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198306000-00007
更新日期:1983-06-01 00:00:00
abstract:OBJECTIVE:Several studies have suggested that intravenous hydroxyethyl starch treatment may dampen acute inflammatory responses. It is well documented that limited oxygen delivery to tissues (hypoxia) is common in acute inflammation, and numerous parallels exist between acute responses to hypoxia and to inflammation, i...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.CCM.0000218814.77568.BC
更新日期:2006-06-01 00:00:00
abstract:OBJECTIVE:The goals of this review article are to review the importance and value of standardized definitions in clinical research, as well as to propose the necessary tools and infrastructure needed to advance nosology and medial taxonomy to improve the quality of clinical trials in the field of critical care. DATA S...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/CCM.0b013e3181920ee8
更新日期:2009-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the role of cholesterol and lipoproteins in children with severe meningococcal sepsis. DESIGN:Retrospective observational study. SETTING:A university-affiliated pediatric intensive care unit. PATIENTS:Fifty-seven patients admitted to the pediatric intensive care unit with meningococcal sepsis o...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000171272.50888.ad
更新日期:2005-07-01 00:00:00
abstract:OBJECTIVE:Treatment options to ameliorate brain damage following cardiopulmonary resuscitation from cardiac arrest are limited. DESIGN:In a porcine model, we evaluated the effects of xenon treatment on neuropathologic and functional outcomes after cardiopulmonary resuscitation. SETTING:Prospective, randomized laborat...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181802874
更新日期:2008-08-01 00:00:00
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
doi:10.1097/00003246-200301000-00015
更新日期:2003-01-01 00:00:00
abstract:OBJECTIVES:The contribution of individual immune response to Staphylococcus aureus bacteremia on outcome has not been well studied. The objective was to relate the host cytokine response to outcome of Staphylococcus aureus bacteremia. DESIGN:Prospective observational study. SETTING:Three U.S. university-affiliated me...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001465
更新日期:2016-04-01 00:00:00
abstract:OBJECTIVE:The Cardiac Arrhythmia Suppression Trial II showed that moricizine acutely increases the occurrence of sudden cardiac death. Thus the objective of this investigation was to evaluate the antifibrillatory properties of moricizine (a new antiarrhythmic agent) alone and in combination with lidocaine (an establish...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199310000-00029
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVES:Controversy exists regarding the ideal injectate temperature for measuring cardiac output. Iced temperature injectate gives a higher signal/noise ratio and less variability in the measured cardiac output. Thus, less volume and fewer measurements are required. Advocates of room temperature injectate have sugg...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199603000-00021
更新日期:1996-03-01 00:00:00
abstract::Critical care clinicians no longer consider family members as visitors in the intensive care unit. Family-centered care has emerged from the results of qualitative and quantitative studies evaluating the specific needs of families of patients dying in the intensive care unit. In addition, interventional studies have e...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000237049.44246.8C
更新日期:2006-11-01 00:00:00
abstract:OBJECTIVE:Acute lung injury is a detrimental complication for victims of burn accidents. Airway obstruction plays an important role in pulmonary dysfunction in these patients. In this study, we tested the hypothesis that aerosolized anticoagulants will reduce the degree of airway obstruction and improve pulmonary funct...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000291647.18329.83
更新日期:2007-12-01 00:00:00
abstract:OBJECTIVE:Our objective was to quantify the association between intensive care unit-acquired dysglycemia (hyperglycemia, hypoglycemia, and high variability) and in-hospital mortality. DESIGN:Retrospective, observational study. SETTING:eICU Research Institute participating hospitals with an active tele-ICU program bet...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182656ae5
更新日期:2012-12-01 00:00:00
abstract::The venous-arterial PCO2 gradient may increase in certain low-flow states, such as CPR and canine endotoxemia. To determine whether venous hypercarbia also occurs in hemorrhagic shock, we studied 12 anesthetized, mechanically ventilated dogs. We performed laparotomies on the animals, inserting catheters into their ren...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198705000-00013
更新日期:1987-05-01 00:00:00
abstract:OBJECTIVES:Hepatic ischemia-reperfusion is a major clinical problem with limited treatment options. The pathophysiology of hepatic ischemia-reperfusion is characterized by mitochondrial dysfunction and cellular energy deficits. Sirtuin 1 is an energy-sensing enzyme known to modulate mitochondrial biogenesis. We hypothe...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001637
更新日期:2016-08-01 00:00:00
abstract:BACKGROUND:Although survival is traditionally modeled using Cox proportional hazards modeling, this approach may be inappropriate in sepsis, in which the proportional hazards assumption does not hold. Newer, more flexible models, such as Gray's model, may be more appropriate. OBJECTIVES:To construct and compare Gray's...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.ccm.0000114819.37569.4b
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the cardiopulmonary effects of the novel endothelin receptor antagonist tezosentan in endotoxin-induced lung injury in sheep and to assess the dose response to tezosentan and endothelin-1 in healthy sheep. DESIGN:Prospective, randomized, controlled experimental study. SETTING:University animal l...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000114575.08269.f6
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:To examine variations in case-mix, structure, resource use, and outcome performance among teaching and nonteaching intensive care units (ICU). DESIGN:Prospective inception cohort study. PATIENTS:A consecutive sample of 15,297 patients at 35 hospitals, which compared 8,269 patients admitted to 20 teaching IC...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/00003246-199310000-00009
更新日期:1993-10-01 00:00:00
abstract:OBJECTIVE:Persistent pulmonary hypertension of the newborn is characterized by the presence of intense vasoconstriction and vascular remodeling. Protein tyrosine phosphorylation has been recognized as a critical regulatory element in signal transduction, because it is dynamically regulated by the opposing actions of pr...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-200106000-00030
更新日期:2001-06-01 00:00:00
abstract::A new iridium/iridium-oxide electrode heated to 42 degrees C was used to monitor transcutaneous carbon dioxide levels during surgery in 27 adult patients. The purpose of this study was to compare arterial and transcutaneous CO2 values. This metal electrode performed similarly to glass CO2 electrodes. In addition, its ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198510000-00015
更新日期:1985-10-01 00:00:00
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
doi:10.1097/CCM.0b013e31822575fc
更新日期:2011-11-01 00:00:00
abstract:OBJECTIVE:To estimate the prevalence of, the risk factors associated with, and the outcome of tracheostomy in a heterogeneous population of mechanically ventilated patients. DESIGN:Prospective, observational cohort study. SETTING:A total of 361 intensive care units from 12 countries. PATIENTS:A cohort of 5,081 patie...
journal_title:Critical care medicine
pub_type: 评论,杂志文章,多中心研究
doi:10.1097/01.ccm.0000150026.85210.13
更新日期:2005-02-01 00:00:00
abstract::Instantaneous heart rate, indices of long-term and short-term heart-rate variability (HRV), and transcutaneous O2 (PtcO2) and CO2 (PtcCO2) tensions were recorded simultaneously on 164 occasions in 16 neonates. There was significant inverse correlation between PtcCO2 and both HRV indices, while no linear correlation wa...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198501000-00003
更新日期:1985-01-01 00:00:00
abstract::In a prospective 30-month study of nosocomial infections in a pediatric ICU (PICU), the incidence, sites, and causes of infection were determined. Factors associated with increased risk of infection were investigated. In 1,388 patients who remained in the PICU for a minimum of 72 h, 116 infections occurred (6.1 infect...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-198803000-00005
更新日期:1988-03-01 00:00:00
abstract:OBJECTIVE:The use of corticosteroids in patients with sepsis or septic shock has been controversial for many decades. Clinical studies have reported beneficial, as well as negative results. We conducted a meta-analysis to assess the clinical evidence and to evaluate treatment effects in specific subgroups of patients. ...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-199507000-00021
更新日期:1995-07-01 00:00:00
abstract:OBJECTIVES:Sepsis-associated changes of the arachidonic acid metabolism and the utility of arachidonic acid metabolites for the diagnosis of sepsis have been poorly investigated so far. Therefore, the primary objective of our study was to screen for differentially regulated arachidonic acid metabolites in septic patien...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182416f05
更新日期:2012-05-01 00:00:00
abstract:OBJECTIVES:To investigate aortic functional alterations in the acute phase of aneurysmal subarachnoid hemorrhage and to evaluate the relationship between potential cardiovascular alterations and delayed cerebral infarctions or poor Glasgow Outcome Scale score at discharge from critical care unit. DESIGN:Prospective ob...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31822e9fab
更新日期:2012-01-01 00:00:00
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
doi:10.1097/00003246-198603000-00013
更新日期:1986-03-01 00:00:00