Thanya Limapichat1, Krittapat Pattanapong1. 1. Department of Emergency Medicine, Songklanagarind Hospital, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand.
Abstract
OBJECTIVE: To compare the effect of isotonic crystalloid solutions between lactated Ringer's solution (LRS) and normal saline solution (NSS) on lactate clearance in septic patients at the emergency department (ED). MATERIALS AND METHODS: This study is a single-center retrospective chart review. The study enrolled patients older than 18 years with sepsis and initial serum lactate level >2 mg/dL in the ED. The primary outcome was to determine which isotonic solution was better for serum lactate clearance in septic patients. The secondary outcomes were serum creatinine change within 24 h and the 48-h survival rate after admission. RESULTS: A total of 120 patients were enrolled with a median crystalloid volume administered in the ED of 1000 mL. Within 2 h of resuscitation, there was no difference in lactate clearance between the LRS and NSS groups with median values of 29.2% and 25%, respectively (P=0.839). The 48-h survival rate after admission did not differ between the LRS and NSS groups with median values of 90% and 86%, respectively. Both isotonic solutions increased serum creatinine levels within 24 h of treatment with median values of 0.3 for each group (P=0.647). CONCLUSION: Among septic patients in the ED treated with NSS or LRS, there was no difference in lactate clearance, serum creatinine change within 24 h, or 48-h survival. However, several factors were associated with increased lactate levels, such as older age and use of vasopressors and immunosuppressive agents.
OBJECTIVE: To compare the effect of isotonic crystalloid solutions between lactated Ringer's solution (LRS) and normal saline solution (NSS) on lactate clearance in septic patients at the emergency department (ED). MATERIALS AND METHODS: This study is a single-center retrospective chart review. The study enrolled patients older than 18 years with sepsis and initial serum lactate level >2 mg/dL in the ED. The primary outcome was to determine which isotonic solution was better for serum lactate clearance in septic patients. The secondary outcomes were serum creatinine change within 24 h and the 48-h survival rate after admission. RESULTS: A total of 120 patients were enrolled with a median crystalloid volume administered in the ED of 1000 mL. Within 2 h of resuscitation, there was no difference in lactate clearance between the LRS and NSS groups with median values of 29.2% and 25%, respectively (P=0.839). The 48-h survival rate after admission did not differ between the LRS and NSS groups with median values of 90% and 86%, respectively. Both isotonic solutions increased serum creatinine levels within 24 h of treatment with median values of 0.3 for each group (P=0.647). CONCLUSION: Among septic patients in the ED treated with NSS or LRS, there was no difference in lactate clearance, serum creatinine change within 24 h, or 48-h survival. However, several factors were associated with increased lactate levels, such as older age and use of vasopressors and immunosuppressive agents.
Authors: Matthew M Churpek; Ashley Snyder; Xuan Han; Sarah Sokol; Natasha Pettit; Michael D Howell; Dana P Edelson Journal: Am J Respir Crit Care Med Date: 2017-04-01 Impact factor: 21.405
Authors: Matthew W Semler; Wesley H Self; Jonathan P Wanderer; Jesse M Ehrenfeld; Li Wang; Daniel W Byrne; Joanna L Stollings; Avinash B Kumar; Christopher G Hughes; Antonio Hernandez; Oscar D Guillamondegui; Addison K May; Liza Weavind; Jonathan D Casey; Edward D Siew; Andrew D Shaw; Gordon R Bernard; Todd W Rice Journal: N Engl J Med Date: 2018-02-27 Impact factor: 91.245
Authors: Wesley H Self; Matthew W Semler; Jonathan P Wanderer; Li Wang; Daniel W Byrne; Sean P Collins; Corey M Slovis; Christopher J Lindsell; Jesse M Ehrenfeld; Edward D Siew; Andrew D Shaw; Gordon R Bernard; Todd W Rice Journal: N Engl J Med Date: 2018-02-27 Impact factor: 91.245