23 de novembro de 2012

Artigo recomendado: "Prognostic Significance of Blood Lactate and Lactate Clearance in Trauma Patients"

Marie-Alix Régnier, Mathieu Raux, Yannick Le Manach, Yves Asencio, Johann Gaillard, Catherine Devilliers, Olivier Langeron, Bruno Riou

Anesthesiology 2012; 117:1276-88 Régnier et al.

Background: Lactate has been shown to be a prognostic biomarker in trauma. Although lactate clearance has already been proposed as an intermediate endpoint in randomized trials, its precise role in trauma patients remains to be determined.

Methods: Blood lactate levels and lactate clearance (LC) were calculated at admission and 2 and 4 h later in trauma patients. The association of initial blood lactate level and lactate clearance with mortality was tested using receiver-operating characteristics curve, logistic regression using triage scores, Trauma Related Injury Severity Score as a reference standard, and reclassification method.

Results: The authors evaluated 586 trauma patients (mean age 38 ± 16 yr, 84% blunt and 16% penetrating, mortality 13%). Blood lactate levels at admission were elevated in 327 (56%) patients. The lactate clearance should be calculated within the first 2 h after admission as LC0–2 h was correlated with LC0–4 h (R2 = 0.55, P < 0.001) but not with LC2–4 h (R2 = 0.04, not significant). The lactate clearance provides additional predictive information to initial blood lactate levels and triage scores and the reference score. This additional information may be summarized using a categorical approach (i.e., less than or equal to −20 %/h) in contrast to initial blood lactate. The results were comparable in patients with high (5 mM/l or more) initial blood lactate.

Conclusions: Early (0–2 h) lactate clearance is an important and independent prognostic variable that should probably be incorporated in future decision schemes for the resuscitation of trauma patients.

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