An intensivist on a learning frenzy. Caring for the critically ill using evidence-based medicine.
Today, we're going to be reviewing what some might consider to be a landmark study: the CLOVERS trial. The first thing most clinicians do when a patient is hypotensive is provide IV fluids. The surviving sepsis guidelines recommend 30cc/kg in patients who are in septic shock. It often bears reminding that the objective of providing …
Continue reading More Fluids vs. Vasopressors in the First 24h of Septic Shock (CLOVERS Trial)
This post will be a compendium of all things and questions we ask ourselves regarding lactate/lactic acid in sepsis and other critically ill patients. We have become a culture where, as soon as a person hints at being sick, we check a stat lactate/lactic acid. If we understand our enemy, we won't be frightened by …
Continue reading Lactic Acid/Lactate in Sepsis & the Critically Ill: The Ultimate Guide
This is a question I remember asking myself quite a bit during my training when I used to check/trend lactate levels more than I do today. Does it really matter whether I check it from an arterial line or from a venous stick? This study which was a prospective study of 100 patients who had …
Continue reading Lactate Measurements: Venous or Arterial Samples?
There's a pendulum in medicine. Some things are over recognized and aggressively treated, some things are under appreciated (like subtle decreases in serum bicarb showing that the patient is becoming more acidotic and no one notices because the patient has obesity hypoventilation syndrome and their baseline bicarb is 34 and now has a bicarb of …
Continue reading Lactic Acid has a WIDE Differential Diagnosis (not just Sepsis)
I need to eat my words on this one, because now there's data to show that there's a benefit to rechecking lactate levels in septic patients, but not for the reasons why one would think. During my rounds over the course of the weekend, I recall telling several nurses that there's no data to suggest …
Continue reading Lactic Acid is an Alarm, not a Treatment in Sepsis and Septic Shock
Having an elevated lactate in septic acid on admission is bad. Trending it, as studies that I have shown on this page does not change mortality. Seeing the numbers downtrend do give us that warm and fuzzy feeling inside, though. We give off a sigh of relief when that number becomes "euboxic". This article was …
Continue reading Lactic Acidosis: Does it really mean Hypoperfusion?