Lactate profiles of pediatric shock patients in Cipto Mangunkusumo General Hospital 2015: a pilot study
Abstract: The 2015 Surviving
Sepsis Campaign (SSC) guidelines for management of shock recommend blood
lactate to assess the success of resuscitation in shock. However, a study in
adults found that 1/3 of septic shock patients had normal lactate levels
(alactatemia) and lower mortality rates.
Objective To evaluate lactate profiles, possible factors affecting
lactate levels, and mortality outcomes in pediatric shock patients in the
emergency room (ER) and pediatric intensive care unit (PICU).
Methods This was a retrospective study on pediatric shock patients aged 1
month to 18 years in the ER or PICU from
June 2014 to December 2015. Data were taken from subjects’ medical records
including lactate levels, examination data required to calculate a PELOD score,
and mortality outcomes.
Results Of 223 shock patients evaluated, only 92 cases (41.2%) underwent
lactate examinations. Of these, 59 (64.1%) had alactatemia and 33 (35.9%) had
hyperlactatemia. A total of 23.7% of the alactatemia group and 36.4% of the
hyperlactatemia group died, thus, the initial lactate level was not
significantly associated with patient outcomes (P=0.197). The mortality rates
of patients with <10% and ³10% lactate clearance were 31.3% and 17.6%,
respectively (P=0.362).
Conclusion In alactatemia patients, lactate level can not be used as a
goal for resuscitation. Further study is needed to find a biomarker for
assessing the success of pediatric shock resuscitation. Moreover, the clinical
relevance of alactatemia is uncertain in pediatric shock patients.
Keywords: lactate; pediatric;
shock; emergency room; pediatric intensive care unit
Author: Irene Yuniar
Journal Code: jpkedokterangg170068
