Grip Jonathan, Falkenström Tobias, Promsin Panuwat, Wernerman Jan, Norberg Åke, Rooyackers Olav
Clinical Science Intervention and Technology (CLINTEC), Department of Anesthesiology and Intensive Care, Karolinska Inititutet, Huddinge, Sweden.
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Huddinge, Sweden.
Crit Care. 2020 Feb 10;24(1):46. doi: 10.1186/s13054-020-2753-6.
Plasma lactate concentrations and their trends over time are used for clinical prognosis, and to guide treatment, in critically ill patients. Although heavily relied upon for clinical decision-making, lactate kinetics of these patients is sparsely studied.
To establish and validate a feasible method to study lactate kinetics in critically ill patients.
Healthy volunteers (n = 6) received a bolus dose of C-labeled lactate (20 μmol/kg body weight), and 43 blood samples were drawn over 2 h to determine the decay in labeled lactate. Data was analyzed using non-compartmental modeling calculating rates of appearance (R) and clearance of lactate. The area under the curve (AUC) was calculated using a linear-up log-down trapezoidal approach with extrapolation beyond 120 min using the terminal slope to obtain the whole AUC. After evaluation, the same protocol was used in an unselected group of critically ill patients (n = 10).
R for healthy volunteers and ICU patients were 12.8 ± 3.9 vs 22.7 ± 11.1 μmol/kg/min and metabolic clearance 1.56 ± 0.39 vs 1.12 ± 0.43 L/min, respectively. ICU patients with normal lactate concentrations showed kinetics very similar to healthy volunteers. Simulations showed that reducing the number of samples from 43 to 14 gave the same results. Our protocol yielded results on lactate kinetics very similar to previously published data using other techniques.
This simple and user-friendly protocol using an isotopically labeled bolus dose of lactate was accurate and feasible for studying lactate kinetics in critically ill ICU patients.
ANZCTR, ACTRN12617000626369, registered 8 March 2017. https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372507&isReview=true.
血浆乳酸浓度及其随时间的变化趋势用于危重症患者的临床预后评估及指导治疗。尽管临床决策严重依赖乳酸浓度，但对这些患者的乳酸动力学研究却很少。
建立并验证一种研究危重症患者乳酸动力学的可行方法。
健康志愿者（n = 6）静脉注射一剂C标记的乳酸（20 μmol/kg体重），在2小时内采集43份血样以测定标记乳酸的衰减情况。使用非房室模型分析数据，计算乳酸的生成速率（R）和清除率。采用线性上升对数下降梯形法计算曲线下面积（AUC），利用终末斜率外推超过120分钟以获得完整的AUC。评估后，对一组未经挑选的危重症患者（n = 10）采用相同方案。
健康志愿者和重症监护病房患者的乳酸生成速率分别为12.8±3.9和22.7±11.1 μmol/kg/分钟，代谢清除率分别为1.56±0.39和1.12±0.43 L/分钟。乳酸浓度正常的重症监护病房患者的动力学与健康志愿者非常相似。模拟显示，将样本数量从43个减少到14个可得到相同结果。我们的方案得出的乳酸动力学结果与先前使用其他技术发表的数据非常相似。
这种使用同位素标记乳酸推注剂量的简单且用户友好的方案对于研究危重症重症监护病房患者的乳酸动力学是准确且可行的。
澳大利亚和新西兰临床试验注册中心，ACTRN12617000626369，于2017年3月8日注册。https://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372507&isReview=true。
Zotero 插件