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Association Between Initial Emergency Department Lactate and Use of Vasoactive Medication in Children With Septic
Michael J Miescier1, Roni D Lane1, Xiaoming Sheng2
1From the Division of Pediatric Emergency Medicine, Department of Pediatrics.
Insights
Elevated initial serum lactate levels in pediatric septic shock patients are linked to increased need for vasoactive medications. This finding highlights lactate as a key indicator for early intervention in pediatric emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Critical Care
- Biomarkers
Background:
- Current pediatric septic shock guidelines prioritize clinical signs for early detection.
- Elevated serum lactate correlates with mortality in adult septic shock.
- The role of initial lactate in pediatric septic shock management requires further clarification.
Purpose of the Study:
- To investigate the association between initial serum lactate levels in pediatric emergency department (PED) patients with septic shock and the subsequent need for vasoactive medication within 24 hours.
Main Methods:
- Retrospective study of 864 pediatric patients (2008-2012) treated for septic shock in a tertiary care children's hospital.
- Included patients had serum lactate measured in the PED.
- Multivariable logistic regression analyzed the relationship between initial lactate and vasoactive medication use.
Main Results:
- Median initial lactate was 2.1 mmol/L; 14% of patients received vasoactive medication within 24 hours.
- Lactate levels of 3.1-5 mmol/L (OR 1.82) and ≥5.1 mmol/L (OR 5.00) were associated with increased vasoactive medication use.
- Hypotension, abnormal pulses, and altered mental status also correlated with vasoactive medication use.
Conclusions:
- Higher initial serum lactate levels in the pediatric emergency department are significantly associated with the need for vasoactive medication within 24 hours for patients with septic shock.
Objectives:
Current guidelines emphasize early recognition of pediatric septic shock using clinical examination findings. Elevated serum lactate has been associated with increased mortality in adult patients with septic shock. Our objective was to determine the association between the initial serum lactate obtained in the pediatric emergency department (PED) from patients treated for septic shock and the use of vasoactive medication within 24 hours.
Methods:
This was a retrospective study from 2008 through 2012 of PED patients at a tertiary care children's hospital. Patients younger than 18 years treated for septic shock were included if they had a serum lactate obtained in the PED.
Results:
Eight hundred sixty-four PED encounters met inclusion criteria. Median initial PED lactate was 2.1 mmol/L (interquartile range, 1.4-3.2 mmol/L). Overall, 121 patients (14%) received vasoactive medication within 24 hours of the initial PED lactate. A multivariable logistic regression analysis demonstrated associations between initial lactate levels of 3.1 to 5 mmol/L (odds ratio, 1.82; 95% confidence interval, 1.02-3.26) and 5.1 mmol/L or greater (odds ratio, 5.00; 95% confidence interval, 2.56-9.76) and the use of vasoactive medication within 24 hours. Other factors associated with use of vasoactive medication within 24 hours included hypotension, abnormal pulses, and mental status changes.
Conclusions:
Increased initial lactate is associated with use of vasoactive medication within 24 hours in PED patients with septic shock.
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