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Response to a letter to the editor
YJCRC-52479; No of Page 1 Journal of Critical Care xxx (2016) xxx
Contents lists available at ScienceDirect
Journal of Critical Care journal homepage: www.jccjournal.org
Response to a letter to the editor Sharukh Lokhandwala, MDa, Parth V. Patel, BSN RNb, Michael W. Donnino, MDb,c,⁎ a b c
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
We thank Zhou et al., and Ascarruz-Asencios et al., for their interest in our manuscript, “Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock” [1]. Both author groups inquired about the use of venous and arterial lactate. All lactate values were obtained using a Siemens Rapidlab 1265 blood gas analyzer, using an assay specific for L-Lactate. While we did include either arterial or venous lactate measurements, almost all of our values were venous lactate thus mitigating this issue. In response to your inquiry, we reviewed our measurements and determined that of all lactate values that could be identified as either venous or arterial, only 5/88 (5.7%) were arterial. Therefore, we do not think this had any significant impact on our findings. Like Zhou et al., we agree that there are numerous ways to use lactate to risk stratify patients. While we agree that Ranzani et al. performed a robust study that provides a novel sepsis classification system, their analysis included only the initial lactate value and included any lactate measurement at that time point. Our study evaluated several different measures of serial lactate values in patients with an initially elevated lactate ≥ 4 mmol/L. Therefore, our studies and approaches are distinct. Regarding Ascarruz-Asencios et al.'s question over the proportion of patients treated as ‘severe sepsis’ and ‘septic shock’, all patients were
treated at the discretion of the physicians who cared for them. However, all patients in our study met criteria for an institution-specific sepsis bundle prompting physicians to provide early antimicrobial therapy, crystalloid intravenous fluid resuscitation, and vasopressors for persistent hypotension. As noted in Table 2 of our manuscript, intravenous fluid resuscitation was quite similar in all groups. Lastly, we agree that there are various methods reported in the literature evaluating lactate reduction and acknowledge the nuance as pointed out regarding the Jansen et al. study [2]. That stated, we evaluated the test the characteristics of three methods that have previously been described and allow for comparisons between these approaches.
References [1] Lokhandwala S, Andersen LW, Nair S, Patel P, Cocchi MN, Donnino MW. Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. J Crit Care 2017;37:179–84. [2] Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 2010;182: 752–61.
⁎ Corresponding author at: Beth Israel Deaconess Medical Center, Emergency Medicine, One Deaconess Rd, W/CC 2, Boston, MA 02215, United States. E-mail address: [email protected] (M.W. Donnino).
http://dx.doi.org/10.1016/j.jcrc.2017.04.012 0883-9441/© 2016 Published by Elsevier Inc.
Please cite this article as: Lokhandwala S, et al, Response to a letter to the editor, Journal of Critical Care (2016), http://dx.doi.org/10.1016/ j.jcrc.2017.04.012
Contents lists available at ScienceDirect
Journal of Critical Care journal homepage: www.jccjournal.org
Response to a letter to the editor Sharukh Lokhandwala, MDa, Parth V. Patel, BSN RNb, Michael W. Donnino, MDb,c,⁎ a b c
Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, University of Washington, Seattle, WA, United States Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States
We thank Zhou et al., and Ascarruz-Asencios et al., for their interest in our manuscript, “Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock” [1]. Both author groups inquired about the use of venous and arterial lactate. All lactate values were obtained using a Siemens Rapidlab 1265 blood gas analyzer, using an assay specific for L-Lactate. While we did include either arterial or venous lactate measurements, almost all of our values were venous lactate thus mitigating this issue. In response to your inquiry, we reviewed our measurements and determined that of all lactate values that could be identified as either venous or arterial, only 5/88 (5.7%) were arterial. Therefore, we do not think this had any significant impact on our findings. Like Zhou et al., we agree that there are numerous ways to use lactate to risk stratify patients. While we agree that Ranzani et al. performed a robust study that provides a novel sepsis classification system, their analysis included only the initial lactate value and included any lactate measurement at that time point. Our study evaluated several different measures of serial lactate values in patients with an initially elevated lactate ≥ 4 mmol/L. Therefore, our studies and approaches are distinct. Regarding Ascarruz-Asencios et al.'s question over the proportion of patients treated as ‘severe sepsis’ and ‘septic shock’, all patients were
treated at the discretion of the physicians who cared for them. However, all patients in our study met criteria for an institution-specific sepsis bundle prompting physicians to provide early antimicrobial therapy, crystalloid intravenous fluid resuscitation, and vasopressors for persistent hypotension. As noted in Table 2 of our manuscript, intravenous fluid resuscitation was quite similar in all groups. Lastly, we agree that there are various methods reported in the literature evaluating lactate reduction and acknowledge the nuance as pointed out regarding the Jansen et al. study [2]. That stated, we evaluated the test the characteristics of three methods that have previously been described and allow for comparisons between these approaches.
References [1] Lokhandwala S, Andersen LW, Nair S, Patel P, Cocchi MN, Donnino MW. Absolute lactate value vs relative reduction as a predictor of mortality in severe sepsis and septic shock. J Crit Care 2017;37:179–84. [2] Jansen TC, van Bommel J, Schoonderbeek FJ, Sleeswijk Visser SJ, van der Klooster JM, Lima AP, et al. Early lactate-guided therapy in intensive care unit patients: a multicenter, open-label, randomized controlled trial. Am J Respir Crit Care Med 2010;182: 752–61.
⁎ Corresponding author at: Beth Israel Deaconess Medical Center, Emergency Medicine, One Deaconess Rd, W/CC 2, Boston, MA 02215, United States. E-mail address: [email protected] (M.W. Donnino).
http://dx.doi.org/10.1016/j.jcrc.2017.04.012 0883-9441/© 2016 Published by Elsevier Inc.
Please cite this article as: Lokhandwala S, et al, Response to a letter to the editor, Journal of Critical Care (2016), http://dx.doi.org/10.1016/ j.jcrc.2017.04.012